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Lymph node hypoplasia is associated with adverse outcomes in node-negative colon cancer using advanced lymph node dissection methods

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Abstract

Purpose

Lymph node size as a prognostic parameter has not been investigated well in the past. Recent data, however, have indicated that this parameter could be even more important than the lymph node count.

Methods

Based on the results of earlier studies, we analyzed the lymph node size and number of node-negative colon cancer patients with regard to survival. Data from 115 node-negative cases of colon cancer were analyzed. Lymph nodes with diameters ≤5 mm were defined as small, and all other lymph nodes were classified as intermediate/large in size and labeled LN5. All of the cases were categorized according to the number of LN5s. The LN5 very low (LN5vl) group included cases with less than two LN5s. All of the other cases were assigned to the LN5 low/high (LN5l/h) group.

Results

The overall survival analysis revealed significantly worse outcomes for the LN5vl group, with a mean survival of 34 months compared to the LN5l/h group, with a mean survival of 40 months (P = 0.022). After adjusting for the pT1/2 and pT3/4 stages, we still found a significant outcome difference (P = 0.012). Multivariate analysis identified LN5vl and T-stage as being independently correlated with the outcome. The vast majority of LN5vl cases (91 %) were located in the left colon. The location itself, however, was not prognostic (P = 0.478).

Conclusion

LN5 count, as a marker of immune response, could be shown as being prognostic in node-negative colon cancer. Patients with low LN5 counts showed poor outcomes. These patients could perhaps profit from adjuvant chemotherapy.

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Acknowledgments

The authors are grateful to Kai-Uwe Hebick for careful data management.

Author contributions

Patrick Mayr: study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript.

Georg Aumann: analysis and interpretation of data and critical revision of manuscript.

Tina Schaller: acquisition of data and critical revision of manuscript.

Gerhard Schenkirsch: acquisition of data and critical revision of manuscript.

Matthias Anthuber: study conception and design and critical revision of manuscript.

Bruno Märkl: study conception and design, acquisition of data, analysis and interpretation of data, and critical revision of manuscript.

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Authors and Affiliations

  1. Institute of Pathology, Zentralklinikum Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany

    Patrick Mayr, Tina Schaller & Bruno Märkl

  2. Department of Visceral and Transplantation Surgery, Klinikum Augsburg, Augsburg, Germany

    Georg Aumann & Matthias Anthuber

  3. Clinical and Population-Based Cancer Registry of Augsburg, Klinikum Augsburg, Augsburg, Germany

    Gerhard Schenkirsch

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  1. Patrick Mayr
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Correspondence to Bruno Märkl.

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Conflicts of interest

Patrick Mayr declares that he has no conflicts of interest.

Georg Aumann declares that he has no conflicts of interest.

Tina Schaller declares that she has no conflicts of interest.

Gerhard Schenkirsch declares that he has no conflicts of interest.

Matthias Anthuber declares that he has no conflicts of interest.

Bruno Märkl declares that he has no conflicts of interest

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Mayr, P., Aumann, G., Schaller, T. et al. Lymph node hypoplasia is associated with adverse outcomes in node-negative colon cancer using advanced lymph node dissection methods. Langenbecks Arch Surg 401, 181–188 (2016). https://doi.org/10.1007/s00423-016-1377-4

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