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The re-evaluation of optimal lymph node yield in stage II right-sided colon cancer: is a minimum of 12 lymph nodes adequate?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Adequate lymphadenectomy is critical for accurate nodal staging and planning adjuvant therapy in colon cancer. However, the optimal lymph node (LN) yield for stage II right-sided colon cancer (RSCC) is still unclear. This population-based study aimed to determine the optimal LN yield associated with survival and LN positivity in patients with stage II RSCC.

Methods

All patients with stage II–III RSCC were identified from the Surveillance, Epidemiology, and End Results database over a 10-year interval (2006–2015). The optimal threshold for LN yield was explored using an outcome-oriented approach based on survival and LN positivity.

Results

The median number of LNs examined for all 17,385 patients with stage II RSCC was 17 (IQR 12–23). Nineteen LNs were determined as the optimal cut-off point to maximize survival benefit from lymphadenectomy. Increased LN yield was associated with a gradual increase in the risk of node positivity, with no change after 19 nodes. Compared with patients with 19 or more LNs examined, the group with fewer LNs had a significantly poor cancer-specific survival (< 12 nodes: hazard ratio (HR) 2.26, P < 0.001; 12–18 nodes: HR 1.58, P < 0.001) and overall survival (< 12 nodes: HR 1.80, P < 0.001; 12–18 nodes: HR 1.31, P < 0.001). Similar survival results were found in the validation cohort. Patients with older age, small tumor size, and appendix and transverse colon cancer were more likely to receive inadequate LN harvest.

Conclusion

A minimum of 19 LNs is needed to be examined for optimal survival and adequate node staging in lymph node-negative RSCC.

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Acknowledgements

We thank all the staff members of the National Cancer Institute who have participated in the Surveillance, Epidemiology, and End Results (SEER) program.

Funding

This study was supported in part by the Qianjiang Talent Project of Zhejiang Province (Grant/Award Numbers: 2013R10079).

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Authors and Affiliations

  1. Department of Colorectal Surgery, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China

    Yibo Cai & Haixing Ju

  2. Department of Pathology, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China

    Guoping Cheng & Xiu Zhu

  3. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China

    Xingang Lu

Authors
  1. Yibo Cai
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  2. Guoping Cheng
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  4. Haixing Ju
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  5. Xiu Zhu
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Contributions

All authors meet the ICMJE authorship criteria and contributed substantially to the manuscript. X Zhu, HX Ju, and YB Cai designed the study conception. YB Cai, GP Cheng, and XG Lu finished the analysis and interpretation of data. YB Cai and X Zhu drafted the work.

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Correspondence to Haixing Ju or Xiu Zhu.

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Fig. S1

Kaplan–Meier CSS curves for patients with stage II RSCC according to number of LNs examined (<12 vs. 12-18 vs. ≥ 19 nodes). A CSS in patients with older age. B CSS in patients with small tumor size. C, CSS in patients with appendix cancer. D, CSS in patients with transverse colon cancer. (TIF 4479 kb)

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Cai, Y., Cheng, G., Lu, X. et al. The re-evaluation of optimal lymph node yield in stage II right-sided colon cancer: is a minimum of 12 lymph nodes adequate?. Int J Colorectal Dis 35, 623–631 (2020). https://doi.org/10.1007/s00384-019-03483-z

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