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Lymph Node Harvest in Colon Cancer: Influence of Microsatellite Instability and Proximal Tumor Location

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Abstract

Background

At least 12 harvested lymph nodes are recommended for proper staging of colon cancer. The effect of tumor-related factors associated with lymph node harvest is not well understood as data are lacking. We investigated tumor-related factors in relation to the number of lymph nodes harvested.

Methods

Patient and tumor characteristics were investigated in relation to harvested lymph nodes (LN ≥ 12), number of metastatic nodes, LN ratio (LNR), and prognosis with univariate and multivariate analyses.

Results

An LN harvest ≥12 nodes was achieved in 36% of the patients. Having <12 nodes harvested was not associated with increased risk for locoregional recurrence, distant metastasis, or decreased survival. Tumor size >5 cm, microsatellite instability (MSI), and proximal tumor location predicted a harvest of LN ≥ 12. The highest rate (54%) of LN ≥ 12 was found for MSI cancers [odds ratio (OR) 2.9, 95% confidence interval (CI) 1.3–6.5; P = 0.011]. Multivariate analysis identified a proximal location as an independent factor of LN ≥ 12 (adjusted OR 3.5, 95% CI 1.5–8.2; P = 0.003), with MSI an independent factor in stage II to III colon cancer (adjusted OR 2.6, 95% CI 1.1–6.0; P = 0.026). To determine the best prognosticator, LNR was the only significant factor in the multivariate analysis (Cox proportional hazards) with a hazard ratio (HR) of 2.9 (95% CI 1.1–7.8; P = 0.038) for LNR 0.01–0.17 and an HR of 5.8 (95% CI 2.5–13.1; P < 0.001).

Conclusions

Proximal tumor location and microsatellite instability are associated with a higher number of lymph nodes harvested, pointing to possible underlying genetic and immunologic mechanisms. The LNR is an independent prognostic variable for colon cancer.

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Acknowledgment

This study was funded in part from a grant from the Stavanger Health Trust Research Council.

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Authors and Affiliations

  1. Department of Surgery, Stavanger University Hospital, POB 8100, 4068, Stavanger, Norway

    Kjetil Søreide, Bjørn Steinar Nedrebø, Jon Arne Søreide & Hartwig Kørner

  2. Department of Surgical Sciences, University of Bergen, Bergen, Norway

    Kjetil Søreide, Jon Arne Søreide & Hartwig Kørner

  3. Department of Pathology, Stavanger University Hospital, Stavanger, Norway

    Aida Slewa

Authors
  1. Kjetil Søreide
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  2. Bjørn Steinar Nedrebø
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  3. Jon Arne Søreide
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  4. Aida Slewa
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  5. Hartwig Kørner
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Correspondence to Kjetil Søreide.

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Søreide, K., Nedrebø, B.S., Søreide, J.A. et al. Lymph Node Harvest in Colon Cancer: Influence of Microsatellite Instability and Proximal Tumor Location. World J Surg 33, 2695–2703 (2009). https://doi.org/10.1007/s00268-009-0255-4

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