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Lymph node count and prognosis in colorectal cancer: The influence of examination quality
Author(s) -
Bläker Hendrik,
Hildebrandt Bert,
Riess Hanno,
von Winterfeld Moritz,
IngoldHeppner Barbara,
Roth Wilfried,
Kloor Matthias,
Schirmacher Peter,
Dietel Manfred,
Tao Sha,
Jansen Lina,
ChangClaude Jenny,
Ulrich Alexis,
Brenner Hermann,
Hoffmeister Michael
Publication year - 2014
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29221
Subject(s) - lymph node , medicine , colorectal cancer , lymph , stage (stratigraphy) , oncology , cancer , population , adverse effect , pathology , paleontology , environmental health , biology
Colorectal cancer guidelines recommend adjuvant chemotherapy in stage II disease when less than 12 lymph nodes are assessed. The recommendation bases on previous studies showing an association of a low lymph node count and adverse outcome. Compared to current standards, however, the quality of lymph node examination in the studies was low. We, therefore, investigated the prognostic role of <12 lymph nodes in cancers diagnosed adherent to current quality measures. Stage I–IV colorectal cancers from 1,899 patients enrolled into a population‐based cohort study were investigated for the prognostic impact of a lymph node count <12. The stage specific share of patients diagnosed with ≥12 nodes (stage I–IV: 62, 85, 85, 78%, respectively) was used to compare lymph node examination quality to other studies. We found no impact of a lymph node count <12 on overall, cancer‐specific or recurrence‐free survival for any tumour stage. Compared to studies reporting an adverse prognostic impact of a low lymph node count in stages II and III the stage‐specific shares of patients with ≥12 nodes were markedly higher in this study (85% vs . 24–58% in previous analyses) and this correlated with increased rates of stage III compared to stage II cancers. In conclusion our data indicate, that the previously reported effect of a low lymph node count on the patients' outcomes is eliminated by improved lymph node examination quality and thus question the general applicability of a 12 lymph node cut off for adjuvant chemotherapy decision making in stage II disease.