Lymph node count and prognosis in colorectal cancer: The influence of examination quality |
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| Authors: | Bert Hildebrandt Hanno Riess Moritz von Winterfeld Barbara Ingold‐Heppner Wilfried Roth Matthias Kloor Peter Schirmacher Manfred Dietel Sha Tao Lina Jansen Jenny Chang‐Claude Alexis Ulrich Hermann Brenner Michael Hoffmeister |
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| Affiliation: | 1. Department of Oncology, Charite University Medicine Hospital, Berlin, Germany;2. Department of General Pathology, Institute of Pathology, Charite University Medicine Hospital, Berlin, Germany;3. Department of General Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany;4. Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany;5. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany;6. Division of Cancer Epidemiology, Unit of Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany;7. Department of Surgery, University of Heidelberg, Heidelberg, Germany;8. German Cancer Consortium (DKTK), Heidelberg, Germany |
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| Abstract: | 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. |
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| Keywords: | colorectal cancer lymph nodes prognosis |
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