Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens

Background Staging of colorectal cancer is dependent on the number of lymph nodes in a surgical specimen that are positive for metastatic cancer. It is generally recommended that a minimum of 12 lymph nodes be examined to ensure adequate staging. It is unclear which factors specifically contribute to variation in the number of lymph nodes retrieved from surgical specimens. This study aims to understand the factors affecting the number of lymph nodes identified in surgical colorectal cancer specimens. Methods A total of 264 retrospectively collected cases of colorectal cancer surgically treated at the University Health Network in Toronto from 2004 to 2006 were analyzed. We used univariate analyses of variance (ANOVA), and univariate and multivariable linear and logistic regression analyses to study variation in the lymph node number associated with a variety of explanatory variables. Results The average number of lymph nodes retrieved per case was 18.1, with 70 (26.5%) cases containing fewer than 12. Variation in the lymph node number was greatest between different pathology assistants (p = < 0.001). The mean number of nodes retrieved by different pathology assistants ranged from 12.6 to 29.7. On average, surgery for recurrent cancer removed 6.0 (95% CI 1.2 to 10.9, p = 0.02) fewer lymph nodes than for primary cancer. Each additional year of patient age was associated with retrieval of 0.1 (95% CI 0.04 to 0.2, p = 0.005) fewer nodes, and rectal cancer specimens had 2.7 (95% CI 0.04 to 5.4, p = 0.05) fewer lymph nodes than colon cancer specimens. Conclusion Most of the variation in the number of lymph nodes identified in surgical specimens from colorectal cancer operations was accounted for by differences between pathology assistants. Presented at the SAGES Scientific Session April 18–22, 2007 Las Vegas, Nevada     

Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer

PURPOSE: We postulate that the number of lymph nodes examined in cystectomy specimens can have an impact on the outcome of patients with bladder cancer. MATERIALS AND METHODS: We analyzed data on 322 patients with muscle invasive bladder cancer who underwent radical cystectomy and bilateral pelvic lymphadenectomy. We evaluated the associations of the number of lymph nodes identified by the pathologist in the surgical specimen with the local recurrence rate and survival outcome. RESULTS: Patients were divided into groups by lymph node status and the distribution of the number of lymph nodes examined. In stages pN0 and pN+ cases improved survival was associated with a greater number of lymph nodes examined. We determined that at least 9 lymph nodes should be studied to define lymph node status accurately. CONCLUSIONS: These results indicate that surgical resection and pathological assessment of an adequate number of lymph nodes in cystectomy specimens increases the likelihood of proper staging and impacts patient outcome. Such information is important not only for the therapy and prognosis of individuals, but also for identifying those who may benefit from adjuvant chemotherapy.     

微卫星状态对结直肠癌根治术(微创)淋巴结检出数量的影响

目的:探讨微卫星状态对结直肠癌根治术淋巴结检出数量的影响.方法:回顾性收集2015年1月至2019年12月收治的1280例结直肠癌患者的临床资料.采用PCR方法检测肿瘤标本的微卫星状态,分为高度微卫星不稳定性(MSI-H)、低度微卫星不稳定性(MSI-L)与微卫星稳定性(MSS).观察指标:人口学特征、手术标本病理学检...     

Number of lymph nodes examined and its impact on colorectal cancer staging

The status of lymph nodes is the most important prognosticator in colorectal cancer patients. Patients with lymph node involvement have a lower survival rate and are candidates for adjuvant therapy. The purpose of our study was to determine the number of lymph nodes that needs to be examined to accurately detect nodal metastasis. We conducted a retrospective study of 151 patients who underwent colorectal cancer operation at Harbor-UCLA Medical Center. Data from the operative report and pathology report were collected and analyzed. Fourteen (33.3%) patients with five to nine nodes examined had positive nodes. Twenty-six (57.8%) patients with 10 to 14 nodes examined had positive nodes. Patients who had 10 to 14 nodes examined were significantly more likely to have positive lymph nodes (P = 0.03). Patients with advanced T stage had a significantly higher number of positive lymph nodes (78.1% in T4 vs 11.1% in T1, P < 0.0001). Patients with poorly differentiated cancer showed a trend toward a higher positive node rate. Tumor differentiation and T stage seem to correlate with higher nodal metastasis rate. A higher number of lymph nodes examined was associated with a higher nodal metastasis rate. Examination of at least 10 lymph nodes would increase the yield of positive lymph nodes and avoid under-staging of patients with colorectal cancer.     

The impact of facility volume/size on breast cancer treatment and outcome

Recent studies have suggested that outcomes and survival from breast cancer are improved when definitive treatment is rendered at high-volume and/or teaching centers. Consolidation of such cases in tertiary centers, however, is often impractical and impossible. Patients often desire primary treatment of their breast cancer in their own communities. The current study was undertaken to examine the impact of treatment facility type on the treatment performed as well as on overall survival. Breast cancer treatment and survival data were available from the American College of Surgeons National Cancer Data Base. Only patients in whom no previous treatment had been rendered were included in the analysis. Data were stratified with regard to type and size of treatment facility/hospital; stage distribution; initial treatment performed; and 1-, 2-, and 5-year survival. A total of 665,409 patients were included in the current analysis. There were no significant differences in stage distribution between facility types nor was there a significant difference in the treatment performed (although there was a slight trend toward breast conservation at the larger centers). This was true overall and for each stage of cohort. There were also no significant differences in 1-, 2-, and 5-year survival rates overall and at any stage (although again, there was a slight trend toward a minimal survival advantage at the larger centers). There was no significant impact of facility size or type on either breast cancer treatment performed or overall survival. There was no evidence that more "advanced" treatments were offered at larger centers nor was there evidence of improved outcome/survival at larger centers. Care can be rendered safely, efficiently, and effectively in the community setting.     

Factors affecting the number of lymph nodes retrieved after colo-rectal cancer surgery: A prospective single-centre study

BackgroundThe number of harvested lymph nodes (LNs) in colorectal cancer surgery relates to oncologic radicality and accuracy of staging. In addition, it affects the choice of adjuvant therapy, as well as prognosis. The American Joint Committee on Cancer defines at least 12 LNs harvested as adequate in colorectal cancer resections. Despite the importance of the topic, even in high-volume colorectal centres the rate of adequacy never reaches 100%. The aim of this study was to identify factors that affect the number of harvested LNs in oncologic colorectal surgery.Materials and methodsWe prospectively collected all consecutive patients who underwent colorectal cancer resection from January 1st 2013 to December 31st 2017 at Emergency Surgery Unit St Orsola University Hospital of Bologna.ResultsSix hundred and forty-three consecutive patients (382 elective, 261 emergency) met the study inclusion criteria. Emergency surgery and laparoscopic approach did not have a significant influence on the number of harvested LNs. The adequacy of lymphadenectomy was negatively affected by age >80 (OR 3.47, p < 0.001), ASA score ≥3 (OR 3.48, p < 0.001), Hartmann's or rectal resection (OR 3.6, p < 0.001) and R1–R2 resection margins (OR 3.9, p = 0.006), while it was positively affected by T-status ≥3 (OR 0.33 p < 0.001).ConclusionBoth the surgical technique and procedure regimen did not affect the number of lymphnodes retrieved. Age >80 and ASA score ≥3 and Hartmann's procedure or rectal resection showed to be risk factors related to inadequate lymphadenectomy in colorectal cancer surgery.     

Surgeon and hospital volume and the management of colorectal cancer patients in Australia

BACKGROUND: The evidence for a relationship between patient outcomes and clinician and hospital volume is increasing. The National Colorectal Cancer Care Survey was undertaken to determine the management patterns in Australia for individuals newly diagnosed with colorectal cancer in a 3 month period in the year 2000. METHODS: All new cases of colorectal cancer registered at each Australian State Cancer Registry were entered into the survey. This generated a questionnaire that was sent to the treating surgeon. Chi-squared tests and logistic regression analyses were used to determine levels of statistical significance. RESULTS: Of 2,383 surgical questionnaires generated, 2,015 (85%) were completed. The majority (58%) of surgeons treated one or two patients with colorectal cancer over the 3 months of the survey. There was variation across surgeon cohorts for preoperative measures including the use of deep vein thrombosis prophylaxis. Patients seen by low volume surgeons were most likely to be given a permanent stoma (P < 0.0001). Patients with rectal cancer who were operated on by high volume surgeons were significantly more likely to receive a colonic pouch (P < 0.0001). CONCLUSION: This nationwide population-based survey of the treatment of colorectal cancer patients suggests that the delivery of care by surgeons (the majority) who treat patients with rectal cancer infrequently should be evaluated.     

Urgency of referral and its impact on outcome in patients with colorectal cancer

Aim Primary care referral for patients with bowel symptoms is triaged by general practitioners to urgent or routine based on the clinical suspicion of malignancy. Triage directly influences time to assessment and investigation. This study aimed to establish whether urgency of referral of patients with large bowel malignancy has any effect on management. Method An analysis was undertaken of all patients with colorectal cancer referred by primary care and discussed at the regional colorectal multi‐disciplinary team (MDT) meetings from January 2009 to December 2010. Demographics and tumour data were collated prospectively from MDT records, and operation and investigation reports. Results Of 369 primary case referrals with colorectal cancer, 303 (82.1%) were urgent and 66 (17.9%) routine. Patient characteristics (age, sex, American Society of Anesthesiologists grade) and resection rates were similar in both groups and no significant difference in tumour location was observed. The time from referral to diagnosis was significantly longer in the routine group (mean 73.7 days vs 30.2 days; P = 0.001). Dukes stage was less advanced for the routine referral group, (P = 0.002). Conclusion Urgency of referral decreased the time to diagnosis. This did not influence resection rates. Dukes stage was higher for urgent referrals. Long‐term follow‐up is required to determine any impact on survival.     

淋巴结清除数目对结直肠癌患者预后的影响

目的研究结直肠癌患者局部淋巴结切除标本中切除淋巴结数目和预后的关系。方法对 1989年 1月至 2 0 0 0年 12月间有完整病理学检查和随访资料的 76例外科手术治疗的结直肠癌病例做回顾性分析。以有无淋巴结转移分为两组 ,每组根据淋巴结切除数再分两组 ,即切除数 >5 0枚组和≤ 5 0枚组 ,计算 5年生存率并进行生存率Log rank检验。 结果无淋巴结转移组中 ,切除淋巴结数 >5 0枚者较≤ 5 0枚者 5年生存率高 2 3% ,生存率差异有显著性意义 (χ2 =5 4 8,P <0 0 5 )。在有淋巴结转移组中 ,切除淋巴结数 >5 0枚者较≤ 5 0枚者 5年生存率高 36 % ,生存率也有显著差异 (χ2 =13 6 5 ,P <0 0 1)。结论充分的淋巴结切除可以改善结直肠癌患者的预后。淋巴结切除数目应作为规范结直肠癌手术的质量控制指标     

The number of positive lymph nodes in the central compartment has prognostic impact in papillary thyroid cancer

Background

Central compartment lymph node (CCLN) metastasis in papillary thyroid cancer (PTC) is associated with higher risk of loco-regional recurrence and distant metastasis. This study evaluated the prognostic implication of the number of metastatic CCLN in PTC.

Methods

Prospective data collection on 91 patients with PTC who underwent total thyroidectomy and CCLN dissection with or without lateral neck dissection between January 2005 and December 2010 was made. Number of positive CCLN was correlated with known prognostic factors (age, gender, tumour size, extrathyroidal extension and lateral node metastasis).

Results

Patients were divided into three groups according to the number of positive CCLN: group A = 0 (n?=?35); B = 1–2 nodes (n?=?32) and C = >3 nodes (n?=?24). The risk of lateral compartment disease increased in parallel with the number of positive CCLN (31 vs. 50 vs. 75 % in groups A-B-C, respectively; p?<?0.004). Gender/age/tumour size/extrathyroidal extension did not correlate with number of positive CCLN. The increasing number of positive CCLN did not influence post-ablation iodine uptake (1.25 vs. 1.14 vs. 2.63 %) and correlated with mean thyroglobulin values at 1-year post-ablation (12.3 vs. 42.3 vs. 91.48 μg/L)

Conclusions

The number of CCLN metastasis is a risk factor for lateral compartment disease with no correlation with other prognostic markers.     

早期远端胃癌腹腔镜与传统开腹手术淋巴结清扫数目比较的Meta分析

目的对比分析对于早期远端胃癌患者行腹腔镜与传统开腹手术淋巴结清扫的数目。方法检索福建医科大学图书馆网页2000年1月至2008年12月间MEDLINE、EMBASE及TheCochraneLibrary等数据库和中国期刊全文数据库（CNKI）及中国生物医学期刊文献数据库（CMCC）有关比较早期远端胃癌腹腔镜与传统开腹手术淋巴结清扫数目的文献。由3位胃肠外科医生各自独立地对入选研究的有关试验设计、研究对象特征和研究结果等内容进行摘录,并用RevMan5．0软件进行统计分析。结果按筛选标准,共有14篇文献入选。全体研究样本量合计早期远端胃癌患者1454例,其中腹腔镜手术（LADG）组815例,传统开腹手术（CODG）组639例。分析结果显示,LADG组清扫淋巴结数目比CODG组少3．26枚／例,其加权均数差（WMD）为-3．26[95％CI-6．24～0．27,P=0．03],差异具有统计学意义。但对其进行敏感性分析显示：2005—2008年发表的文献、D1＋α／β淋巴结清扫、回顾性非随机对照研究等3个亚组的LADG和CODG清扫的淋巴结数目相似,其WMD分别为-2．84[95％CI-6．79～1．11,P=0．16]和-2．80[95％CI-7．57～1．97,P=0．251及-2．89[95％CI-6．48～0．70,P=0．11],差异无统计学意义。结论随着腹腔镜外科医师技术逐渐成熟,对早期远端胃癌进行D1＋α／β淋巴结清扫术,LADG和CODG清扫的淋巴结数目相当。     

获卵数对体外受精-胚胎移植妊娠结局的影响

在体外受精-胚胎移植(IVF-ET)助孕过程中,获卵数是影响妊娠结局的重要因素。由于个体差异性,即使采用相同的控制性促排卵(COS)策略,获卵数亦存在较大差异。获卵数较少时,可利用胚胎数减少,从而导致周期取消率升高,临床妊娠率降低。获卵数过多时,卵母细胞利用效率下降,卵巢过度刺激综合征(OHSS)风险增高,影响最终妊娠结局。适量的获卵数可在充分利用卵母细胞、获得较满意妊娠结局的同时,减少OHSS等并发症的发生,并可避免胚胎浪费,减少治疗费用。长方案作为目前临床上非常成熟的促排卵方案,在IVF中有着广泛的应用。本文拟综述长方案周期不同获卵数对IVF妊娠结局的影响。     

Influence of volume of work on the outcome of treatment for patients with colorectal cancer

BACKGROUND: Recent recommendations for the reorganization of cancer services emphasize the importance of a 'minimal acceptable volume of work'. The influence of both hospital and surgical workload has been examined using a population-based series of patients with colorectal cancer. METHODS: Nine hundred and twenty-seven patients with primary colorectal cancer diagnosed during the period 1 January to 30 June 1993 were identified from the North Western Regional Cancer Registry. Case notes were reviewed for information on patient age and sex, histological diagnosis, disease stage, degree of tumour differentiation, mode of admission, identity of operating surgeon, timing of operative procedure, and use of radiotherapy and/or chemotherapy. A multivariate Cox proportional hazards model was then constructed to examine, simultaneously, the effects of patient-, disease- and health service-related variables on survival. RESULTS: Age, tumour stage and differentiation, and mode of admission were revealed as significant independent prognostic variables. After adjusting for these variables, neither operator grade (consultant versus junior), consultant workload nor hospital throughput were identified as independently influencing patient survival. CONCLUSION: The results of this study do not support an association between volume of work and patient outcome.     

结直肠癌病检淋巴结数目与TNM分期及预后的关系

目的 探讨病检淋巴结数目与结直肠癌分期及预后的关系.方法 将567例结直肠癌患者根据术后病检的淋巴结数目分为3个组:≤6枚、7～11枚、≥12枚组,比较各组5年生存率的差别.TNM分期(Ⅰ～Ⅳ期)分别以病检淋巴结数目分为<12枚和≥12枚两组,比较各分期中两组的5年生存率的差别,分析预后相关因素.5年生存率的比较采用Kaplan-Meier法并经Log-rank检验,预后多因素分析采用Cox比例风险模型.结果 567例平均病检淋巴结数目为(16.75±9.88)枚,病检淋巴结数目分别为≤6枚,7～11枚,≥12枚时,结直肠癌5年生存率各为32.3%(21/65),43.8%(53/121),57.7%(220/381),单因素分析表明,病检淋巴结数目≥12枚的结直肠癌5年生存率明显高于其他两组(≤6枚,7～11枚)(P<0.05).<12枚、≥12枚淋巴结两组在Ⅰ期或Ⅳ期的结直肠癌5年生存率无明显差别(89.5%vs.89.1%,8.0%vs.18.2%,P>0.05),而≥12枚淋巴结的Ⅱ期和Ⅲ期5年生存率明显高于<12枚(71.1%vs.32.6%,48.8%vs.30.0%,P<0.05),多因素COX回归模型分析表明,病检淋巴结数目是Ⅱ、Ⅲ期结直肠癌独立的预后因素.结论 病检的淋巴结数目主要通过影响Ⅱ、Ⅲ期的预后与结直肠癌总5年生存率明显相关,是Ⅱ、Ⅲ期结直肠癌独立的预后因素.

Abstract：

Objective To study the relationship between the number of examined lymph nodes and the prognosis of colorectal cancer by TNM stage. Methods According to the number of examined lymph nodes, 567 patients of colorectal carcinoma who underwent resection were divided into three groups: ≤ 6,7-11 and ≥ 12, the 5-year overall survival rates of three groups were compared. For each TNM stage ( stage Ⅰ -Ⅳ ) , patients were substratified into two groups basing on the number of examined lymph nodes:<12 group and ≥12 group, the 5-year survival rates of two groups in each TNM stage were assessed, and prognostic factors of stage Ⅱ and Ⅲ stage were analyzed. 5-year survival curves were estimated with the Kaplan-Meier method and compared by the log-rank test. Cox proportional models were used to conduct multivariate analyses of prognostic factors. Results The average number of examined lymph nodes was 16. 75 ±9. 88. With the patients grouped by the number of lymph nodes ( ≤6,7 -11 and ≥12 nodes) , the 5-year survival rate was 32. 3% , 43. 8% , and 57. 7% , the univariable analysis indicated that the 5-year survival rate of ≥ 12 examined nodes were significantly higher than the other groups (P<0. 05). There was no difference between two groups in the 5-year survival rates of stage Ⅰ or Ⅳ colorectal cancer (89. 5% vs.89. 1% ,8. 0% vs. 18. 2% , P>0. 05 ) , however, the 5-year survival rates of stage Ⅱ and Ⅲ colorectal cancer in ≥12 group were significantly higher than<12 group(71. 1% vs. 32. 6% ,48. 8% vs. 30. 0% ,P<0. 05) , multivariable analysis revealed that the number of lymph nodes examined was an independent factor of prognosis of stage Ⅱ and Ⅲ colorectal cancer. Conclusions The number of examined lymph nodes significantly influenced the 5-year overall survival rate of TNM stage Ⅱ and Ⅲ colorectal cancer.