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The Importance of Lymph Node Retrieval and Positive Lymph Nodes in Male Patients With Colorectal Cancer-5 Year Retrospective Single Institution Study
Varun Jain*1, Tatjana Gavrancic1, Sheetal Malhotra1, 2, Qing Liu1, Yeun Hee Anna Park1, 3
1Internal medicine, Mount Sinai School of Medicine Bronx program, New York, NY; 2Internal medicine, North Central Bronx Hospital, Bronx, NY; 3hematology and oncology, Columbia University, New York, NY
Introduction:The National Comprehensive Cancer Network and American Joint Committee of Cancer recommend retrieving more than 12 lymph nodes for adequate colorectal cancer (CRC) staging. Nodal status and presence of metastasis is an important prognostic factor for and may guide decision making for adjuvant chemotherapy. Recent data have shown variable results for survival based on the number of lymph nodes sampled and the lymph node ratio (number of positive lymph nodes of the total sampled). In our study, we aimed to assess the influence of lymph node retrieval and positive lymph node status on overall survival of male veteran colorectal cancer patients.
Methods: A retrospective chart review study at a Veterans Affairs Medical Center in a large metropolitan area was conducted. Charts of patients diagnosed with colon cancer from 1/1/2008 to 1/1/2012 were reviewed and data on age, diagnosis of cancer ,symptoms, histologic type of tumor, and stage, number of lymph nodes harvested, number of lymph nodes positive for cancer, tumor invasion, date of diagnosis and date of death were recorded . Descriptive statistics including average/median, range and standard deviation were calculated. Lymph node ratio (LNR) was calculated from the number lymph nodes positive for cancer of total number of lymph nodes harvested. Survival was calculated from date of diagnosis to date of death. Differences in survival were assessed through t-tests for different groups. Pearson's correlations and regression analysis were carried out for survival for the four groups of interest (>12 nodes harvested, 12 or more nodes harvested. LNR<0.2 and LNR >0.2)
Results: Data from 84 patients were obtained with a median survival of 299 days. On diagnosis, 26 (31%) were stage I, 21 (25%) were stage II, 16 (18%) were stage III, and 21 (25%) were stage IV. 23 (27.3%) patients had local invasion at time of diagnosis.An average of 14.5 lymph nodes (range 4-29), were sampled per patient. 22 (26%) patients had < 12 nodes sampled, and 42 (50%) had ≥12 nodes sampled. The average LNR for the whole group was 0.07 (SD±0.15). There was a significant inverse relationship between survival and the number of lymph nodes sampled in the group having less than 12 lymph nodes harvested (r= -0.46, P<0.05). There was also a significant relationship between LNR and survival for those whose LNR was < 0.2 (r= -0.40, p<0.05). There were no significant differences in survival based on mode of diagnosis (screening colonoscopy vs. presence of symptoms) or presence of local invasion at diagnosis.
Conclusion: Survival in colorectal cancer may be associated with the number of lymph nodes harvested for biopsy; with improved survival in patients who have at least 12 nodes biopsied as well as when LNR<0.2.
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