scholarly journals Optimal examined lymph node count in node-negative colon cancer should be determined

2021 ◽  
Author(s):  
Huolun Feng ◽  
Zejian Lyu ◽  
Weijun Liang ◽  
Guanfu Cai ◽  
Zhenru Deng ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Optimal Number ◽  
Cutoff Point ◽  
Optimal Cutoff ◽  
Cox Models ◽  
Node Negative ◽  
Lymph Node Count ◽  
Optimal Cutoff Point

Background: We aimed to investigate the association between optimal examined lymph node (ELNs) and overall survival to determine the optimal cutoff point. Methods: Cox models and locally weighted scatterplot smoothing were used to fit hazard ratios and explore an optimal cutoff point based on the Chow test. Results: Overall survival increased significantly with the corresponding increase in the number of ELNs after adjusting for covariates. In Chow's test, the optimal cutoff point for node-negative colon cancer was 15, which was validated in both cohorts after controlling for confounders (Surveillance, Epidemiology, and End Results database: hazard ratio: 0.701, p < 0.001; single-center: HR: 0.563, p = 0.031). Conclusions: We conservatively suggest that the optimal number of ELNs for prognostic stratification is 15 in node-negative colon cancer.

scholarly journals Determining the optimal cutoff point for lymph node density and its impact on overall survival in children with Wilms’ tumor

2019 ◽  
Vol Volume 11 ◽  
pp. 759-766 ◽  
Author(s):  
Zhenyu Pan ◽  
Qingting Bu ◽  
Haisheng You ◽  
Jin Yang ◽  
Qingqing Liu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Cutoff Point ◽  
Node Density ◽  
Optimal Cutoff ◽  
Lymph Node Density ◽  
Optimal Cutoff Point

Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer

2016 ◽  
Vol 34 (32) ◽  
pp. 3892-3897 ◽  
Author(s):  
Vasu Divi ◽  
Michelle M. Chen ◽  
Brian Nussenbaum ◽  
Kim F. Rhoads ◽  
Davud B. Sirjani ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Lymph Node ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
National Cancer Database ◽  
Node Negative ◽  
Lymph Node Count ◽  
Node Positive

Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The < 18 LN group, compared with the ≥ 18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when ≥ 18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.

scholarly journals Association of Lymph Node Count and Overall Survival in Node-Negative Endometrial Cancers

2017 ◽  
pp. 1-15
Author(s):  
Brandon-Luke L. Seagle ◽  
Douglas Gilchrist-Scott ◽  
Stephen Graves ◽  
Anna E. Strohl ◽  
Wilberto Nieves-Neira ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Stage I ◽  
Stage Iiia ◽  
Node Negative ◽  
Lymph Node Count ◽  
Endometrial Cancers ◽  
Node Count

Purpose To estimate whether the number of lymph nodes removed during surgery is associated with overall survival among women with endometrial cancer. Methods We performed a retrospective cohort study of women with node-negative, stage I to IIIB endometrial cancer (n = 152,702) identified from the 1998-2011 National Cancer Database. Multivariable Cox proportional hazards regression tested for an association of lymph node count with survival. Restricted mean survival and relative hazard curves were plotted for survival as a function of number of removed lymph nodes. Results Among women with node-negative endometrioid endometrial cancer, for each additional five lymph nodes removed, the hazard for death decreased: stage I, the hazard ratio (HR) was 0.95 (95% CI, 0.93 to 0.97; P < .001), stage II, HR was 0.90 (95% CI, 0.87 to 0.94; P < .001); and stage IIIA-B, HR was 0.92 (95% CI, 0.88 to 0.96; P < .001). When grouped by grade, each additional five lymph nodes removed was also associated with decreased hazard for death: grade 1, HR was 0.96 (95% CI, 0.93 to 0.99; P = .009); grade 2, HR was 0.91 (95% CI, 0.89 to 0.94; P < .001); and grade 3, HR was 0.95 (95% CI, 0.92 to 0.97; P < .001). Increased lymph node dissection was also associated with increased survival among women with node-negative stage II (HR, 0.92; 95% CI, 0.86 to 0.98; P = .01) or stage IIIA-B (HR, 0.94; 95% CI, 0.89 to 0.99; P = .025) uterine serous carcinoma, but not among women with carcinosarcoma or clear cell adenocarcinoma. Five-year survival for women with one to four nodes removed and endometrioid or serous histology was 85% (95% CI, 84% to 85%) and 54% (95% CI, 50% to 59%), respectively. Five-year survival was significantly higher for women with ≥ 20 removed nodes and endometrioid (91%; 95% CI, 90% to 91%) or serous (72%; 95% CI, 68% to 76%) histology ( P < .001). Conclusion Increased lymph node count is associated with a 1% to 14% decreased hazard of death per each additional five lymph nodes removed and a 5% to 20% increased 5-year survival among women with pathologically node-negative endometrioid and serous endometrial cancers.

scholarly journals The Prognostic Value of Lymph Nodes Dissection Number on Survival of Patients with Lymph Node-Negative Gastric Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Wu Song ◽  
Yujie Yuan ◽  
Liang Wang ◽  
Weiling He ◽  
Xinhua Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Tumor Invasion ◽  
Prognostic Value ◽  
Operation Time ◽  
Invasion Depth ◽  
Node Negative ◽  
Tumor Invasion Depth

Objective.The study was designed to explore the prognostic value of examined lymph node (LN) number on survival of gastric cancer patients without LN metastasis.Methods.Between August 1995 and January 2011, 300 patients who underwent gastrectomy with D2 lymphadenectomy for LN-negative gastric cancer were reviewed. Patients were assigned to various groups according to LN dissection number or tumor invasion depth. Some clinical outcomes, such as overall survival, operation time, length of stay, and postoperative complications, were compared among all groups.Results.The overall survival time of LN-negative GC patients was50.2±30.5months. Multivariate analysis indicated that LN dissection number(P<0.001)and tumor invasion depth(P<0.001)were independent prognostic factors of survival. The number of examined LNs was positively correlated with survival time(P<0.05)in patients with same tumor invasion depth but not correlated with T1 stage or examined LNs>30. Besides, it was not correlated with operation time, transfusion volume, length of postoperative stay, or postoperative complication incidence(P>0.05).Conclusions.The number of examined lymph nodes is an independent prognostic factor of survival for patients with lymph node-negative gastric cancer. Sufficient dissection of lymph nodes is recommended during surgery for such population.

scholarly journals Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ameer Hamza ◽  
Ramen Sakhi ◽  
Sidrah Khawar ◽  
Ahmed Alrajjal ◽  
Jacob Edens ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Scientific Evidence ◽  
Quality Standard ◽  
Optimal Number ◽  
Lymph Node Staging ◽  
Lymph Node Count ◽  
National Quality ◽  
Node Count

As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated.

scholarly journals The Prognostic Significance of Tumor Deposit Count for Colorectal Cancer Patients after Radical Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Kuo Zheng ◽  
Nanxin Zheng ◽  
Cheng Xin ◽  
Leqi Zhou ◽  
Ge Sun ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Value ◽  
Validation Cohort ◽  
Cutoff Point ◽  
Disease Specific Survival ◽  
Optimal Cutoff ◽  
Training Cohort ◽  
Tumor Deposit ◽  
Optimal Cutoff Point ◽  
Disease Specific

Background. The prognostic value of tumor deposit (TD) count in colorectal cancer (CRC) patients has been rarely evaluated. This study is aimed at exploring the prognostic value of TD count and finding out the optimal cutoff point of TD count to differentiate the prognoses of TD-positive CRC patients. Method. Patients diagnosed with CRC from Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010, to December 31, 2012, were analyzed. X-tile program was used to identify the optimal cutoff point of TD count in training cohort, and a validation cohort was used to test this cutoff point after propensity score matching (PSM). Univariate and multivariate Cox proportional hazard models were used to assess the risk factors of survival. Results. X-tile plots identified 3 (P<0.001) as the optimal cutoff point of TD count to divide the patients of training cohort into high and low risk subsets in terms of disease-specific survival (DSS). This cutoff point was validated in validation cohort before and after PSM (P<0.001, P=0.002). More TD count, which was defined as more than 3, was validated as an independent risk prognostic factor in univariate and multivariate analysis (P<0.001). Conclusion. More TD count (TD count≥4) was significantly associated with poor disease-specific survival in CRC patients.

Prognostic Significance of Tumor Deposits in Combination with Lymph Node Metastasis in Stage III Colon Cancer: A Propensity Score Matching Study

2020 ◽  
Vol 86 (2) ◽  
pp. 164-170
Author(s):  
Peilin Zheng ◽  
Chen Lai ◽  
Weimin Yang ◽  
Zhikang Chen
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Propensity Score ◽  
Confidence Interval ◽  
Propensity Score Matching ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Node Metastasis

Tumor deposits in colon cancer are related to poor prognosis, whereas the prognostic power of tumor deposits in combination with lymph node metastasis (LNM) is controversial. This study aimed to compare the overall survival between LNM alone and LNM in combination with tumor deposits, and to verify whether the number of tumor deposits can be considered LNM in patients with both LNM and tumor deposits in stage III colon cancer by propensity score matching (PSM). Patients carrying resected stage III adenocarcinoma of colon cancer were identified from the Surveillance, Epidemiology, and End Results database (2010–2015). The Kaplan-Meier method, Cox proportional hazard models and PSM were used. On the whole, 23,168 patients (20,451 (88.3%) with only LNM and 2,717 (11.7%) with both LNM and tumor deposits) were selected. After undergoing PSM, patients with both LNM and tumor deposits showed worse overall survival (hazard ratio = 1.33, 95% confidence interval: 1.20–1.47, P < 0.001). After the number of tumor deposits was added with that of positive regional lymph nodes, patients with both LNM and tumor deposits seemed to have prognostic implications similar to those with LNM alone (hazard ratio = 1.02, 95% confidence interval: 0.93–1.12, P = 0.66). The simultaneous presence of LNM and tumor deposits, as compared with the presence of only LNM, had an association with a worse outcome. Tumor deposits should be considered as LNM in patients with both tumor deposits and LNM in stage III colon cancer.

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