Impact of lymph node retrieval and pathological ultra-staging on the prognosis of stage II colon cancer.
OBJECTIVE
A minimum number of lymph nodes must be assessed for accurate diagnosis of stage II colon cancer. We assessed number of lymph nodes retrieved, pathological ultra-staging, and outcome in stage II colon cancer.


METHODS
Consecutively treated patients with stage II colon cancer were identified. Baseline and outcome data were collected. Retrospective ultra-staging using lymphovascular invasion (LVI) and nodal micrometastases was performed. Patients were divided into two groups: group I had <or=6 nodes and group II had >6 nodes retrieved. Survival was analyzed.


RESULTS
One hundred and fifteen patients were included in the study. The 5 year overall survival was worse in group I versus II (P = 0.03). LVI and micrometastases were identified but neither predicted survival. Disease failure in group I was due to distant metastases rather than local recurrence.


CONCLUSIONS
Inadequate retrieval and assessment of lymph nodes is associated with worse outcome in stage II colon cancer patients. Recurrence patterns support the hypothesis that disease recurrence occurred due to inaccurate staging. In this small study, LVI or nodal micrometastases did not predict survival. Maximal attention should be paid to the total number of lymph nodes retrieved before embarking on potentially more resource intensive staging methods.
Law
Calvin H L
CH
The Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Wright
Frances C
FC
Rapanos
Theodore
T
Alzahrani
Mohamed
M
Hanna
Sherif S
SS
Khalifa
Mahmoud
M
Smith
Andrew J
AJ
D000368:Aged; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000098:blood supply / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome