title: The number of lymph nodes examined debate in colon cancer: how much is enough?
abstract: BACKGROUND
  Much debate exists over the significance of the number of lymph nodes (LN) examined after colon resection.
  
  
  METHODS
  The Surveillance, Epidemiology and End Results (SEER) database was queried for patients who presented with colonic adenocarcinoma. Multiple Cox proportional hazard regressions were run using successive LN cut-offs (6-26), first controlling for and then stratifying by T-stage. This was repeated in subsets of patients delineated by LN status. Additional variables controlled for in every regression were age, gender, ethnicity, marital status, number of positive LN, grade, metastases, and extent of surgery. After each regression, a Harrell's C statistic and an Akaike's information criterion (AIC) were performed to test the predictive capacity and fit of the model, respectively.
  
  
  RESULTS
  128,071 patients met selection criteria. The highest Harrell's C statistics among all patients were the cutoffs at 14 LN and 15 LN. Between those, the AIC shows that the cutoff at 15 LN fit the data more closely than the 14 LN cutoff. The models with the best predictive ability and best fit by T-stage were T1, 14 LN; T2, 10 LN; T3, 10 LN; T4, 12 LN.
  
  
  CONCLUSIONS
  Using a population-based dataset, we show the optimal number of LN examined is dependent upon the patient's tumor stage. Across all T-stages, the highest optimal number of LN resected was 15. Since it is possible to estimate but not perfectly predict the stage of a patient's tumor preoperatively, we believe the recommendation should be based on the most conservative measure.
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Downing
authors.forename: Kerry-Ann
authors.initials: KA
authors.lastname: Cadogan
authors.forename: Gezzer
authors.initials: G
authors.lastname: Ortega
authors.forename: Zenab
authors.initials: Z
authors.lastname: Jaji
authors.forename: Oluwaseyi B
authors.initials: OB
authors.lastname: Bolorunduro
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Debra H
authors.initials: DH
authors.lastname: Ford
authors.forename: Wayne A I
authors.initials: WA
authors.lastname: Frederick
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018426:SEER Program