title: Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age.
abstract: BACKGROUND
  A national surveillance program of colon cancer treatment was introduced in 2007. We examined prognostic factors for colon cancer operated in 2000 with an aim of improving survival in the new program and a special focus on the merit of lymph node yield.
  
  
  METHODS
  A cohort of 269 patients, 152 women (56.5%), with a mean age of 71 years, was operated for colon cancer in 2000 at three teaching hospitals and followed up for 7 years.
  
  
  RESULTS
  Overall 5-year survival was 58.0%, and overall hospital mortality was 5.2%, with 4.5% in elective cases and 12.5% after urgent surgery. In only 41.1% of the specimens were 12 or more lymph nodes retrieved, but this did not affect survival in the combined cohort, although one of the hospitals achieved a significantly better result with a harvest of 12 or more lymph nodes. In a multivariate analysis, old age, gender, a high lymph node ratio (LNR) at stage III, and tumor-node-metastasis stage were adverse factors for survival.
  
  
  CONCLUSIONS
  The operative mortality was high and should be reassessed. The lymph node count did not have a significant impact on outcome overall, whereas the LNR proved significant for stage III. A prospective protocol using overall lymph node yield as a surrogate measure for more radical surgery, nevertheless, seems warranted to improve the lymph node harvest according to international recommendations.
authors.affiliation: Department of Surgery, Haraldsplass Deaconal Hospital, University of Bergen, PO Box 6165, 5892, Bergen, Norway.
authors.forename: Kristian E
authors.initials: KE
authors.lastname: Storli
authors.forename: Karl
authors.initials: K
authors.lastname: Søndenaa
authors.forename: Ida R K
authors.initials: IR
authors.lastname: Bukholm
authors.forename: Idunn
authors.initials: I
authors.lastname: Nesvik
authors.forename: Tore
authors.initials: T
authors.lastname: Bru
authors.forename: Bjørg
authors.initials: B
authors.lastname: Furnes
authors.forename: Bjarte
authors.initials: B
authors.lastname: Hjelmeland
authors.forename: Knut B
authors.initials: KB
authors.lastname: Iversen
authors.forename: Geir E
authors.initials: GE
authors.lastname: Eide
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D012727:Sex Characteristics; D055815:Young Adult