The clinical significance of lymph node size in colon cancer.
To date, the clinical value of lymph node size in colon cancer has been investigated only in a few studies. Only in radiological diagnosis is lymph node size routinely recognized, and nodes ≥10 mm in diameter are considered pathologic. However, the few studies regarding this topic suggest that lymph node size is not a reliable indicator of metastatic disease. Moreover, we hypothesized that increasing lymph node size is associated with favorable outcome. By performing a morphometric study, we investigated the clinical significance of lymph node size in colon cancer in terms of metastatic disease and prognosis. A cohort of 237 cases with excellent lymph node harvest (mean lymph node count: 33±17) was used. The size distribution in node-positive and -negative cases was almost identical. In all, 151 out of the 305 metastases detected (49.5%) were found in lymph nodes with diameters ≤5 mm. Only 25% of lymph nodes >10 mm showed metastases. Minute lymph nodes ≤1 mm were involved only very rarely (2 of 81 cases). In 67% of the cases, the largest positive lymph node was <10 mm. The prognostic relevance of lymph node size was investigated in a subset of 115 stage I/II cases. The occurrence of ≥7 lymph nodes that were >5 mm in diameter was significantly associated with better overall survival. Our data show that lymph node size is not a suitable factor for preoperative lymph node staging. Minute lymph nodes have virtually no role in correct histopathological lymph node staging. Finally, large lymph nodes in stage I/II disease might indicate a favorable outcome.
Institute of Pathology, Klinikum Augsburg, Augsburg, Germany. Bruno.Maerkl@klinikum-augsburg.de
Bruno
B
Märkl
Janine
J
Rößle
Hans M
HM
Arnholdt
Tina
T
Schaller
Ines
I
Krammer
Claudio
C
Cacchi
Hendrik
H
Jähnig
Gerhard
G
Schenkirsch
Hanno
H
Spatz
Matthias
M
Anthuber
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate