title: Lymph node hypoplasia is associated with adverse outcomes in node-negative colon cancer using advanced lymph node dissection methods.
abstract: OBJECTIVE
  Lymph node size as a prognostic parameter has not been investigated well in the past. Recent data, however, have indicated that this parameter could be even more important than the lymph node count.
  
  
  METHODS
  Based on the results of earlier studies, we analyzed the lymph node size and number of node-negative colon cancer patients with regard to survival. Data from 115 node-negative cases of colon cancer were analyzed. Lymph nodes with diameters ≤5 mm were defined as small, and all other lymph nodes were classified as intermediate/large in size and labeled LN5. All of the cases were categorized according to the number of LN5s. The LN5 very low (LN5vl) group included cases with less than two LN5s. All of the other cases were assigned to the LN5 low/high (LN5l/h) group.
  
  
  RESULTS
  The overall survival analysis revealed significantly worse outcomes for the LN5vl group, with a mean survival of 34 months compared to the LN5l/h group, with a mean survival of 40 months (P = 0.022). After adjusting for the pT1/2 and pT3/4 stages, we still found a significant outcome difference (P = 0.012). Multivariate analysis identified LN5vl and T-stage as being independently correlated with the outcome. The vast majority of LN5vl cases (91 %) were located in the left colon. The location itself, however, was not prognostic (P = 0.478).
  
  
  CONCLUSIONS
  LN5 count, as a marker of immune response, could be shown as being prognostic in node-negative colon cancer. Patients with low LN5 counts showed poor outcomes. These patients could perhaps profit from adjuvant chemotherapy.
authors.affiliation: Institute of Pathology, Zentralklinikum Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mayr
authors.affiliation: Department of Visceral and Transplantation Surgery, Klinikum Augsburg, Augsburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Aumann
authors.affiliation: Institute of Pathology, Zentralklinikum Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Schaller
authors.affiliation: Clinical and Population-Based Cancer Registry of Augsburg, Klinikum Augsburg, Augsburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schenkirsch
authors.affiliation: Department of Visceral and Transplantation Surgery, Klinikum Augsburg, Augsburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Anthuber
authors.affiliation: Institute of Pathology, Zentralklinikum Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany. bruno.maerkl@klinikum-augsburg.de.
authors.forename: Bruno
authors.initials: B
authors.lastname: Märkl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015203:Reproducibility of Results; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D008751:Methylene Blue
keywords: Colon cancer; Hyperplasia; Hypoplasia; Lymph node size; Stage migration