title: Whether regional lymph nodes evaluation should be equally required for both right and left colon cancer.
abstract: Despite the adequacy of nodal evaluation was gradually improved for colon cancer, the disparity in nodal examination for right colon cancer (RCC) and left colon cancer (LCC) still begs the question of whether 12 nodes is an appropriate threshold for both RCC and LCC. From Surveillance, Epidemiology, and End-Results (SEER) database, we identified 53897 RCC patients and 11822 LCC patients. Compared with LCC patients, RCC patients examined more lymph nodes (18.7 vs 16.3), and more likely to examine ≥12 nodes (P<0.001), whereas RCC patients showed lower rates of node positivity (P<0.001). To balance the nodal disparity between RCC and LCC, we revised the 12-node measure based on different tumor locations. With the X-tile, we determined 15 as the optimal node number for RCC and 11 for LCC. To validate the availability of this revised nodal evaluation, the 5-year cancer specific survival (CSS) was calculated according to the optimal node number in RCC and LCC patients, Cox's regression model were used to further assess the prognostic value of this revised nodal evaluation. The results showed that 5-year CSSs were significantly improved for RCC patients with ≥15 lymph nodes, and also for LCC patients with ≥11 lymph nodes (P<0.001). This revised nodal evaluation could also improve the rate of nodal positivity and long-term survival in both RCC and LCC patients compared with 12-node measure. Therefore, the lymph node examination should be discriminately evaluated for RCC and LCC, instead of using 12-node measure to colon cancer as a whole.
authors: Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Xu
authors: X
authors: Guan
authors: Follow up center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Wei
authors: W
authors: Chen
authors: Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors: Zheng
authors: Z
authors: Liu
authors: Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors: Zheng
authors: Z
authors: Jiang
authors: Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Hanqing
authors: H
authors: Hu
authors: Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Zhixun
authors: Z
authors: Zhao
authors: Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Song
authors: S
authors: Wang
authors: Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Yinggang
authors: Y
authors: Chen
authors: Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Guiyu
authors: G
authors: Wang
authors: Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.|Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors: Xishan
authors: X
authors: Wang
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000473:pathology*; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000033:anatomy & histology* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D055815:Young Adult
keywords: colectomy; colon cancer; lymph node; surgery; survival