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Population‐based study to re‐evaluate optimal lymph node yield in colonic cancer
Background It is well established that lymph node (LN) yield in colonic cancer resection has prognostic significance, although optimal numbers are not clear. Here, LN thresholds associated with both LN positivity and survival were evaluated in a single population‐based data set. Methods Treatment re...
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| Published in: | British journal of surgery 2017-07, Vol.104 (8), p.1087-1096 |
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| container_title | British journal of surgery |
| container_volume | 104 |
| creator | Del Paggio, J. C. Peng, Y. Wei, X. Nanji, S. MacDonald, P. H. Krishnan Nair, C. Booth, C. M. |
| description | Background
It is well established that lymph node (LN) yield in colonic cancer resection has prognostic significance, although optimal numbers are not clear. Here, LN thresholds associated with both LN positivity and survival were evaluated in a single population‐based data set.
Methods
Treatment records were linked to the Ontario Cancer Registry to identify a 25 per cent random sample of all patients with stage II/III colonic cancer between 2002 and 2008. Multivariable regression and Cox models evaluated factors associated with LN positivity and cancer‐specific survival (CSS) respectively. Optimal thresholds were obtained using sequential regression analysis.
Results
On adjusted analysis of 5508 eligible patients, younger age (P |
| doi_str_mv | 10.1002/bjs.10540 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7938819</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1903158899</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4090-a191b24881ccb33f2132af14c11114bc0ba7d39390c272b3bbf77ee354500e193</originalsourceid><addsrcrecordid>eNpdkc9OFTEUxhsjkSu68AVMEzdsRk7bGabdkAhBxZBgIq6btnOu9Ka3HaYzkNnxCDyjT2Iv_4KczTnp-eXr136EfGDwmQHwPbvKZWhqeEUWTOw3FWf78jVZAEBbMcHFNnmb8wqACWj4G7LNZVNz1dQLcv4z9VMwo0_x782tNRk7msepm-mY6IDlDK9MmMyINPWjX5tAw7zuL2hMHdLZY-ioj9SlkKJ31JnocHhHtpYmZHz_0HfI76_H50ffq9OzbydHX04rV4OCyjDFLK-lZM5ZIZa8WDVLVjtWqrYOrGk7oYQCx1tuhbXLtkUUTd0AIFNihxzc6_aTXWPnMI6DCbofis9h1sl4_f8m-gv9J13pVoly60Zg90FgSJcT5lGvfXYYgomYpqyZAsEaKdUG_fQCXaVpiOV5G0q2kkshC_XxuaMnK48fXoC9e-DaB5yf9gz0JkldktR3SerDH7_uBvEPdjmSSA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1908782838</pqid></control><display><type>article</type><title>Population‐based study to re‐evaluate optimal lymph node yield in colonic cancer</title><source>Oxford Journals Online</source><creator>Del Paggio, J. C. ; Peng, Y. ; Wei, X. ; Nanji, S. ; MacDonald, P. H. ; Krishnan Nair, C. ; Booth, C. M.</creator><creatorcontrib>Del Paggio, J. C. ; Peng, Y. ; Wei, X. ; Nanji, S. ; MacDonald, P. H. ; Krishnan Nair, C. ; Booth, C. M.</creatorcontrib><description>Background
It is well established that lymph node (LN) yield in colonic cancer resection has prognostic significance, although optimal numbers are not clear. Here, LN thresholds associated with both LN positivity and survival were evaluated in a single population‐based data set.
Methods
Treatment records were linked to the Ontario Cancer Registry to identify a 25 per cent random sample of all patients with stage II/III colonic cancer between 2002 and 2008. Multivariable regression and Cox models evaluated factors associated with LN positivity and cancer‐specific survival (CSS) respectively. Optimal thresholds were obtained using sequential regression analysis.
Results
On adjusted analysis of 5508 eligible patients, younger age (P < 0·001), left‐sided tumours (P = 0·003), higher T category (P < 0·001) and greater LN yield (relative risk 0·89, 95 per cent c.i. 0·81 to 0·97; P = 0·007) were associated with a greater likelihood of LN positivity. Regression analyses with multiple thresholds suggested no substantial increase in LN positivity beyond 12–14 LNs. Cox analysis of stage II disease showed that lower LN yield was associated with a significant increase in the risk of death from cancer (CSS hazard ratio range 1·55–1·74; P < 0·001) compared with a greater LN yield, with no significant survival benefit beyond a yield of 20 LNs. Similarly, for stage III disease, a lower LN yield was associated with an increase in the risk of death from cancer (CSS hazard ratio range 1·49–2·20; P < 0·001) versus a large LN yield. In stage III disease, there was no observed LN threshold for survival benefit in the data set.
Conclusion
There is incongruity in the optimal LN evaluation for colonic cancer. Although the historically stated threshold of 12 LNs may ensure accurate staging in colonic cancer, thresholds for optimal survival are associated with far greater yields.
Twelve is not the magic number</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.10540</identifier><identifier>PMID: 28542954</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cancer ; Colonic Neoplasms - mortality ; Colonic Neoplasms - surgery ; Colorectal cancer ; Epidemiologic Methods ; Female ; Health risk assessment ; Humans ; Lymph Node Excision - mortality ; Lymphatic Metastasis ; Lymphatic system ; Male ; Middle Aged ; Ontario - epidemiology ; Original ; Population-based studies ; Socioeconomic Factors ; Young Adult</subject><ispartof>British journal of surgery, 2017-07, Vol.104 (8), p.1087-1096</ispartof><rights>2017 BJS Society Ltd Published by John Wiley & Sons Ltd</rights><rights>2017 BJS Society Ltd Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2017 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><rights>2017 BJS Society Ltd Published by John Wiley & Sons Ltd 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4090-a191b24881ccb33f2132af14c11114bc0ba7d39390c272b3bbf77ee354500e193</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28542954$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Del Paggio, J. C.</creatorcontrib><creatorcontrib>Peng, Y.</creatorcontrib><creatorcontrib>Wei, X.</creatorcontrib><creatorcontrib>Nanji, S.</creatorcontrib><creatorcontrib>MacDonald, P. H.</creatorcontrib><creatorcontrib>Krishnan Nair, C.</creatorcontrib><creatorcontrib>Booth, C. M.</creatorcontrib><title>Population‐based study to re‐evaluate optimal lymph node yield in colonic cancer</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
It is well established that lymph node (LN) yield in colonic cancer resection has prognostic significance, although optimal numbers are not clear. Here, LN thresholds associated with both LN positivity and survival were evaluated in a single population‐based data set.
Methods
Treatment records were linked to the Ontario Cancer Registry to identify a 25 per cent random sample of all patients with stage II/III colonic cancer between 2002 and 2008. Multivariable regression and Cox models evaluated factors associated with LN positivity and cancer‐specific survival (CSS) respectively. Optimal thresholds were obtained using sequential regression analysis.
Results
On adjusted analysis of 5508 eligible patients, younger age (P < 0·001), left‐sided tumours (P = 0·003), higher T category (P < 0·001) and greater LN yield (relative risk 0·89, 95 per cent c.i. 0·81 to 0·97; P = 0·007) were associated with a greater likelihood of LN positivity. Regression analyses with multiple thresholds suggested no substantial increase in LN positivity beyond 12–14 LNs. Cox analysis of stage II disease showed that lower LN yield was associated with a significant increase in the risk of death from cancer (CSS hazard ratio range 1·55–1·74; P < 0·001) compared with a greater LN yield, with no significant survival benefit beyond a yield of 20 LNs. Similarly, for stage III disease, a lower LN yield was associated with an increase in the risk of death from cancer (CSS hazard ratio range 1·49–2·20; P < 0·001) versus a large LN yield. In stage III disease, there was no observed LN threshold for survival benefit in the data set.
Conclusion
There is incongruity in the optimal LN evaluation for colonic cancer. Although the historically stated threshold of 12 LNs may ensure accurate staging in colonic cancer, thresholds for optimal survival are associated with far greater yields.
Twelve is not the magic number</description><subject>Adult</subject><subject>Age Distribution</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer</subject><subject>Colonic Neoplasms - mortality</subject><subject>Colonic Neoplasms - surgery</subject><subject>Colorectal cancer</subject><subject>Epidemiologic Methods</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Lymph Node Excision - mortality</subject><subject>Lymphatic Metastasis</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Ontario - epidemiology</subject><subject>Original</subject><subject>Population-based studies</subject><subject>Socioeconomic Factors</subject><subject>Young Adult</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNpdkc9OFTEUxhsjkSu68AVMEzdsRk7bGabdkAhBxZBgIq6btnOu9Ka3HaYzkNnxCDyjT2Iv_4KczTnp-eXr136EfGDwmQHwPbvKZWhqeEUWTOw3FWf78jVZAEBbMcHFNnmb8wqACWj4G7LNZVNz1dQLcv4z9VMwo0_x782tNRk7msepm-mY6IDlDK9MmMyINPWjX5tAw7zuL2hMHdLZY-ioj9SlkKJ31JnocHhHtpYmZHz_0HfI76_H50ffq9OzbydHX04rV4OCyjDFLK-lZM5ZIZa8WDVLVjtWqrYOrGk7oYQCx1tuhbXLtkUUTd0AIFNihxzc6_aTXWPnMI6DCbofis9h1sl4_f8m-gv9J13pVoly60Zg90FgSJcT5lGvfXYYgomYpqyZAsEaKdUG_fQCXaVpiOV5G0q2kkshC_XxuaMnK48fXoC9e-DaB5yf9gz0JkldktR3SerDH7_uBvEPdjmSSA</recordid><startdate>201707</startdate><enddate>201707</enddate><creator>Del Paggio, J. C.</creator><creator>Peng, Y.</creator><creator>Wei, X.</creator><creator>Nanji, S.</creator><creator>MacDonald, P. H.</creator><creator>Krishnan Nair, C.</creator><creator>Booth, C. M.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201707</creationdate><title>Population‐based study to re‐evaluate optimal lymph node yield in colonic cancer</title><author>Del Paggio, J. C. ; Peng, Y. ; Wei, X. ; Nanji, S. ; MacDonald, P. H. ; Krishnan Nair, C. ; Booth, C. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4090-a191b24881ccb33f2132af14c11114bc0ba7d39390c272b3bbf77ee354500e193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Age Distribution</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer</topic><topic>Colonic Neoplasms - mortality</topic><topic>Colonic Neoplasms - surgery</topic><topic>Colorectal cancer</topic><topic>Epidemiologic Methods</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Lymph Node Excision - mortality</topic><topic>Lymphatic Metastasis</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Ontario - epidemiology</topic><topic>Original</topic><topic>Population-based studies</topic><topic>Socioeconomic Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Del Paggio, J. C.</creatorcontrib><creatorcontrib>Peng, Y.</creatorcontrib><creatorcontrib>Wei, X.</creatorcontrib><creatorcontrib>Nanji, S.</creatorcontrib><creatorcontrib>MacDonald, P. H.</creatorcontrib><creatorcontrib>Krishnan Nair, C.</creatorcontrib><creatorcontrib>Booth, C. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Del Paggio, J. C.</au><au>Peng, Y.</au><au>Wei, X.</au><au>Nanji, S.</au><au>MacDonald, P. H.</au><au>Krishnan Nair, C.</au><au>Booth, C. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Population‐based study to re‐evaluate optimal lymph node yield in colonic cancer</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2017-07</date><risdate>2017</risdate><volume>104</volume><issue>8</issue><spage>1087</spage><epage>1096</epage><pages>1087-1096</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Background
It is well established that lymph node (LN) yield in colonic cancer resection has prognostic significance, although optimal numbers are not clear. Here, LN thresholds associated with both LN positivity and survival were evaluated in a single population‐based data set.
Methods
Treatment records were linked to the Ontario Cancer Registry to identify a 25 per cent random sample of all patients with stage II/III colonic cancer between 2002 and 2008. Multivariable regression and Cox models evaluated factors associated with LN positivity and cancer‐specific survival (CSS) respectively. Optimal thresholds were obtained using sequential regression analysis.
Results
On adjusted analysis of 5508 eligible patients, younger age (P < 0·001), left‐sided tumours (P = 0·003), higher T category (P < 0·001) and greater LN yield (relative risk 0·89, 95 per cent c.i. 0·81 to 0·97; P = 0·007) were associated with a greater likelihood of LN positivity. Regression analyses with multiple thresholds suggested no substantial increase in LN positivity beyond 12–14 LNs. Cox analysis of stage II disease showed that lower LN yield was associated with a significant increase in the risk of death from cancer (CSS hazard ratio range 1·55–1·74; P < 0·001) compared with a greater LN yield, with no significant survival benefit beyond a yield of 20 LNs. Similarly, for stage III disease, a lower LN yield was associated with an increase in the risk of death from cancer (CSS hazard ratio range 1·49–2·20; P < 0·001) versus a large LN yield. In stage III disease, there was no observed LN threshold for survival benefit in the data set.
Conclusion
There is incongruity in the optimal LN evaluation for colonic cancer. Although the historically stated threshold of 12 LNs may ensure accurate staging in colonic cancer, thresholds for optimal survival are associated with far greater yields.
Twelve is not the magic number</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>28542954</pmid><doi>10.1002/bjs.10540</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Online |
| subjects | Adult Age Distribution Aged Aged, 80 and over Cancer Colonic Neoplasms - mortality Colonic Neoplasms - surgery Colorectal cancer Epidemiologic Methods Female Health risk assessment Humans Lymph Node Excision - mortality Lymphatic Metastasis Lymphatic system Male Middle Aged Ontario - epidemiology Original Population-based studies Socioeconomic Factors Young Adult |
| title | Population‐based study to re‐evaluate optimal lymph node yield in colonic cancer |
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