TY - JOUR
T1 - Predictors of lymph node count in colorectal cancer resections
T2 - Data from US nationwide prospective cohort studies
AU - Morikawa, Teppei
AU - Tanaka, Noriko
AU - Kuchiba, Aya
AU - Nosho, Katsuhiko
AU - Yamauchi, Mai
AU - Hornick, Jason L.
AU - Swanson, Richard S.
AU - Chan, Andrew T.
AU - Meyerhardt, Jeffrey A.
AU - Huttenhower, Curtis
AU - Schrag, Deborah
AU - Fuchs, Charles S.
AU - Ogino, Shuji
PY - 2012/8
Y1 - 2012/8
N2 - Objective: To identify factors that influence the total and negative lymph node counts in colorectal cancer resection specimens independent of pathologists and surgeons. Design: We used multivariate negative binomial regression. Covariates included age, sex, body mass index, family history of colorectal carcinoma, year of diagnosis, hospital setting, tumor location, resected colorectal length (specimen length), tumor size, circumferential growth, TNM stage, lymphocytic reactions and other pathological features, and tumor molecular features (microsatellite instability, CpG island methylator phenotype, long interspersed nucleotide element 1 [LINE-1] methylation, and BRAF, KRAS, and PIK3CA mutations). Setting: Two US nationwide prospective cohort studies. Patients: Patients with rectal and colon cancer (N=918). Main Outcome Measures: The negative and total node counts (continuous). Results : Specimen length, tumor size, ascending colon location, T3N0M0 stage, and year of diagnosis were positively associated with the negative node count (all P ≤ .002). Mutation of KRAS might also be positively associated with the negative node count (P =.03; borderline significance considering multiple hypothesis testing). Among node-negative (stages I and II) cases, specimen length, tumor size, and ascending colon location remained significantly associated with the node count (all P ≤ .002), and PIK3CA and KRAS mutations might also be positively associated (P =.03 and P =.049, respectively, with borderline significance). Conclusions: This molecular pathological epidemiology study shows that specimen length, tumor size, tumor location, TNM stage, and year of diagnosis are operator- independent predictors of the lymph node count. These crucial variables should be examined in any future evaluation of the adequacy of lymph node harvest and nodal staging when devising individualized treatment plans for patients with colorectal cancer.
AB - Objective: To identify factors that influence the total and negative lymph node counts in colorectal cancer resection specimens independent of pathologists and surgeons. Design: We used multivariate negative binomial regression. Covariates included age, sex, body mass index, family history of colorectal carcinoma, year of diagnosis, hospital setting, tumor location, resected colorectal length (specimen length), tumor size, circumferential growth, TNM stage, lymphocytic reactions and other pathological features, and tumor molecular features (microsatellite instability, CpG island methylator phenotype, long interspersed nucleotide element 1 [LINE-1] methylation, and BRAF, KRAS, and PIK3CA mutations). Setting: Two US nationwide prospective cohort studies. Patients: Patients with rectal and colon cancer (N=918). Main Outcome Measures: The negative and total node counts (continuous). Results : Specimen length, tumor size, ascending colon location, T3N0M0 stage, and year of diagnosis were positively associated with the negative node count (all P ≤ .002). Mutation of KRAS might also be positively associated with the negative node count (P =.03; borderline significance considering multiple hypothesis testing). Among node-negative (stages I and II) cases, specimen length, tumor size, and ascending colon location remained significantly associated with the node count (all P ≤ .002), and PIK3CA and KRAS mutations might also be positively associated (P =.03 and P =.049, respectively, with borderline significance). Conclusions: This molecular pathological epidemiology study shows that specimen length, tumor size, tumor location, TNM stage, and year of diagnosis are operator- independent predictors of the lymph node count. These crucial variables should be examined in any future evaluation of the adequacy of lymph node harvest and nodal staging when devising individualized treatment plans for patients with colorectal cancer.
UR - http://www.scopus.com/inward/record.url?scp=84865609236&partnerID=8YFLogxK
U2 - 10.1001/archsurg.2012.353
DO - 10.1001/archsurg.2012.353
M3 - Article
C2 - 22508672
AN - SCOPUS:84865609236
SN - 0004-0010
VL - 147
SP - 715
EP - 723
JO - Archives of Surgery
JF - Archives of Surgery
IS - 8
ER -