The prognostic significance of lymph node size in node-positive colon cancer.

OBJECTIVES:To (i) show the outcome benefits of enlarged lymph nodes in node-positive colon cancer cases, as it was shown previously in negative node cases; (ii) disprove the stage migration theory and (iii) list the factors affecting lymph node size and yield. METHODS:A retrospective study including...

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Main Authors: Philipp Schrembs, Benedikt Martin, Matthias Anthuber, Gerhard Schenkirsch, Bruno Märkl
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2018-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC6086396?pdf=render
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spelling doaj-6f83f67e94d94b1694dbe053380cc5af2020-11-25T02:54:57ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01138e020107210.1371/journal.pone.0201072The prognostic significance of lymph node size in node-positive colon cancer.Philipp SchrembsBenedikt MartinMatthias AnthuberGerhard SchenkirschBruno MärklOBJECTIVES:To (i) show the outcome benefits of enlarged lymph nodes in node-positive colon cancer cases, as it was shown previously in negative node cases; (ii) disprove the stage migration theory and (iii) list the factors affecting lymph node size and yield. METHODS:A retrospective study including 234 node-positive colon cancer cases was scheduled and performed. All recovered lymph nodes (6969) from 234 cases were microscopically examined in regard to (a) lymph node size (b) presence of metastasis (c) extent of intra-nodal metastasis. On the basis of resulting data, a statistical analysis was performed. RESULTS:Metastases occurred in all size categories, though more often in larger lymph nodes. Fifty-one percent of all metastasised nodes were 2 to 6 mm in size. Approximately half of all nodes >10 mm were microscopically free of cancer. Cases with a small lymph node metastasis to lymph node size ratio (MSR) had a better prognosis than others: 85 months (95% CI: 72-97) vs. 67 months (95% CI: 47-88), p <0.001 (mean, overall survival). To differentiate between cases with the same ratio but different absolute lymph nodes sizes, we divided the cases into two groups that differed in their number of moderate to large lymph nodes. The group with more moderate to large lymph nodes showed a clear outcome benefit: 104 months (95% CI: 86-122) vs. 66 months (95% CI: 54-77), p = 0.014 (mean, overall survival). CONCLUSIONS:Metastasised lymph nodes affect all size categories, and large lymph nodes are not always metastasised. The combination of enlarged lymph nodes and a small lymph node metastasis to lymph node size ratio (MSR) is associated with a better prognosis than others. When enlarged lymph nodes were considered as surrogate markers of an effective local immune response due to nodal hyperplasia, the immune system could be seen as the confounder affecting both lymph node size and prognosis. Our results are pointing in this direction and, along with other reasons, are challenging the stage migration theory.http://europepmc.org/articles/PMC6086396?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Philipp Schrembs
Benedikt Martin
Matthias Anthuber
Gerhard Schenkirsch
Bruno Märkl
spellingShingle Philipp Schrembs
Benedikt Martin
Matthias Anthuber
Gerhard Schenkirsch
Bruno Märkl
The prognostic significance of lymph node size in node-positive colon cancer.
PLoS ONE
author_facet Philipp Schrembs
Benedikt Martin
Matthias Anthuber
Gerhard Schenkirsch
Bruno Märkl
author_sort Philipp Schrembs
title The prognostic significance of lymph node size in node-positive colon cancer.
title_short The prognostic significance of lymph node size in node-positive colon cancer.
title_full The prognostic significance of lymph node size in node-positive colon cancer.
title_fullStr The prognostic significance of lymph node size in node-positive colon cancer.
title_full_unstemmed The prognostic significance of lymph node size in node-positive colon cancer.
title_sort prognostic significance of lymph node size in node-positive colon cancer.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2018-01-01
description OBJECTIVES:To (i) show the outcome benefits of enlarged lymph nodes in node-positive colon cancer cases, as it was shown previously in negative node cases; (ii) disprove the stage migration theory and (iii) list the factors affecting lymph node size and yield. METHODS:A retrospective study including 234 node-positive colon cancer cases was scheduled and performed. All recovered lymph nodes (6969) from 234 cases were microscopically examined in regard to (a) lymph node size (b) presence of metastasis (c) extent of intra-nodal metastasis. On the basis of resulting data, a statistical analysis was performed. RESULTS:Metastases occurred in all size categories, though more often in larger lymph nodes. Fifty-one percent of all metastasised nodes were 2 to 6 mm in size. Approximately half of all nodes >10 mm were microscopically free of cancer. Cases with a small lymph node metastasis to lymph node size ratio (MSR) had a better prognosis than others: 85 months (95% CI: 72-97) vs. 67 months (95% CI: 47-88), p <0.001 (mean, overall survival). To differentiate between cases with the same ratio but different absolute lymph nodes sizes, we divided the cases into two groups that differed in their number of moderate to large lymph nodes. The group with more moderate to large lymph nodes showed a clear outcome benefit: 104 months (95% CI: 86-122) vs. 66 months (95% CI: 54-77), p = 0.014 (mean, overall survival). CONCLUSIONS:Metastasised lymph nodes affect all size categories, and large lymph nodes are not always metastasised. The combination of enlarged lymph nodes and a small lymph node metastasis to lymph node size ratio (MSR) is associated with a better prognosis than others. When enlarged lymph nodes were considered as surrogate markers of an effective local immune response due to nodal hyperplasia, the immune system could be seen as the confounder affecting both lymph node size and prognosis. Our results are pointing in this direction and, along with other reasons, are challenging the stage migration theory.
url http://europepmc.org/articles/PMC6086396?pdf=render
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