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From the Department of Surgical Oncology (NEJ, ERS) and Division of Population Science and the Department of Biostatistics (ALH, HW), Fox Chase Cancer Center, Philadelphia, Pennsylvania; Cancer and Leukemia Group B (RJM), Boston, Massachusetts; Southwest Oncology Group (JSM), Philadelphia, Pennsylvania; Dana-Farber Cancer Institute (PJC), Boston, Massachusetts; and Eastern Cooperative Oncology Group (DGH), Philadelphia, Pennsylvania.
Correspondence: Address correspondence and reprint requests to: Elin R. Sigurdson, MD, PhD, Department of Surgical Oncology, Fox Chase Cancer Center, 7701 Burholme Avenue, Philadelphia, PA 19111; Fax: 215-728-2773; E-mail: e_sigurdson{at}fccc.edu
Background: Correct determination of nodal status is pivotal to accurate staging and predicting survival.
Methods: This is a secondary analysis of INT0089, an intergroup trial of adjuvant chemotherapy for high-risk stage II and III colon cancer. A subset of patients was studied who underwent right or left hemicolectomy and from whom at least 10 lymph nodes were examined. A mathematical model was created to estimate the probability of a true negative result on the basis of the number of nodes examined. The number of nodes needed to predict nodal negativity with 85%, 50%, and 25% probability on the basis of tumor stage was calculated.
Results: In this analysis, 1585 patients were studied. The average number of nodes removed at surgery was comparable between treatment groups at 18.5 (median of 16 in all groups). With this model, when 18 nodes are removed at resection, there is a <25% probability of true node negativity in T1/T2 tumors, whereas <10 nodes need to be examined in T3 and T4 tumors to achieve the same probability.
Conclusions: Tumor stage and the number of nodes retrieved at resection influence the accuracy of determining nodal status in colon cancer. Most patients are understaged. Underestimating nodal stage may influence decisions regarding adjuvant therapy, as well as overall prognosis.
Key Words: Lymph node status • Colon cancer • Survival • 5-fluorouracil chemotherapy • Prognostic factors
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