Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer
Background:. Optimal therapy for stage II colon cancer remains unclear, and national guidelines recommend “consideration” of adjuvant chemotherapy (ACT) in the presence of high-risk features, including inadequate lymph node yield (LNY, <12 nodes). This study aims to determine whether the survival...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2023-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000338 |
| _version_ | 1797375044903501824 |
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| author | Alan Zambeli-Ljepović, MD, MHS Daniel Hoffman, MD Katherine E. Barnes, BS Fernanda Romero-Hernandez, MD Amir Ashraf Ganjouei, MD, MPH Mohamed A. Adam, MD Ankit Sarin, MD, MHA |
| author_facet | Alan Zambeli-Ljepović, MD, MHS Daniel Hoffman, MD Katherine E. Barnes, BS Fernanda Romero-Hernandez, MD Amir Ashraf Ganjouei, MD, MPH Mohamed A. Adam, MD Ankit Sarin, MD, MHA |
| author_sort | Alan Zambeli-Ljepović, MD, MHS |
| collection | DOAJ |
| description | Background:. Optimal therapy for stage II colon cancer remains unclear, and national guidelines recommend “consideration” of adjuvant chemotherapy (ACT) in the presence of high-risk features, including inadequate lymph node yield (LNY, <12 nodes). This study aims to determine whether the survival benefit of ACT in stage II disease varies based on the adequacy of LNY.
Methods:. We used the National Cancer Database (NCDB) to identify adults who underwent resection for a single primary T3 or T4 colon cancer between 2006 and 2018. Multivariable logistic regression tested for associations between ACT and prespecified demographic and clinical characteristics, including the adequacy of LNY. We used Cox proportional hazards models to assess overall survival and restricted cubic splines to estimate the optimal LNY threshold to dichotomize patients based on overall survival.
Results:. Unadjusted 5- and 10-year survival rates were 84% and 75%, respectively, among patients who received ACT and 70% and 50% among patients who did not (log-rank P < 0.01). Inadequate LNY was independently associated with both receipt of ACT (odds ratios, 1.50; P < 0.01) and decreased overall survival [hazard ratio (HR), 1.56; P < 0.01]. ACT was independently associated with improved survival (HR, 0.67; P < 0.01); this effect size did not change based on the adequacy of LNY (interaction P = 0.41). Results were robust to re-analysis with our cohort-optimized threshold of 18 lymph nodes.
Conclusions:. Consistent with contemporary guidelines, patients with inadequate LNY are more likely to receive ACT. LNY adequacy is an independent prognostic factor but, in isolation, should not dictate whether patients receive ACT. |
| first_indexed | 2024-03-08T19:16:32Z |
| format | Article |
| id | doaj.art-6fdc21fe074f4bc7b9df3f25e49754d1 |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-08T19:16:32Z |
| publishDate | 2023-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-6fdc21fe074f4bc7b9df3f25e49754d12023-12-27T06:49:28ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932023-12-0144e33810.1097/AS9.0000000000000338202312000-00004Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon CancerAlan Zambeli-Ljepović, MD, MHS0Daniel Hoffman, MD1Katherine E. Barnes, BS2Fernanda Romero-Hernandez, MD3Amir Ashraf Ganjouei, MD, MPH4Mohamed A. Adam, MD5Ankit Sarin, MD, MHA6From the * Department of Surgery, University of California, San Francisco, San Francisco, CAFrom the * Department of Surgery, University of California, San Francisco, San Francisco, CAFrom the * Department of Surgery, University of California, San Francisco, San Francisco, CAFrom the * Department of Surgery, University of California, San Francisco, San Francisco, CAFrom the * Department of Surgery, University of California, San Francisco, San Francisco, CAFrom the * Department of Surgery, University of California, San Francisco, San Francisco, CA† Department of Surgery, University of California Davis, Sacramento, CA.Background:. Optimal therapy for stage II colon cancer remains unclear, and national guidelines recommend “consideration” of adjuvant chemotherapy (ACT) in the presence of high-risk features, including inadequate lymph node yield (LNY, <12 nodes). This study aims to determine whether the survival benefit of ACT in stage II disease varies based on the adequacy of LNY. Methods:. We used the National Cancer Database (NCDB) to identify adults who underwent resection for a single primary T3 or T4 colon cancer between 2006 and 2018. Multivariable logistic regression tested for associations between ACT and prespecified demographic and clinical characteristics, including the adequacy of LNY. We used Cox proportional hazards models to assess overall survival and restricted cubic splines to estimate the optimal LNY threshold to dichotomize patients based on overall survival. Results:. Unadjusted 5- and 10-year survival rates were 84% and 75%, respectively, among patients who received ACT and 70% and 50% among patients who did not (log-rank P < 0.01). Inadequate LNY was independently associated with both receipt of ACT (odds ratios, 1.50; P < 0.01) and decreased overall survival [hazard ratio (HR), 1.56; P < 0.01]. ACT was independently associated with improved survival (HR, 0.67; P < 0.01); this effect size did not change based on the adequacy of LNY (interaction P = 0.41). Results were robust to re-analysis with our cohort-optimized threshold of 18 lymph nodes. Conclusions:. Consistent with contemporary guidelines, patients with inadequate LNY are more likely to receive ACT. LNY adequacy is an independent prognostic factor but, in isolation, should not dictate whether patients receive ACT.http://journals.lww.com/10.1097/AS9.0000000000000338 |
| spellingShingle | Alan Zambeli-Ljepović, MD, MHS Daniel Hoffman, MD Katherine E. Barnes, BS Fernanda Romero-Hernandez, MD Amir Ashraf Ganjouei, MD, MPH Mohamed A. Adam, MD Ankit Sarin, MD, MHA Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer Annals of Surgery Open |
| title | Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer |
| title_full | Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer |
| title_fullStr | Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer |
| title_full_unstemmed | Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer |
| title_short | Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer |
| title_sort | inadequate lymph node yield an inadequate indication for adjuvant chemotherapy in stage ii colon cancer |
| url | http://journals.lww.com/10.1097/AS9.0000000000000338 |
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