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Increasing Negative Lymph Node Count Is Independently Associated With Improved Long-Term Survival in Stage IIIB and IIIC Colon Cancer

Paul M. Johnson, Geoff A. Porter, Rocco Ricciardi, Nancy N. Baxter

From the Department of Surgery, Dalhousie University, Halifax, Nova Scotia; Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Minnesota, Minneapolis, MN

Address reprint requests to Nancy Baxter, MD, PhD, Division of General Surgery, St Michael's Hospital, 30 Bond St, CC16-040, Toronto, Ontario, Canada, M5B 1W8; e-mail: baxtern{at}smh.toronto.on.ca

PURPOSE: The purpose of this study was to examine the impact of the number of negative lymph nodes on survival in patients with stage III colon cancer.

PATIENTS AND METHODS: Patients who underwent surgery for stage III colon cancer between January 1988 and December 1997 were identified from the Surveillance, Epidemiology and End Results cancer registry. The number of negative and positive nodes was determined for 20,702 eligible patients. Disease-specific survival was examined by substage according to the number of negative nodes identified. A proportional hazards model was constructed to determine the effect of the number of negative nodes on survival.

RESULTS: For stage IIIB and IIIC patients, there was a significant decrease in disease-specific mortality as the number of negative nodes increased; cumulative 5-year cancer mortality was 27% in stage IIIB patients with 13 or more negative nodes identified versus 45% in those with three or fewer negative lymph nodes evaluated (P < .0001). In patients with stage IIIC cancer, those with 13 or more negative nodes had a 5-year mortality of 42% versus 65% in those with three or fewer negative lymph nodes evaluated (P < .0001). There was no association between the number of negative nodes identified and disease-specific survival for patients with stage IIIA disease. After controlling for the number of positive nodes, a higher number of negative nodes was found to be independently associated with improved disease-specific survival.

CONCLUSION: The number of negative nodes is an important independent prognostic factor for patients with stage IIIB and IIIC colon cancer.

Supported by an American Society of Clinical Oncology career development award (N.N.B.).

Presented in part at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, San Francisco, CA, January 26-28, 2006.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Correspondence

• Quality of Pathology Reporting Impacts on Lymph Node Yield in Colon Cancer
  Nicholas A. Rieger, Frances S. Barnett, James W.E. Moore, Sumitra S. Ananda, Matthew Croxford, Julie Johns, and Peter Gibbs
  JCO 2007 25: 463 [Full Text]

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