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Number and Size of Lymph Nodes Recovered From Dukes B Rectal Cancers: Correlation with Prognosis and Histologic Antitumor Immune Response

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Diseases of the Colon & Rectum

Abstract

Purpose

In rectal cancer variation in lymph node recovery influences the detection of nodal metastases and prognosis among Dukes B (Stage II) cases. However, the possible prognostic importance of node size and inherent patient/tumor characteristics in determining node recovery has not been studied.

Methods

We examined 269 Dukes B (Stage II) rectal tumors, with a mean of 12 nodes per case. Primary tumor characteristics were correlated with the number and size of recovered nodes. Clinical follow-up permitted determination of long-term survival.

Results

The five-year survival of 94 Dukes B cases with nine or fewer nodes was 69.4 percent vs. 87.6 percent in 175 cases with ten or more nodes (P = 0.001). Lymph nodes were smaller in patients dying of recurrence; among 130 Dukes B patients whose mean node diameter was <4 mm, survival was 73.3 vs. 88 percent when mean nodal diameter was ≥4 mm. The number and size of recovered nodes was related to patient age, histologic antitumor immune response, and tumor growth pattern. By combining the number and size of nodes, a poor prognosis subgroup of 98 Dukes B patients with relatively few large nodes (no more than 5 measuring ≥4 mm) was identified with a five-year survival of 65.6 percent compared with 89.6 percent for the remaining 158 Dukes B cases (P < 0.0001).

Conclusions

In Dukes B rectal tumors, the number and size of lymph nodes are related to inherent patient and tumor characteristics and permit the identification of Dukes B cases at increased risk of recurrence. A valid comparison of nodal sampling efficiency between centers necessitates measuring and counting harvested lymph nodes.

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Author information

Authors and Affiliations

  1. Cork Cancer Research Center and Departments of Surgery & Histopathology, Mercy University Hospital, Cork, Ireland

    John Murphy M.B., Gerald C. O’Sullivan M.Ch., F.R.C.S.I. & Garry Lee M.B., F.R.C.Path.

  2. Academic Department of Pathology & CR-UK Colorectal Cancer Unit, St. Mark’s Hospital, Northwick Park, Harrow, London, United Kingdom

    Marc Pocard M.D., Jeremy R. Jass M.D., F.R.C.Path. & Ian C. Talbot M.D., F.R.C.Path.

  3. Cork Cancer Research Center and Surgery, University College, Cork, Republic of Ireland

    Gerald C. O’Sullivan M.Ch., F.R.C.S.I.

Authors
  1. John Murphy M.B.
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  2. Marc Pocard M.D.
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  3. Jeremy R. Jass M.D., F.R.C.Path.
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  4. Gerald C. O’Sullivan M.Ch., F.R.C.S.I.
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  5. Garry Lee M.B., F.R.C.Path.
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  6. Ian C. Talbot M.D., F.R.C.Path.
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Corresponding author

Correspondence to Gerald C. O’Sullivan M.Ch., F.R.C.S.I..

Additional information

Supported by Cancer Research Appeal Mercy Hospital, Cork, Ireland and Cancer Research, United Kingdom

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Murphy, J., Pocard, M., Jass, J.R. et al. Number and Size of Lymph Nodes Recovered From Dukes B Rectal Cancers: Correlation with Prognosis and Histologic Antitumor Immune Response. Dis Colon Rectum 50, 1526–1534 (2007). https://doi.org/10.1007/s10350-007-9024-3

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  • DOI: https://doi.org/10.1007/s10350-007-9024-3

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