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A New N Staging System for Colorectal Cancer in the Era of Extended Lymphadenectomy

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Complete mesocolic excision is becoming popular in colon cancer surgery in Western countries, and in the tumor-node-metastasis (TNM) classification of rectal cancer, a part of the lateral pelvic lymph nodes is classified as regional. However, the appropriateness of TNM staging according to the assessment of nodal status exclusively by extended lymphadenectomy remains unclear.

Patients and Methods

Using a nationwide multicenter database in Japan, we retrospectively analyzed 6866 patients with stage III colorectal cancer (CRC) treated with extended (D3) dissection. First, the best cutoff values for the number of metastatic nodes were explored. Second, the utility of the metastatic status of the main lymph nodes (i.e., at the origin of the feeding artery) and the lateral pelvic lymph nodes (“jN3” category in the Japanese staging system) as N staging criteria was evaluated. The modified N staging system that had the best risk stratification power was determined according to the Akaike information criterion (AIC).

Results

Excellent performance was noted when the number of metastatic nodes was categorized by cutoff values of “3/4” and “6/7.” Categorization of nodal metastasis was proven the most clinically efficacious when classified as modified-N1 (N1 and jN3-negative), modified-N2a (N2a and jN3-negative), and modified-N2b (N2b and/or jN3-positive; AIC, 22,810.8), rather than the classification based on the TNM (AIC, 22,849.2) or Japanese staging system (AIC, 22,811.1).

Conclusions

We structured a modified N staging system according to the number and extent of lymph node metastases. The modified system may be used in stage III cases for precise risk stratification.

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Acknowledgment

This work was supported by the Japanese Society for Cancer of the Colon and Rectum (JSCCR). We certify that we do not have any commercial associations that may pose a conflict of interest in connection with the submitted article.

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Authors and Affiliations

  1. Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan

    Eiji Shinto MD, Kazuo Hase MD & Hideki Ueno MD

  2. Department of Surgery, Kindai University School of Medicine, Osaka, Japan

    Jin-ichi Hida MD

  3. Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan

    Hideyuki Ike MD

  4. Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan

    Hirotoshi Kobayashi MD

  5. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Yojiro Hashiguchi MD

  6. Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara MD

Authors
  1. Eiji Shinto MD
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  2. Jin-ichi Hida MD
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  3. Hideyuki Ike MD
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  4. Hirotoshi Kobayashi MD
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  5. Yojiro Hashiguchi MD
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  6. Kazuo Hase MD
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  7. Hideki Ueno MD
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  8. Kenichi Sugihara MD
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Corresponding author

Correspondence to Eiji Shinto MD.

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Shinto, E., Hida, Ji., Ike, H. et al. A New N Staging System for Colorectal Cancer in the Era of Extended Lymphadenectomy. Ann Surg Oncol 25, 3891–3897 (2018). https://doi.org/10.1245/s10434-018-6786-x

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  • DOI: https://doi.org/10.1245/s10434-018-6786-x

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