Prognostic Impact of Lymph Node Harvest and Lymph Node Ratio in Patients With Colon Cancer

BACKGROUND: The prognostic impact of the number of lymph nodes and ratio in colon cancer is still debated. OBJECTIVES: The aim of this study was to evaluate lymph node harvest in patients with colon cancer over time, and to test the hypotheses that investigation of more lymph nodes, and low lymph node ratio in stage III patients, has positive prognostic impact. DESIGN: This is a prospective, observational study. SETTINGS: This study was conducted in a single institution treating all patients with colon cancer in a defined catchment area. PATIENTS: All patients admitted in the period 1993 to 2009 (n = 1481) were included. MAIN OUTCOME MEASURES: The primary outcomes measured were the number of examined regional lymph nodes according to treatment period, 5-year overall survival and time to recurrence, and univariate (Kaplan-Meier) and multivariate (Cox regression) analyses of prognostic factors. RESULTS: Nine hundred fifty (65%) patients underwent curative resection. Median number of examined lymph nodes increased from 7 to 15 (p < 0.001), and the proportion of patients with stage III disease increased from 25% to 33% (p = 0.02) during the study period. In patients with stage I to III disease, time to recurrence (proportion of patients without recurrence or death of colon cancer) improved from 65% to 82% during the period (p < 0.001). An association between lymph node count (<8 compared with >= 12) and overall survival was found for patients with stage II disease (57% vs 71%, p = 0.004). Hazard ratio for death within 5 years was 0.7 (p = 0.043) when 8 to 11 nodes were examined and 0.6 (p = 0.001) when >= 12 nodes were examined (<8 reference). In patients with stage III disease, increasing lymph node ratio was associated with reduced overall survival and time to recurrence in uni- and multivariate analyses. LIMITATIONS: This study was limited by the small number of patients in each stage. CONCLUSIONS: The number of examined lymph nodes increased in the study period. A stage migration was observed, and time to recurrence improved in patients with stage I to III disease. In patients with stage III disease, lymph node ratio was a stronger prognostic factor than the total number of lymph nodes examined.