J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 The Korean Surgical Society 10.4174/jkss.2009.77.4.262 Original Article Total Number of Lymph Nodes Retrieved in Stage III Rectal Cancer Patient Lee Seung Hwan M.D. Oh Seung Yeop Ph.D. Baek Ok Joo M.D. Kim Young Bae Ph.D. 1 Suh Kwang Wook Ph.D. Department of Surgery, Ajou University College of Medicine, Suwon, Korea. Department of Pathology, Ajou University College of Medicine, Suwon, Korea. Corresponding author (suhkw@ajou.ac.kr) 10 2009 30 09 2009 77 4 262 266 25 05 2009 16 07 2009 Copyright © 2009 The Korean Surgical Society 2009 Purpose

Adequate lymph node analysis is critical for appropriate staging in colorectal cancer. The aim of this study is to determine whether 12 or more nodes recovered in stage III rectal cancer results in improved oncologic outcomes.

 Methods

Two hundred and forty-eight patients with stage III rectal cancer from 1995 through 2004 were reviewed. They were categorized into 2 subgroups by the number of nodes retrieved (<12 and ≥12), and oncologic outcomes in terms of 5-year overall and disease-free survival were analyzed for all patients, patients with American Joint Committee on Cancer (AJCC) N1 disease (N=145), and those with AJCC N2 (N=103).

 Results

Five-year overall and disease-free survival was 79.0% and 58.4%, respectively. There was no significant difference in clincopathologic features between <12 retrieval group and ≥12 group. Although there was significant difference in overall survival and disease-free survival between the number (<12 and ≥12) of lymph nodes removed in N2 disease (P=0.043; P=0.022) in univariate analysis, the total number of lymph nodes retrieved was not a prognostic factor affecting survival in multivariate analysis. The N2 stage and lateral margin involvement were prognostic factors affecting survival in multivariate analysis.

 Conclusion

This study showed that the total number of lymph nodes analyzed for stage III rectal cancer is not a prognostic factor on overall or disease-free survival in multivariate analysis.

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(A) Kaplan-Meier disease-free survival according to the total number of lymph nodes retrieved. (B) Kaplan-Meier overall survival according to the total number of lymph nodes retrieved.

Patients and tumor characteristics

Five-year overall survival and disease free survival according to the number of nodes examined

*5-year OS = 5-year overall survival rate; †5-year DFS = 5-year disease free survival rate.

Multivariate analysis for 5-year overall survival

Multivariate analysis for 5-year disease-free survival