Research Papers:

Whether regional lymph nodes evaluation should be equally required for both right and left colon cancer

Xu Guan, Wei Chen, Zheng Liu, Zheng Jiang, Hanqing Hu, Zhixun Zhao, Song Wang, Yinggang Chen, Guiyu Wang _ and Xishan Wang

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Oncotarget. 2016; 7:59945-59956. https://doi.org/10.18632/oncotarget.11007

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Xu Guan1,*, Wei Chen2,*, Zheng Liu3,*, Zheng Jiang3, Hanqing Hu1, Zhixun Zhao1, Song Wang1, Yinggang Chen1, Guiyu Wang1, Xishan Wang1,3

1Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China

2Follow up center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China

3Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

*These authors have contributed equally to this work

Correspondence to:

Guiyu Wang, email: [email protected]

Xishan Wang, email: [email protected]

Keywords: colon cancer, surgery, colectomy, lymph node, survival

Received: April 14, 2016    Accepted: July 19, 2016    Published: August 2, 2016


Despite the adequacy of nodal evaluation was gradually improved for colon cancer, the disparity in nodal examination for right colon cancer (RCC) and left colon cancer (LCC) still begs the question of whether 12 nodes is an appropriate threshold for both RCC and LCC. From Surveillance, Epidemiology, and End-Results (SEER) database, we identified 53897 RCC patients and 11822 LCC patients. Compared with LCC patients, RCC patients examined more lymph nodes (18.7 vs 16.3), and more likely to examine ≥12 nodes (P<0.001), whereas RCC patients showed lower rates of node positivity (P<0.001). To balance the nodal disparity between RCC and LCC, we revised the 12-node measure based on different tumor locations. With the X-tile, we determined 15 as the optimal node number for RCC and 11 for LCC. To validate the availability of this revised nodal evaluation, the 5-year cancer specific survival (CSS) was calculated according to the optimal node number in RCC and LCC patients, Cox’s regression model were used to further assess the prognostic value of this revised nodal evaluation. The results showed that 5-year CSSs were significantly improved for RCC patients with ≥15 lymph nodes, and also for LCC patients with ≥11 lymph nodes (P<0.001). This revised nodal evaluation could also improve the rate of nodal positivity and long-term survival in both RCC and LCC patients compared with 12-node measure. Therefore, the lymph node examination should be discriminately evaluated for RCC and LCC, instead of using 12-node measure to colon cancer as a whole.

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