Relationship between colon cancer survival, resected lymph nodes and clinical-demographic characteristics
DOI:
https://doi.org/10.33448/rsd-v14i4.48557Keywords:
Colorectal cancer (CRC); Survival; Lymph nodes.Abstract
Objective: Establish the relationship between colon cancer survival, resected lymph nodes and their clinical and demographic characteristics. Methodology: This is an observational, retrospective, descriptive and cross-sectional study, based on the review of medical records. Results: The study reviewed 230 medical records of patients with colorectal cancer (CRC), more than half of whom were women between 50 and 75 years old. 71.3% of surgeries were elective, with 65.2% performed by videolaparoscopy, with the most common location being the rectosigmoid colon in 6 of 10 patients. Patients over 50 years had a higher median survival of 96 months. Survival was higher for tumors in the transverse colon, N0 and stage IIB. Most tumors were classified as T3 (54.8%) and N0 (53.9%). 90% of patients were in M0. Survival was higher in patients with 12 or more lymph nodes removed (88 months) compared with less than 12 (80 months). 89.6% did not receive neoadjuvant therapy, but among those who did, 9.1% used chemotherapy and radiotherapy. Chemotherapy was the adjuvant treatment in 52.6% of cases. Conclusion: CRC remains a health problem, with an increased incidence in younger patients. Overall survival is influenced by factors such as tumor location, sex, age, disease stage, and lymph node involvement. In the study, the removal of 12 or more lymph nodes did not provide a significant survival advantage, and the presence of metastatic lymph nodes worsened the prognosis. Lymphadenectomy remains essential in the curative treatment of CRC, allowing better staging and guidance for chemotherapy.
References
American Cancer Society. (2025). Colorectal Cancer Early Detection, Diagnosis, and Staging. cancer.org. 1.800.227.2345. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html.
Amir, F. et al. (2024). Lymph node ratio is a more robust predictor of overall survival than N stage in stage III colorectal adenocarcinoma. Diagnostic Pathology. 19, 44. DOI: https://doi.org/10.1186/s13000-024-01449-6.
Andrew, A. & Renshaw, E. W. G. (2020). How Many Lymph Nodes Are Enough in a Colorectal Resection? Wolters Kluwer Health. 44(9). https://sci-hub.se/10.1097/PAS.0000000000001504.
Brouwer, N. P. M., Hugen, N. & Nagtegaal, I. D. (2020). More extensive lymphadenectomy in colon cancer; how far are we willing to go for a biomarker? Tech Coloproctol. 24(7), 761-4. doi: 10.1007/s10151-020-02239-0. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297704/.
Chi, C. F. et al. (2020). How does lymph node yield affect survival outcomes of stage I and II colon cancer?. World Journal of Surgical Oncology. 18, 22. DOI: https://doi.org/10.1186/s12957-020-1802-6. https://wjso.biomedcentral.com/counter/pdf/10.1186/s12957-020-1802-6.pdf.
Ciepiela, I. et al. (2024). Tumor location matters, next generation sequencing mutation profiling of left-sided, rectal, and right-sided colorectal tumors in 552 patients. Sci Rep. 14, 4619. https://doi.org/10.1038/s41598-024-55139-w.
Duan, B. et al. (2022). Colorectal Cancer: An Overview. In: Morgado-Diaz JA, editor. Gastrointestinal Cancers, Brisbane (AU): Exon Publications. Carbone, F. et al. (2019). The impact of D2 lymphadenectomy on pathology understaging of right colon cancer. Ann Laparosc Endosc Surg. 4, 95.
DOI: http://dx.doi.org/10.21037/ales. https://ales.amegroups.org/article/view/5420/html.
Fidan, E.; Merev, E.; Usta, A.; Alandag, C.; Disli, S. & Ozdover, A. (2022). The association between the lymph node ratio, surgical margin, and survival in patients with colon cancer receiving adjuvant chemotherapy. Pak J Med Sci. 38(3), 605-11. doi: https://doi.org/10.12669/pjms.38.3.5085. https://www.pjms.org.pk/index.php/pjms/article/view/5085/1253
Foo, C. C. et al. (2020). How does lymph node yield affect survival outcomes of stage I and II colon cancer? World J Surg Oncol. 18(1), 22. doi: 10.1186/s12957-020-1802-6. https://pubmed.ncbi.nlm.nih.gov/31996214/.
Geddes, A. E. et al. (2022). An analysis of sexual dimorphism in the tumor microenvironment of colorectal cancer. Front Oncol. 12, 986103. https://doi.org/10.3389/fonc.2022.986103.
Huh, J. W., Kim, Y. J. & Kim, H. R. (2012). Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg. 255, 70–8. https://doi.org/10.1097/SLA.0b013e31823785f6.
Hye, J. K. & Gyu–Seog C. (2019). Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives. Ann Coloproctol. 35 (3): 109-117. https://doi.org/10.3393/ac.2019.06.12. https://coloproctol.org/upload/pdf/ac-2019-06-12.pdf.
İmamoğlu. G. İ. (2021). The impact of lymph node ratio on overall survival in patients with colorectal cancer. J Cancer Res Ther. 17(4), 1069-74. doi: 10.4103/jcrt.JCRT_11_19. https://pubmed.ncbi.nlm.nih.gov/34528566/#:~:text=Multivariate%20analysis%20showed%20that%20ratio%20of%20removed%20positive,4.24%20%5B95%25%20confidence%20interval%3A%202.15-8.34%5D%3B%20P%20%3C%200.019%29.
Irani, J. L. et al. (2023). Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum. 66, 15–40. https://doi.org/10.1097/DCR.0000000000002650.
Karabay, U., Yılmaz, L., Aytekin, A. & Bulut, A. (2023). The Relationship Between the Resected Colon Length and the Number of Lymph Nodes in Colorectal Cancer: A Retrospective Cohort Study. European Journal of Therapeutics. 29(4), 731–40.
https://doi.org/10.58600/eurjther1862. https://eurjther.com/index.php/home/article/view/1862/1482.
Kenichi Ishii, J. W., Goto, K., Suwa, Y., Nakagawa, K., Suwa, H., Ozawa, M., Ishibe, A., Kunisaki, C. & Endo, I. (2022). The prognostic signifcance of apical lymph node metastasis in patients with high risk stage III colon cancer. Scientifc Reports. 12, 2059. DOI: https://doi.org/10.1038/s41598-022-06054-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8825832/pdf/41598_2022_Article_6054.pdf.
Liu. P-L, Wang. D-D., Pang, C-J. & Zhang, L-Z. (2022). Impact of adequate lymph nodes dissection on survival in patients with stage I rectal cancer. Front. Oncol. 12:985324. DOI: 10.3389/fonc.2022.985324. https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.985324/full
Marcin Włodarczyk, J. W. et al. (2019). D3 lymphadenectomy for right colon can. Ann Laparosc Endosc Surg. 4, 96.
http://dx.doi.org/10.21037/ales. https://ales.amegroups.org/article/view/5424/html
Michaela Ramser, L. A. (2021). Evaluation of the prognostic relevance of the recommended minimum number of lymph nodes in colorectal cancer—a propensity score analysis. International Journal of Colorectal Disease. 36, 779–89. DOI: https://doi.org/10.1007/s00384-021-03835-8. https://link.springer.com/content/pdf/10.1007/s00384-021-03835-8.pdf
Mounika, R. N. & Ananthamurthy, A. (2023). Lymph node yield in colorectal cancer specimens and its impact on pathological staging: Does number matter? Journal of Cancer Research and Therapeutics. 19(3), 671-4.
DOI: 10.4103/jcrt.jcrt_980_21. https://journals.lww.com/cancerjournal/Fulltext/2023/19030/lymph_node_yield_in_colorectal_cancer_specimens.25.aspx.
Özkan, M. B. (2022). Impact of Lymph Node Ratio as a Prognostic Factor for Survival in Colorectal Cancer Patients. Turk J Colorectal. 32, 23-30.
DOI: 10.4274/tjcd.galenos.2021.2021-9-6. https://cms.turkishjcrd.com/Uploads/Article_51204/TJCD-32-23-En.pdf.
Mroczkowski, P. et al. (2024). Prognostic Value of Metastatic Lymph Node Ratio and Identification of Factors Influencing the Lymph Node Yield in Patients Undergoing Curative Colon Cancer Resection. Cancers. 16, 218.
https://doi.org/10.3390/ cancers16010218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10778473/pdf/cancers-16-00218.pdf
National Cancer Institute. (2024). Physician Data Query (PDQ). Colon Cancer Treatment. https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq
Osman, S. & Guner, L. V. T. (2020). Higher cut-offs for the number of lymph nodes harvested do not predict better prognosis in patients with colon cancer. Journal of Coloproctology. 40(4), 315–20. https://doi.org/10.1016/j.jcol.2020.06.009. https://www.scielo.br/j/jcol/a/FWVhC4hbYGB7TxkxwjrZXRr/?format=pdf&lang=en
Ossibi, P. et al. (2022). Lymphadenectomy for Colorectal Cancer: Experience of the Brazzaville Teaching Hospital. Surgical Science. 13, 79-90. doi: 10.4236/ss.2022.133011. https://www.scirp.org/journal/paperinformation?paperid=115704.
Patel, S. G. et al. (2022). Updates on Age to Start and Stop Colorectal Cancer Screening: Recommendations From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 162, 285–99. https://doi.org/10.1053/j.gastro.2021.10.007.
Simões, P. et al. (2022). Lymph node yield in the pathological staging of resected nonmetastatic colon cancer: The more the better? Surgical Oncology. 43, 101806. https://doi.org/10.1016/j.suronc.2022.101806.
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Editora UAB/NTE/UFSM.
Pericay, C. et al. (2023). SEOM-GEMCAD-TTD clinical guidelines for the adjuvant treatment of colon cancer. Clin Transl Oncol. 26, 2812–25. https://doi.org/10.1007/s12094-024-03559-5.
Petersson J, Matthiessen P, Jadid KD, et al. (2023). Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open. Sci Rep 2023;13:4335. https://doi.org/10.1038/s41598-023-30448-8.
Punmeechao, P. et al. (2021). Relationship between Lymph Node Ratio and Survival Rate in Preopertive Chemoradiation Rectal Cancer Patients. J Med Assoc Thai. 104: 16-20. http://www.jmatonline.com/index.php/jmat/article/view/13201.
Qianqian, L. (2023). Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis. BMJ Open. 13: e072244. doi:10.1136/bmjopen-2023-072244. https://bmjopen.bmj.com/content/bmjopen/13/12/e072244.full.pdf.
Ray, A. L. et al. (2020). The role of sex in the innate and adaptive immune environment of metastatic colorectal cancer. Br J Cancer. 123, 624–32. https://doi.org/10.1038/s41416-020-0913-8.
Sardón Ramos, J. D. et al. (2012). Técnica del ganglio centinela en el cáncer de colon. Gac Med Bilbao. 109, 135–41. https://doi.org/10.1016/j.gmb.2012.06.002.
Sawicki, T. et al. (2021). A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis. Cancers (Basel). 13 (9), 2025. Doi: 10.3390/cancers13092025.
Schnitzbauer, V., Gerken, M., Benz, S. et al. (2020). Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort. Surg Endosc. 34, 1132–41. https://doi.org/10.1007/s00464-019-06861-4.
Shitsuka, R. et al. (2014). Matemática fundamental para tecnologia. (2ed.). Editora Erica.
Simarpreet, I., Tyler, McKechnie, J. L., Biro, J., Lee, Y., Park, L., Doumouras, A., Hong, D. & Eskicioglu, C. (2023). Lymph node harvest as a predictor of survival for colon cancer: A systematic review and meta-analysis. Surgery in Practice and Science. 14, 100190. DOI: https://doi.org/10.1016/j.sipas.2023.100190. https://www.sciencedirect.com/science/article/pii/S2666262023000360?ref=pdf_download&fr=RR-2&rr=8825cd79f93a1f7e.
Üreyen, O., Ulusoy, C., Acar, A, Sağlam, F., Kızıloğlu, İ., Alemdar, A. et al. (2020). Should there be a specific length of the colon-rectum segment to be resected for an adequate number of lymph nodes in cases of colorectal cancers? A retrospective multi-center study. Turk J Surg. 36(1), 23-32. DOI: 10.5578/turkjsurg.4550. https://turkjsurg.com/full-text-pdf/1691/eng.
Vieira, S. (2021). Introdução à bioestatística. Editora GEN/Guanabara Koogan.
Yang, H., Yao, Z., Cui, M., Xing, J., Zhang, C., Zhang, N., Liu, M., Xu, K., Tan, F. & Su, X. (2020). Influence of tumor location on short- and long-term outcomes after laparoscopic surgery for rectal cancer: a propensity score matched cohort study. BMC Cancer. 20(1), 761. doi: 10.1186/s12885-020-07255-9. https://pubmed.ncbi.nlm.nih.gov/32795280/.
Yihuan, Q., Jun, Z., Tenghui, H., Xunliang, J., Ke, W., Rujie, C., Yongtao, D., Jipeng, L. & Li, S. (2023). Finding the minimum number of retrieved lymph nodes in node-negative colorectal cancer using Real-world Data and the SEER database. International Journal of Surgery. 109(12), 4173-84. DOI: 10.1097/JS9.0000000000000746. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10720778/pdf/js9-109-4173.pdf.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Miguel Mateo Sarmiento Álvarez; Frederico Japiassu Santiago; Cesar Bernardo Ortiz Villavicencio; Carlos Adrian Bustamante Garcia; Santiago Picón Saavedra; Gabrielle Vaz Azevedo David; Guilherme Lemos Cotta Pereira
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
