New lymph node staging proposed for colon neuroendocrine tumors

  • Fields AC & al.
  • Ann Surg Oncol
  • 29 Mar 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • The number of positive lymph nodes is an important factor in staging colon neuroendocrine tumors (NETs), with significant survival differences with increasing number of involved nodes.
  • These authors propose N0 (none), N1a (1 positive), N1b (2-9 positive), and N2 (10+ positive) as classifications for nodal metastasis.

Why this matters

  • All the current classification systems are binary (N0 [none] vs N1 [≥1]), which precludes refining prognosis based on lymph node involvement.
  • Staging of other solid tumors is more graded based on the number of positive nodes.

Key results

  • The different proposed grades of nodes have clear 5-year survival rates (95% CIs):
    • N0: 69.8% (66.7%-72.7%).
    • N1a: 63.9% (59.6%-68.0%).
    • N1b: 38.9% (35.4%-42.3%).
    • N2: 15.7% (11.9%-20.0%).
    • P<.05 for all pairwise comparisons.>
  • Nodal stage significantly predicted OS in Cox regression.
  • With the binary approach, 5-year survival (95% CIs):
    • N0: 69.8% (66.7%-72.7%).
    • N1: 42.2% (39.8%-44.7%).

Study design

  • 2472 patients with colon NET identified in US National Cancer Database.
  • Funding: None disclosed. 

Limitations

  • Patients with missing lymph node data were excluded.
  • Relied on overall rather than disease-specific survival.

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