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See Latest ArticlesNodal staging score: A tool to assess adequate staging of node-negative colon cancer
Journal of Clinical Oncology, 11/16/09
Gönen M et al. – Adequate nodal staging of colon cancer has been defined as pathologic examination of at least 12 lymph nodes. We sought to refine this definition by quantifying the likelihood that a pathologically node-negative patient has, indeed, no positive nodes. The minimum number of examined nodes for adequate staging depends on the T stage. The score we developed indicates the adequacy of nodal staging for patients with no positive nodes and can assist clinical decision making in the patient without nodal metastasis.
Methods- Patients with stage I-III adenocarcinoma of colon between 1994 and 2005 and had at least 1 lymph node pathologically examined identified from the Surveillance, Epidemiology and End Results (SEER) database (n = 131,953)
- Estimated sensitivity of pathologic staging of locoregional spread using beta-binomial model and developed the nodal staging score (NSS), which is probability that patient is correctly staged as node negative
- NSS is function of T stage and number of examined nodes
- Probability of missing positive node that is in fact truly present is 29.7% if 5 nodes examined, 20.0% if 8 examined, and drops to 13.6% for 12 nodes examined
- NSS of 90% can be achieved by examining single node for T1 and 4 nodes for T2 tumors
- To maintain similar levels of NSS for T3, 13 nodes need to be examined and for T4 lesions, 21 nodes need to be examined
- Graphical and tabular tools provided to facilitate calculation of NSS and treatment decision making in practice
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