Observational studyPloS one2018
The prognostic significance of lymph node size in node-positive colon cancer.
Observational study in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- A Concept for Preoperative and Intraoperative Molecular Imaging and Detection for Assessing Extent of Disease of Solid Tumors.Oncology reviews · 2024Pooled it
- Preoperative assessment of lymph node metastasis in Colon Cancer patients using machine learning: a pilot study.Cancer imaging : the official publication of the International Cancer Imaging Society · 2020Trial
- Preoperative lymph-node enlargement is associated with favorable survival for patients with pathological stage II colorectal cancer.Surgery today · 2026Article
- Prognostic value of Node-RADS scoring in stage IIICr cervical cancer: development and validation of novel nomograms.Insights into imaging · 2026Article
- Diagnostic performance of CT-based node reporting and data system (Node-RADS) for regional lymph node metastasis in periampullary cancer.Abdominal radiology (New York) · 2026Article
- Clinical Outcomes and Individualized Seed Implantation Planning for Iodine-125 Seeds Brachytherapy in Lymph Node Metastases.Journal of Cancer · 2026Article
- Robot assisted sentinel lymph node biopsy using indocyanine green combined with carbon nanoparticles staining improved detection rates in breast cancer.Scientific reports · 2025Article
- Validation of the Node Reporting and Data System (Node-RADS) for standardized CT evaluation of regional lymph nodes in esophageal squamous cell carcinoma patients.European radiology · 2025Article
- A prospective analysis of lymph node retrieval in colorectal cancer: discrepancies, neoadjuvant impact, and practical implications.Frontiers in medicine · 2025Article
- Construction of a nomogram based on clinicopathologic features to predict the likelihood of No. 253 lymph node metastasis in rectal cancer patients.Langenbeck's archives of surgery · 2024Article
- Lymph node harvesting after laparoscopic complete mesocolic excision colectomy in colon cancer with practical application of glacial acid, absolute ethanol, water, and formaldehyde solution: A prospective cohort study.SAGE open medicine · 2024Article
- Robot-assisted fluorescent sentinel lymph node identification in early-stage colon cancer.Surgical endoscopy · 2023Article
- CT morphological features for predicting the risk of lymph node metastasis in T1 colorectal cancer.European radiology · 2023Article
- Rectal Cancer: Are 12 Lymph Nodes the Limit?Cancers · 2023Article
- Clinical significance of the histopathological metastatic largest lymph node size in colorectal cancer patients.Frontiers in oncology · 2023Article
- Circulating Lymphocytes Reflect the Local Immune Response in Patients with Colorectal Carcinoma.Diagnostics (Basel, Switzerland) · 2022Article
- Primary tumour immune response and lymph node yields in colon cancer.British journal of cancer · 2022Article
- In-House Validated Map of Lymph Node Stations in a Prospective Cohort of Colorectal Cancer: A Tool for a Better Preoperative Staging.Journal of oncology · 2022Article
- The Effect of Gene Mutations on Metastasis and Overall Survival in Metastatic and Nonmetastatic Colon Cancers.Asian Pacific journal of cancer prevention : APJCP · 2021Article
- Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study.Gastroenterology research and practice · 2020Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo (i) show the outcome benefits of enlarged lymph nodes in node-positive colon cancer cases, as it was shown previously in negative node cases; (ii) disprove the stage migration theory and (iii) list the factors affecting lymph node size and yield.
methodsA retrospective study including 234 node-positive colon cancer cases was scheduled and performed. All recovered lymph nodes (6969) from 234 cases were microscopically examined in regard to (a) lymph node size (b) presence of metastasis (c) extent of intra-nodal metastasis. On the basis of resulting data, a statistical analysis was performed.
resultsMetastases occurred in all size categories, though more often in larger lymph nodes. Fifty-one percent of all metastasised nodes were 2 to 6 mm in size. Approximately half of all nodes >10 mm were microscopically free of cancer. Cases with a small lymph node metastasis to lymph node size ratio (MSR) had a better prognosis than others: 85 months (95% CI: 72-97) vs. 67 months (95% CI: 47-88), p <0.001 (mean, overall survival). To differentiate between cases with the same ratio but different absolute lymph nodes sizes, we divided the cases into two groups that differed in their number of moderate to large lymph nodes. The group with more moderate to large lymph nodes showed a clear outcome benefit: 104 months (95% CI: 86-122) vs. 66 months (95% CI: 54-77), p = 0.014 (mean, overall survival).
conclusionsMetastasised lymph nodes affect all size categories, and large lymph nodes are not always metastasised. The combination of enlarged lymph nodes and a small lymph node metastasis to lymph node size ratio (MSR) is associated with a better prognosis than others. When enlarged lymph nodes were considered as surrogate markers of an effective local immune response due to nodal hyperplasia, the immune system could be seen as the confounder affecting both lymph node size and prognosis. Our results are pointing in this direction and, along with other reasons, are challenging the stage migration theory.
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