Comparative analysis of survival in colon cancer undergoing sentinel lymph node mapping vs conventional surgery based on number of positive lymph nodes.

Authors

null

Sabarina Ramanathan

Easton Hospital, Easton, PA

Sabarina Ramanathan , Sukamal Saha , Suresh Mukkamala , Michael Hicks , Patrick Knight , Vinay Bajaj , Daniel Mazzaferro , Thushy Siva , Lori Hutcherson , David Livert , Rajen Oza , David Wiese , Madan L. Arora

Organizations

Easton Hospital, Easton, PA, Michigan State University, Lansing, MI, Drexel University, Philadelphia, PA, McLaren Regional Medical Center/Michigan State University, Flint, MI, McLaren Flint, Flint, MI

Research Funding

Other

Background: Unlike in breast cancer or melanoma, resection during sentinel lymph node mapping (SLNM) in colon cancer (CCa) includes regional lymphadenectomy including SLNs and non-SLNs. However, SLNM often identifies micrometastases that can be missed by conventional (Conv) surgery and pathologic examination. It is unknown whether this impacts survival or recurrence. Hence, a retrospective analysis was undertaken to study overall (OS) and disease -specific (DSS) survival between patients (pts) undergoing SLNM vs Conv surgery based on the number of +ve LNs. Methods: SLNM was done by subserosal injection with blue dye followed by segmental resection including regional lymphadenectomy. All SLNs were ultrastaged and other nodes were examined by conv. methods with H&E. Results: There were 309 pts in SLNM (GpA) vs 499 pts in Conv surgery (GpB); with average no. of lymph nodes (LNs) and +ve LNs 17.3/1.6 vs 14.4/2.49 respectively. For GpA, success rate was 99.6% and the average no of SLN was 3. Of the pts in GpA vs GpB, 1+ve LN were found in 38% vs 27%, 2+ve LNs in 10% vs 16%, and > 2 LNs in 53% vs 57%, respectively. Comparing 5 years OS between GpA vs GpB, for 1+ve LN was 62.8% vs 52.38%, for 2 +ve LNs 72.7% vs 48.65% and for > 2 +ve LNs 35% vs 33.33%, respectively. Similarly, DSS for 1 +veLN was 54.4% vs 47.6%, 2+ve LNs 40% vs 40.54% and > 2+ve LNs, 30.4% vs 25.76%, respectively (Table). Conclusions: Compared to Conv surgery, SLNM identified higher no. of LNs per pt with high success rate. Five-year OS and DSS also are better in SLNM vs Conv surgery for all +ve LN gps. Hence, SLNM in CCa may have prognostic value. A larger multicenter trial needs to be done to validate such data.

Comparison of 5-year OS and DSS between SLNM and conventional.

SLNM (n = 309 )
Group A
Conventional (n = 499)
Group B
p-value
Average # of LNs examined17.314.48< 0.0001
Average # of +ve LNs1.62.49
Average # of SLNs3N/A
Average # of +ve SLNs0.6N/A
SLNM Success Rate99.60%N/A
OS
1 +ve node62.8% ( n = 43 )52.38 % ( n = 63 )0.288
2 +ve nodes72.7% ( n = 11)48.65% ( n = 37)0.189
> 2 +ve nodes35% (n = 60)33.33% ( n = 132)0.870
DSS
1 +ve node54.4% ( n = 46 )47.6 % ( n = 63)0.562
2 +ve node40% (n = 15 )40.54% ( n = 37)0.999
> 2 +ve nodes30.4%(n = 69)25.76% ( n = 132)0.480

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Local-Regional Disease

Citation

J Clin Oncol 35, 2017 (suppl; abstr e15154)

DOI

10.1200/JCO.2017.35.15_suppl.e15154

Abstract #

e15154

Abstract Disclosures

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