Although significant advances in the biology of colorectal cancer have been achieved in the past decade, lymph node status remains the strongest predictor of prognosis. Furthermore, the presence of lymph node metastasis dictates the need for adjuvant therapy. Inconsistencies in the quality of lymph node dissection and examination threaten the usefulness of this marker not only as a prognostic factor but also as the basis for therapeutic decisions. Significant controversy surrounds the concept of what constitutes an adequate number of lymph nodes. Based on a combination of statistical and observational studies, the National Cancer Institute1 (among others) recommended the examination of a minimum of 12 lymph nodes to ensure accurate staging. Several investigations have demonstrated a survival advantage in patients with stage II disease when an increased number of lymph nodes is evaluated.2 The explanation behind this association is unclear; however, factors other than accurate staging likely account for the improvement in survival.
Berho M, Wexner SD. Advances in the Relationship Between Lymph Node Status and PrognosisComment on “Association Between a High Number of Isolated Lymph Nodes in T1 to T4 N0M0 Colorectal Cancer and the Microsatellite Instability”. Arch Surg. 2010;145(1):17-18. doi:10.1001/archsurg.2009.220