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August 2010

Association With a High Number of Lymph Nodes and Microsatellite Instability in Colorectal Cancer

Author Affiliations

Author Affiliations: Department of General and Gastroenterologic Surgery, Stavanger University Hospital, Stavanger, Norway (Drs K. S[[oslash]]reide, Nedreb[[oslash]], J. A. S[[oslash]]reide, and K[[oslash]]rner); and Department of Surgical Sciences, University of Bergen, Bergen, Norway (Drs K. S[[oslash]]reide, J. A. S[[oslash]]reide, and K[[oslash]]rner).

Arch Surg. 2010;145(8):799. doi:10.1001/archsurg.2010.146

We read with interest the recent article in the Archives in which Eveno et al1 report on the association between a high lymph node count and the microsatellite instability (MSI) phenotype in colorectal cancer (CRC), particularly for stage I and II CRC. We find these results particularly exciting as they are in line with our recent findings, albeit for colon cancers only.2 Notably, we also found that MSI is associated with a higher lymph node count in general,2 and MSI was an independent factor in multivariate analysis for a lymph node count of 12 or more in stage II to III colon cancer (adjusted odds ratio, 2.6; 95% confidence interval, 1.1-6.0; P = .03). As the average lymph node count was different in the 2 studies,1,2 we agree with Eveno et al that it would be relevant to confirm the results in larger cohorts of patients undergoing surgery for CRC. We concur with the authors that, “definitive conclusion regarding the biological association between lymphoid reaction to the tumor and MSI status is confounded by that fact that MSI tumors are more common in the proximal colon, where mesentery and lymph nodes may tend to be quantitatively greater.”1 The association of MSI with tumor location in the proximal colon is well described3 and was also confirmed in a previous study from our institution.4 Thus, much remains to be investigated and learned concerning the tumor biology and effects of MSI in colorectal cancers. In agreement with the data from Eveno et al, we also suggest that, with the current knowledge, the number of examined lymph nodes per se cannot be used as a reliable criterion of the quality of surgical or pathologic dissection. This has also recently been argued based on data from large, population-based cohorts as well.5 Nevertheless, the lymph node status (pN) still appears to be the best prognostic factor for patients undergoing curative resection of CRC.4

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