Improving the prediction of colon cancer survival after curative resection.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 552-552
Author(s):  
Aliyah Pabani ◽  
Winson Y. Cheung ◽  
Matthew Mazurek ◽  
Jennifer L. Spratlin ◽  
Karen E. Mulder ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Nodes ◽  
Classification System ◽  
Early Stage ◽  
Tnm Classification ◽  
Tnm Staging ◽  
Primary Adenocarcinoma ◽  
Curative Intent ◽  
N2 Disease ◽  
Staging Systems

552 Background: Cancer staging systems convey valuable prognostic information to both clinicians and patients. Currently, colon cancer is staged according to the American Joint Committee on Cancer (AJCC) TNM classification system. However, survival estimates for patients with the same stage of colon cancer may vary considerably due to other factors including age, sex, grade, and number of lymph nodes sampled. The objectives of this study are to 1) assess the accuracy of the seventh edition of the TNM classification system in predicting survival of patients with primary colon cancer after curative-intent surgery, and 2) evaluate the utility of incorporating additional demographic and tumor variables beyond TNM staging in improving prognostic accuracy. Methods: Patients with curative-intent resection of a first primary adenocarcinoma of the colon at the time of referral to the Cross Cancer Institute between 2004 and 2007 were identified from the Alberta Cancer Registry. We constructed three multivariate Cox’s proportional hazard models to explore the effect of supplementing TNM staging with additional demographic and tumor variables in predicting overall survival (OS). Results: 559 consecutive patients with complete chart records were identified. 52 % (n=290) were male; median age was 74. In the first model based only on T and N elements, N2 disease was correlated with increased mortality (hazard ratio [HR], 2.546; p<0.0001). When the number of lymph nodes examined (HR, 0.980; p=0.034) and number of metastatic lymph nodes detected (HR, 1.094; p<0.0001) were substituted for the N-staging element, both variables correlated positively and negatively with outcome, respectively. Finally, when tumor grade, sex and age were incorporated into the model, number of examined lymph nodes (HR, 0.980; p=0.029) and those containing tumor (HR, 1.093; p<0.0001) remained independent predictors of OS. Conclusions: Incorporating readily available demographic and tumor variables, such as age, sex and number of lymph nodes examined, can enhance the current TNM staging system and improve prognostication in early stage colon cancer.

scholarly journals Prognostic impact of solid tumor component diameter in early-stage non-small cell lung carcinoma treated with intensity-modulated fractionated radiotherapy: a retrospective analysis impact of solid tumor component diameter in NSCLC treated with IMRT

2020 ◽  
Vol 93 (1109) ◽  
pp. 20191027
Author(s):  
Tomohiro Itonaga ◽  
Ryuji Mikami ◽  
Mitsuru Okubo ◽  
Tatsuhiko Saito ◽  
Sachika Shiraishi ◽  
...  
Keyword(s):  
Solid Tumor ◽  
Classification System ◽  
Early Stage ◽  
Tnm Classification ◽  
Small Cell ◽  
Stage I ◽  
Tumor Diameter ◽  
Small Cell Lung ◽  
Intensity Modulated ◽  
Eighth Edition

Objective: To investigate the suitability of the new diameter-based subgroupings of the eighth edition Tumor Node Metastasis (TNM) classification system regarding radiotherapy treatment for early-stage non-small-cell lung cancer (NSCLC), we retrospectively re-analyzed the clinical data of patients treated with intensity-modulated radiotherapy using non-coplanar beams (ncIMRT) for Stage I NSCLC. Methods: Between March 2011 and March 2018, 92 patients with 94 tumors who were diagnosed with Stage I NSCLC according to the seventh edition TNM classification system were enrolled and underwent ncIMRT of 75 Gy in 30 fractions. Local control (LC), progression-free survival (PFS), and overall survival (OS) were retrospectively investigated according to the T-classification subdivisions of the eighth edition and maximal solid tumor component diameter. Results: The median follow-up period was 32.5 months. The median maximum tumor and solid tumor component diameters were 22 mm and 18 mm, respectively. 3-year LC, PFS, and OS rates were 84.1%, 69.4%, and 85.3%, respectively. The 3-year LC rates were 91.0 and 76.8% in the groups with tumor diameter ≤2 cm and >2 cm, corresponding to the T1c and T1b subdivisions of the eighth edition, respectively (p = 0.24). In the ≤2 cm and >2 cm solid tumor component groups, the 3 year LC rates were 93.6 and 63.2%, respectively, which were significantly different (p = 0.007). Conclusion: LC rates after radiotherapy in patients with Stage I NSCLC were correlated with solid tumor component diameter. High LC rates in patients with solid tumor components <2 cm in diameter were associated with high PFS and OS rates. Advances in knowledge: This study suggests that the eighth edition TNM classification system, which focuses on solid tumor components rather than tumor diameter, can be applied to radiotherapy.

Generation and validation of a primary-tumor-derived four-gene prognostic signature for recurrence (R) of stages I/II colorectal cancer (CRC) following potentially curative resection

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4035-4035
Author(s):  
P. F. Lenehan ◽  
D. W. Fry ◽  
E. R. Heyman ◽  
J. F. Eliason ◽  
W. P. Worzel
Keyword(s):  
Early Stage ◽  
Low Risk ◽  
Stage I ◽  
Primary Adenocarcinoma ◽  
Prognostic Signature ◽  
Curative Intent ◽  
Prognostic Test ◽  
Nccn Guidelines ◽  
Ffpe Tumor ◽  
Formalin Fixed Paraffin Embedded

4035 Background: Current guidance for postoperative clinical management of stages I/II CRC patients (pts) is suboptimal. We hypothesized that a molecular prognostic test using primary CRC tissue would better predict the chances of tumor R within 3 years (y) than NCCN Clinical Practice Guidelines. Methods: Archival formalin-fixed paraffin-embedded (FFPE) primary adenocarcinoma tissues obtained at initial resection with curative intent were retrieved for 145 stage I/II (pT1–4 pN0 M0) CRC pts from multiple international sites; none had neoadjuvant or adjuvant therapy. Pts had tumor R by 36 months (mo) or confirmed non-recurrence (NR) for ≥36 mo after surgery. Pts were stratified by R/NR status and then randomized to a Training Set (TSet) (n=73; 34R, 39NR) or Validation Set (VSet) (n=72; 33R, 39NR). Tumor gene expression was quantified by DASL assay (Illumina, San Diego) using a custom 512-gene panel. Genetic programming (GP), a machine-learning technique, defined 15 TSet genes as key for differentiating pts with R versus NR. Results: Successive GP analyses of TSet data evolved a prognostic signature that mathematically combined 4 of the 15 key genes identified. This selected dichotomous rule correctly classified 28/33 R and 35/39 NR VSet pts (85% sensitivity, 90% specificity). ‘High risk’ pts had a significantly higher probability of R by 36 mo than ‘low risk’ pts: 88% PPV, 88% NPV; relative risk (RR) 7.0 (95% CI: 3.1, 16.1; p<0.0001). RR by stage (I/II) = 7.00/7.28 and tumor site (colon/rectum) = 8.75/4.50. Kaplan-Meier recurrence-free survival: hazard ratio 11.8 (95% CI: 4.5, 31.1; p<0.0001). NCCN Guidelines (V.2.2008) correctly classified 24/33 R and 15/39 NR VSet pts: 73% sensitivity, 38% specificity, 50% PPV, 63% NPV; RR 1.33 (95% CI: 0.74, 2.40; p=0.32). Conclusions: A GP derived 4-gene prognostic test using FFPE tumor tissue can differentiate early stage CRC pts at high versus low risk for R within 3y better than current NCCN Guidelines. [Table: see text] [Table: see text]

A Pathologic Abdominal Ultrasonography At Diagnosis Of CLL Significantly Reduces The Time To Progression In Patients With Rai 0 Or Rai 1 Disease

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2869-2869
Author(s):  
Fausto Rossini ◽  
Caterina Cecchetti ◽  
Francesca Farina ◽  
Marianna Sassone ◽  
Chiara Scollo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Prognostic Factors ◽  
Lymph Nodes ◽  
Lymphocyte Count ◽  
Early Stage ◽  
Absolute Lymphocyte Count ◽  
Low Risk ◽  
Time To Progression ◽  
Staging Systems

Abstract The most common staging systems for CLL were developed many years ago and are based on blood cell count and the presence of enlarged lymph nodes by physical exam. Many studies have tried to identify prognostic factors in early stage patients. A recent paper (Muntanola et al: Abdominal Computed Tomography Predicts Progression in Patients With Rai Stage 0 CLL. J Clin Oncol. 25:1576-1580) showed that patients with Rai 0 disease and a pathologic abdominal CT scan had a reduced time to progression (TTP), more similar to Rai stage I disease; however CT cannot be used routinely, especially in patients with early stage CLL, whose life expectancy may be very long. When compared to CT, ultrasonography (US) can be used at diagnosis and in follow-up, when it can show progression of abdominal lymph nodes. Patients and Methods The aims of the study were to investigate: 1) if a pathologic ultrasonography (PU) showing the presence of abdominal lymphadenopathy at diagnosis could allow identifying patients with different risk of evolution. 2) if there is a correlation between PU and different prognostic factors, such as mutational state, absolute lymphocyte count, CD38 positivity, age 3) if patients with Rai 0 disease and with PU are prognostically similar to Rai 1. Between 1999 and 2011, 189 patients with Rai 0 or Rai 1 CLL had a ultrasonography (US) performed at diagnosis. Lymph nodes more than 10 mm in diameter were considered abnormal. In 137 of them mutational status had been determined. Fluorescence in situ hybridization (FISH) analysis for 11,12, 13 17 was not generally performed at diagnosis but only before the beginning of treatment. The Fisher’s exact or t tests were used to analyze the association between the presence of an abnormal US and the clinical characteristics. Survival time and time to progression (TTP) were analyzed using the Kaplan-Meier method and curves were compared by means of the log-rank test. Results Mean age was 63.2 years (range 41-85). Patients had Rai stage 0 (n=130) disease or Rai stage 1 (n=59). Median absolute lymphocyte count was 12.2 x 10^9/L. Overall, PU were present in 40/189 (21.2%) patients, with dimensions of lymph nodes up to 120 mm. PU were significantly more frequent in patients with Rai 1 disease (23/59 – 39%) than in Rai 0 (17/130 – 13.1%) disease (p<0.01), in patients with unmutated disease (19/50 – 38%) than in patients with mutated disease (13/87 - 14.9%) (p=0.002) and in patients with absolute lymphocyte count at diagnosis > 20 x 10^9/L (15/47 – 31.9%) than in patients with absolute lymphocyte count at diagnosis < 20 x 10^9/L (25/142 – 17.6%) (p=0.03). No significant differences were present in age, hemoglobin concentration, absolute neutrophil count, platelet count or CD38 positivity. When all patients are considered, patients with PU had a shorter time to progression when compared to patients without PU (median 56 months vs not reached - p<0.02). The whole population was divided in three groups: patients with Rai 0 disease and no PU (group A), with Rai 0 disease and the presence of PU (group B), with Rai 1 (group C). The TTP is significantly different in the three groups, with median TTP not reached for gr A, 73 months for gr B and 37 months for gr C; (p <0.001 ). Among patients with Rai 1 disease, median TTP was 60 months in patients with PU and 21 in patients without PU (p=0.077). The presence of PU has a significant prognostic significance for TTP in patients with unmutated disease with median TTP of 68 vs. 25 months (p=0.007). Among patients with mutated disease, median TTP were 112 for patients with PU and not reached for patients without PU (p=n.s.). No differences in overall survival could be shown. Conclusions The presence of PU at diagnosis can identify a subgroup of Rai 0 CLL with shorter TTP; this confirms results reported with computed tomography. Patients with Rai 0 disease and PU had an intermediate but significantly different TTP between Rai 0 without PU and Rai 1. PU retains its importance also when only unmutated patients are considered; among mutated patients, a statistically significant difference could not be shown , also due to the low number of events in these patients. An ultrasonography performed at diagnosis appears to be useful in low-risk CLL patients: it is a non-toxic imaging technique that can identify subgroups of low-risk patients; in patients with PU at diagnosis, it can be repeated in follow-up to evidence progressive abdominal disease. Disclosures: No relevant conflicts of interest to declare.

Comparison between Site N-Category and Number N-Category for Nodal Staging in Carcinoma of the Gastroesophageal Junction: Our Experience and Literature Review

2006 ◽  
Vol 72 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Paolo Aurello ◽  
Francesco D'Angelo ◽  
Giuseppe Nigri ◽  
Riccardo Bellagamba ◽  
Claudia Cicchini ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Gastroesophageal Junction ◽  
Survival Rates ◽  
Staging System ◽  
Tnm Staging ◽  
Type Ii ◽  
Staging Systems ◽  
Siewert Classification

Gastroesophageal junction (GEJ) neoplasms have become more common over the past decade. Like mediastinal and abdominal lymph nodes and other gastric tumors, GEJ tumors spread to the retroperitoneal nodes. The TNM staging system does not consider this pattern and does not clinically distinguish GEJ tumors from gastric and esophageal cancers. The aim of the study is to compare the old and new TNM staging systems to assess whether the new TNM classifies lymph node involvement in these tumors as a prognostic factor. From January 1983 to December 1995, 438 patients underwent curative gastric resections for cancer at the Department of Surgery “P. Valdoni” of the University of Rome “La Sapienza.” Sixty-two had GEJ type II and III tumors according to the Siewert classification system. The old pN1 and new pN1 survival rates (P < 0.05) were statistically different; the old pN2 and new pN2 survival rates (P = 0.483) were not. The multivariate analysis of significant statistical prognostic factors showed that the pTNM staging in type II and type III GEJ tumors is the most important prognostic factor (P < 0.001), followed by the old pN and new pN (P < 0.001) and the pT (P < 0.005). Gender, age, Lauren type, and tumor location according to Siewert (II vs III) were not independently significant prognostic factors. This study concludes that the numbers and locations of metastatic lymph nodes are important prognostic factors that should be included in the next TNM edition.

scholarly journals Analysis of new N-category on prognosis of oesophageal cancer with positive lymph nodes in a Chinese population

2013 ◽  
Vol 47 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Yaping Xu ◽  
Youhua Jiang ◽  
Xinmin Yu ◽  
Qixun Chen ◽  
Xinming Zhou ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Lymph Nodes ◽  
Classification System ◽  
Chinese Population ◽  
Tnm Classification ◽  
Postoperative Radiotherapy ◽  
Postoperative Adjuvant Therapy ◽  
Pathological Stage ◽  
7Th Edition ◽  
N Classification

Abstract Background. The 7th edition of the new TNM classification system for oesophageal cancer (EC) has been published. N-category is now divided into N0, N1, N2 and N3. In this study, we aimed to validate the prognostic ability of the new N classification system in EC with positive lymph nodes in a Chinese population, and evaluate whether the new N classification system can help the decision-making for postoperative adjuvant therapy. Patients and methods. From 2002 to 2008, thoracic EC who underwent oesophagectomy were retrospectively analysed. Patients pathological stage 6th edition of the American Joint Committee on Cancer / Union International Against Cancer (AJCC/UICC) TNM classification were switched to pathological stage 7th edition for this analysis. Patients with pathological stage T1-4N1-3M0 EC were selected. Kaplan-Meier method and Cox regression analysis were employed to compare overall survival (OS). Results. A total of 545 patients met the inclusion criteria: 346 (63.5%) received oesophagectomy alone, 199 (36.5%) received oesophagectomy and adjuvant radiotherapy, and 36.1% (197/545) received oesophagectomy and adjuvant chemotherapy. Univariate analysis and multivariate analysis revealed significant difference in OS among patients at different postoperative pN-category (p<0.001). This was also present in patients receiving postoperative radiotherapy (p<0.001) and those undergoing postoperative chemotherapy (p<0.001). There was no marked difference in OS between patients receiving postoperative adjuvant therapy and surgery alone at the same postoperative pN-category, except that postoperative radiotherapy marginally improved OS in patients with pN2 and pN3 disease. Conclusions. Our results validated the prognostic ability of new N classification system. The N-category is an independent prognostic factor in patients with resectable thoracic EC who were positive for lymph nodes in a Chinese population. Further studies are required to clarify the role of new N classification system in the decision-making for postoperative adjuvant therapy.

External validation of a tumor-derived 5-gene prognostic signature for recurrence (R) of stages I/II colon and stage I rectal cancer following potentially curative resection.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 437-437
Author(s):  
P. F. Lenehan ◽  
L. A. Boardman ◽  
D. W. Fry ◽  
E. R. Heyman ◽  
J. Ohrnberger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Clinical Management ◽  
Early Stage ◽  
External Validation ◽  
Low Risk ◽  
Stage I ◽  
Primary Adenocarcinoma ◽  
Molecular Test ◽  
Curative Intent

437 Background: Optimizing post-operative clinical management for early-stage (I/II) colorectal cancer (CRC) patients (pts) is a significant unmet medical need. We hypothesized that a molecular prognostic test using primary CRC tissue would better predict the chances of tumor R within 36 months (mo) than current NCCN Clinical Practice Guidelines (NCCN). Methods: Pts had tumor R by 36 mo (n=46) or confirmed non-recurrence (NR) for ≥36 mo (n=69) after surgery; none had received neoadjuvant or adjuvant therapy. Archival formalin-fixed paraffin-embedded primary adenocarcinoma tissues (median storage 7 years; range 4-15) obtained at initial surgical resection with curative intent were retrieved for 86 stage I/II (pT1-4 pN0 M0) colon cancer and 29 stage I (pT1-2, pN0 M0) rectal cancer pts from 2 US and 2 European sites that were different from those previously used to generate the molecular test. Tumor gene expression was assessed by qRT-PCR with custom 384- well TaqMan Low Density Arrays (Applied Biosystems) using RNA that had satisfied a set of rigorous quality control parameters. Results: For stages I/II CRC (n=115), the dichotomous rule correctly classified 32/46 R and 38/69 NR pts: sensitivity (S) 0.70, specificity (SP) 0.55. High-risk pts had a significantly higher probability of R by 36 mo than low-risk pts: PPV 0.51, NPV 0.73; hazard ratio (HR) 2.06 (95% CI: 1.10 to 3.86; p=0.020). NCCN (V.1.2011) was not able to differentiate 36-mo R vs NR in this population: S 0.72, SP 0.42, PPV 0.45, NPV 0.69; HR 1.38 (95% CI: 0.73 to 2.63; p=0.315). The SP of the molecular test was significantly greater than that for NCCN (p=0.05). For stage I pts (n=29; 13R, 16NR), the prognostic accuracy of the test (0.79; 23/29) surpassed that for NCCN (0.55; 16/29). Conclusions: External validation of a 5-gene prognostic rule confirmed its ability to differentiate early stage CRC pts at high risk vs low risk for R within 36 mo after surgery better than current NCCN Guidelines, especially for stage I. The improved specificity and high sensitivity of the molecular test confirm its potential utility for optimizing post-op clinical management of early stage CRC. [Table: see text]

Comparison of the 6th and 7th editions of the UICC TNM staging system for gastric cancer: Results of a Chinese single-institution study of 1,503 patients.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 117-117
Author(s):  
W. Wang
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Likelihood Ratio ◽  
Linear Trend ◽  
Tnm Classification ◽  
Stage Iv ◽  
Tnm Staging ◽  
7Th Edition ◽  
Staging Systems ◽  
Gastric Cancer Patients

117 Background: To evaluate the prognostic efficacy of the 7th edition TNM classification compared to the 6th edition in gastric cancer patients. Methods: A total of 1,503 gastric cancer patients undergoing surgical resection were staged using the 6th and 7th edition staging systems. Homogeneity, discriminatory ability, and monotonicity of gradients of the two systems were compared using linear trend X2, likelihood ratio X2 statistics, and Akaike information criterion (AIC) calculations. Results: Significant differences in five-year survival rates were observed for the “T,” “N,” and “M” subgroups using the 7th edition system, except for stage N2 and N3 patients in the 6th edition system. There were no significant differences in survival between IB and IIA in the 7th edition system. Patients with stage IV disease due to T4/N3 in the 6th edition system who were downstaged to stage III in the 7th edition system had significantly better survival than those who remained at stage IV. The 7th edition system had higher linear trend and likelihood ratio X2 scores, and smaller AIC values compared with those for the 6th edition, which represented the optimum prognostic stratification. Conclusions: Our study suggested that the 7th edition system performs superior to the 6th edition in several aspects. No significant financial relationships to disclose.

Log Odds of Positive Lymph Nodes in Colon Cancer: A Meaningful Ratio-based Lymph Node Classification System

2012 ◽  
Vol 36 (3) ◽  
pp. 667-674 ◽  
Author(s):  
Roberto Persiani ◽  
Ferdinando C. M. Cananzi ◽  
Alberto Biondi ◽  
Giuseppe Paliani ◽  
Andrea Tufo ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Classification System ◽  
Log Odds ◽  
Node Classification ◽  
Positive Lymph Nodes

scholarly journals Pancreatic Endosonography: Clinical TNM Staging Compared to Histology

1990 ◽  
Vol 4 (9) ◽  
pp. 572-575 ◽  
Author(s):  
TL Tio
Keyword(s):  
Lymph Nodes ◽  
Pancreatic Carcinoma ◽  
Imaging Technique ◽  
Tnm Classification ◽  
Standard Procedure ◽  
Tnm Staging ◽  
Tumour Invasion ◽  
Gastrointestinal Carcinoma ◽  
Regional Lymph Nodes ◽  
Tissue Diagnosis

Endosonography has been reported to be effective in the staging of gastrointestinal carcinoma. Pancreatic carcinoma is included in the new (1987) TNM classification. Resectability is abandoned in favour of depth of tumour invasion. In the author's preoperative study, endosonography was accurate for staging of tumour categories, and early stages of disease could be distinguished from advanced carcinomas. The presence or absence of regional lymph nodes can be detected. Tissue diagnosis by biopsy and endosonographyguidcd cytology is now possible. This imaging technique will become the standard procedure for the staging of pancreatic carcinoma.

Lymph node retrieval in a randomized trial on western-type versus Japanese-type surgery in gastric cancer.

1996 ◽  
Vol 14 (8) ◽  
pp. 2289-2294 ◽  
Author(s):  
A M Bunt ◽  
J Hermans ◽  
C J van de Velde ◽  
M Sasako ◽  
F A Hoefsloot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Randomized Trial ◽  
Tnm Classification ◽  
Tnm Staging ◽  
Nodal Status ◽  
Lymph Node Status ◽  
Lymph Node Retrieval ◽  
Status Assessment

PURPOSE In the tumor-node-metastasis (TNM) staging system, no recommendations are provided on what lymph node retrieval technique is to be used to determine lymph node status, which leads to variability in nodal status assessment and TNM staging. PATIENT AND METHODS Lymph node retrieval was quantitated using data from 237 curatively resected gastric cancer patients, from a prospective, randomized trial that compared the Western resection with limited (D1) and the Japanese resection with extended lymphadenectomy (D2), and compared data from the literature. Moreover, the efficacy of different lymph node retrieval techniques was determined. RESULTS The mean yield of lymph nodes was 15 in D1 and 30 in D2, which is similar to results from German investigators, but substantially lower than results from Japanese investigators (60 in D2). Use of a fat-clearance technique significantly increased (P = .01) nodal yields compared with conventional retrieval. Significantly higher yields (P < .001) were obtained by a Japanese surgeon using conventional retrieval directly postoperatively. Experience of surgicopathologic teams with processing resection specimens did not influence nodal yields. Further analysis showed that reference values for nodal yields per anatomically defined station as reported in the literature were contradicted by our results and indicated the ambiguity of such standards. CONCLUSION Despite some anatomical variability in the distribution of lymph nodes, advice on the number of nodes to examine per N level, feasible in all patients, should be incorporated into the TNM classification to standardize nodal status assessment. Based on our findings, we advocate retrieval of nodes immediately postoperatively by the surgeon.

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