Trends in lymph node (LN) harvest for colon cancer in routine clinical practice: Does node count matter in the real world?
Bibliographic record
Abstract
e14635 Background: International guidelines recommend 12+ LNs be resected during surgery for colon cancer. Here we report practice patterns in routine care and evaluate whether LN harvest is associated with survival in the general population. Methods: Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with colon cancer who underwent surgical resection during 2002-2008 in Ontario. Surgical pathology reports were reviewed for a random sample of cases representing 25% of all patients treated over the study period. Patients with metastases or unstated number of LNs were excluded. Modified Poisson regression was used to identify factors associated with LN harvest; Cox models were used to explore association between LN harvest and survival. Results: 30,643 patients underwent resection of colon cancer during the study period. Pathology reports were reviewed for 7514 (25%) randomly selected cases; 6759 met eligibility criteria. Over the study period median LN harvest increased from 11 to 17 nodes (p < 0.001) and the proportion of patients with 12+ LNs increased from 45% to 86% (p < 0.001). Despite the increase in LN harvest the proportion of patients with node positive disease did not change (from 43% to 42%, p = 0.569). On adjusted analysis the following factors were associated with 12+ LNs: age (RR 0.85 > 80 vs < 50 years, p < 0.001); co-morbidity (RR 0.87 moderate vs none, p < 0.001); year of surgery (RR 1.90 2008 vs 2002, p < 0.001); laterality (RR 1.22 right vs left, p < 0.001); and hospital volume (RR 0.89 low vs high volume, p < 0.001). After controlling for relevant co-variates (including hospital volume), < 12 LNs was associated with inferior overall survival (OS) and cancer-specific survival (CSS). This association was seen in stage 2 (OS HR 1.43, p < 0.001; CSS HR 1.60, p < 0.001) and stage 3 (OS HR 1.45, p < 0.001; CSS HR 1.51, p < 0.001) disease. Conclusions: Despite a temporal increase in LN harvest the proportion of cases with node positive disease has not changed. LN harvest is associated with survival in patients with stage 2 and stage 3 colon cancer. These data suggest that the association between LN harvest and survival is not due to stage migration.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".