Assessing the quality of colorectal cancer staging: documenting the process in improving the staging of node-negative colorectal cancer

Arch Surg. 2005 Sep;140(9):881-6; discussion 886-7. doi: 10.1001/archsurg.140.9.881.


Hypothesis: Examination of 14 or more nodes is the optimal criterion to accurately stage node-negative colorectal cancer and predict outcome.

Design: Case series.

Setting: Three university-affiliated community medical centers.

Patients: A total of 2149 individuals with apparently localized, invasive colorectal cancer examined between January 1, 1990, and December 31, 2002.

Intervention: Study of tumor registry data.

Main outcome measures: Nodal status and disease-specific survival.

Results: The number of nodes examined ranged from 0 to 97 (mean +/- SD, 18 +/- 15 nodes). The mean number of nodes examined in node-positive individuals was 21.0 vs 16.6 in node-negative individuals (P<.001). The mean number of nodes examined at medical center A was 22.3; center B, 17.9; and center C, 14.0. The mean number of nodes examined for T3 and T4 tumors at center A was 26; center B, 20; and center C, 16 (P<.001). The node-positive rate for all T3 and T4 lesions was 49.7% at center A, 57.8% at center B, and 50.0% at center C (P<.001). Despite significant differences in the mean number of nodes examined between medical centers, the overall survival in patients with node-negative colorectal cancer in the 3 medical centers was not statistically different (P = .79). The criterion of examining 14 or more nodes distinguished between individuals at low risk for recurrence and those at increased risk.

Conclusions: Variability exists between medical centers in the pathological analysis of colorectal cancer specimens. However, within an institution, examining a mean of 14 or more nodes accurately stages apparently node-negative colorectal cancer and accurately predicts outcome.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology*
  • Female
  • Humans
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Predictive Value of Tests
  • Quality of Health Care
  • Survival Analysis