![]() This view, however, cannot directly explain the clear survival benefit of high LN counts seen in the node-negative disease. Traditional Halstedian views propose that removal of involved LNs prevents further spread of the disease from these deposits. The mechanism by which higher LN yields are associated with improved survival is unclear. Recently more radical surgical techniques including complete mesocolic excision (CME) with central vessel ligation (CVL) have been developed that improve LN yields in colon cancer resections. Currently, the American Joint Commission on Cancer (AJCC) and the National Quality Forum recommend a minimum number of 12 LNs for the adequate staging of colorectal cancers (CRC). ![]() Previous studies have highlighted that LN yield is multifactorial being dependent on surgeon, pathologist and patient-related factors. The number of the LNs sampled has also been demonstrated as an independent prognostic marker for improved survival in both node-positive and node-negative disease. Lymph node (LN) yield in colon cancer resections is considered crucial for adequate staging and guiding adjuvant treatment. Immunogenic tumours have a better prognosis, likely explaining the survival benefit with higher LN yields. ![]() The study shows a strong association of an activated immune response in tumours with a high LN yield. Analogous findings were reproduced in the validation dataset. This association was most prominent in node-negative cancers. High LN yield was strongly linked with gene expression changes associated with the adaptive and dendritic cell immune response. There was no association of higher LN yield and increasing nodal positivity. High LN yield was found predictive of overall and disease-free survival. Correlations were validated in an independent set of Stage II colon cancers. Gene set enrichment analysis was performed on transcriptomic changes to identify biological processes associated with LN yield. Based on maximal survival effects, patients were segregated into high (>15) and low (≤15) LN yield. MethodsĬlinical, genomic, transcriptomic, proteomic and methylation data of non-metastatic, colon cancers studied in The Cancer Genome Atlas were interrogated for associations with LN yield. This study aimed to identify whether molecular features in the primary tumour were predictive of LN yield. The mechanism underlying improved survival in non-metastatic colon cancer with higher lymph node (LN) yield is unknown.
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