Prognostic value of positive lymph nodes in rectal cancer

Abdominal "curative" resections for rectal cancer in 109 patients with positive lymph nodes were prospectively studied. The best subdivision of patients for predicting outcome was into 1-3 and greater than 3 positive lymph node groups. Comparison with patients with greater than 3 positive lymph nodes demonstrated that patients with 1-3 positive nodes had less local (35.0 percent vs. 13.0 percent; P = 0.007) and less distant recurrence (45.0 percent vs. 26.0 percent; P = 0.04) and had much better crude five-year survival (58.2 percent vs. 17.0 percent; P less than 0.0001). For predicting postsurgical outcome in patients with positive lymph nodes, the results justify subdividing patients into the following two prognostic subgroups: 1) those with 1-3 involved lymph nodes and 2) those with metastatic tumor in four or more lymph nodes.