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Colon Neuroendocrine Tumors: A New Lymph Node Staging Classification

Adam C. Fields MD, Justin C. McCarty DO, Pamela Lu MD, Benjamin M. Vierra MS, Linda M. Pak MD, MPH, Jennifer Irani MD, Joel E. Goldberg MD, MPH, Ronald Bleday MD, Jennifer Chan MD, Nelya Melnitchouk MD, MSc
Colorectal Cancer
Volume 26, Issue 7 / July , 2019



The American Joint Commission on Cancer, the European Neuroendocrine Tumor Society, and the North American Neuroendocrine Tumor Society all classify colon neuroendocrine tumor (NET) nodal metastasis as N0 or N1. This binary classification does not allow for further prognostication by the total number of positive lymph nodes. This study aimed to evaluate whether the total number of positive lymph nodes affects the overall survival for patients with colon NET.


The National Cancer Database was used to identify patients with colon NET. Nearest-neighborhood grouping was performed to classify patients by survival to create a new nodal staging system. The Surveillance, Epidemiology, and End Results database was used to validate the new nodal staging classification.


Colon NETs were identified in 2472 patients. Distinct 5-year survival rates were estimated for the patients with N0 (no positive lymph nodes; 69.8%; 95% confidence interval [CI], 66.7–72.7%), N1a (1 positive lymph node; 63.9%; 95% CI, 59.6–68.0%), N1b (2–9 positive lymph nodes; 38.9%; 95% CI, 35.4–42.3%), and N2 (≥ 10 positive lymph nodes; 15.7%; 95% CI, 11.9–20.0%; p < 0.001) nodal classifications. The validation population showed distinct 5-year survival rates with the new nodal staging. In multivariable Cox regression, the new nodal stage was a significant independent predictor of overall survival.


The number of positive locoregional lymph nodes in colon NETs is an independent prognostic factor. For patients with colon NETs, N0, N1a, N1b, and N2 classifications for nodal metastasis more accurately predict survival than current staging systems.

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