Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study.

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2025-05-20 DOI:10.1097/JS9.0000000000002545

Qiying Yin, Yanlai Sun, Changqing Jing, Benjia Liang, Xu Guan, Peng Zhang, Kaixiong Tao, Yueming Sun, Yifei Zhang, Shanglei Ning, Minhao Yu, Yanfeng Lv, Lei Wang, Qi Sun, Jiangang Liu, Meng Jiao, Zhao Zhang, Congqing Jiang, Xianghai Ren, Guodong Yu, Bin Ma, Zhibin Ye, Jun Li, Dongning Liu, Xiangheng Kong, Jingbo Chen, Guangyong Zhang, Hui Yang

{"title":"Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study.","authors":"Qiying Yin, Yanlai Sun, Changqing Jing, Benjia Liang, Xu Guan, Peng Zhang, Kaixiong Tao, Yueming Sun, Yifei Zhang, Shanglei Ning, Minhao Yu, Yanfeng Lv, Lei Wang, Qi Sun, Jiangang Liu, Meng Jiao, Zhao Zhang, Congqing Jiang, Xianghai Ren, Guodong Yu, Bin Ma, Zhibin Ye, Jun Li, Dongning Liu, Xiangheng Kong, Jingbo Chen, Guangyong Zhang, Hui Yang","doi":"10.1097/JS9.0000000000002545","DOIUrl":null,"url":null,"abstract":"Background: While the currently recommended minimum number of examined lymph nodes (ELNs) for colorectal cancer is 12, the applicability of this standard to colorectal mucinous adenocarcinoma (MAC), a distinct tumor entity with high metastatic potential, remains controversial. This study aimed to establish and validate the optimal ELN threshold during surgery to achieve superior survival outcomes of MAC patients.Methods: Data from 21 Chinese medical institutions and the Surveillance, Epidemiology, and End Results (SEER) database were analyzed using Cox proportional hazards models to identify prognostic factors affecting MAC patient outcomes. Restricted cubic spline (RCS) analysis was subsequently applied to determine the optimal ELN threshold.Results: The ELN distribution pattern demonstrated significant concordance between the Chinese cohort (n = 1086) and the SEER cohort (n = 12 343), with identical median values (17) and overlapping interquartile ranges (SEER: 12-23 vs. China: 13-22). Multivariate analyses adjusted for potential confounders established ELN quantity as an independent prognostic factor (SEER cohort: hazard ratio [HR] = 0.987, 95% confidence interval [CI]: 0.985-0.990, P < 0.001; Chinese cohort: HR = 0.975, 95% CI: 0.957-0.994, P = 0.011). The RCS models in both databases revealed a nonlinear L-shaped association between the ELN count and all-cause mortality risk, with 17 ELNs identified as the optimal threshold. Notably, patients with ≥17 ELNs exhibited significantly reduced mortality risks in both the SEER cohort (P < 0.001) and the Chinese cohort (P = 0.45), particularly in node-negative patients and those without adjuvant chemotherapy.Conclusion: Elevated ELN counts are correlated with improved survival. Our findings strongly suggest that 17 ELNs is the optimal cutoff for evaluating surgical quality and prognostic stratification in MAC patients, challenging the conventional 12-ELN standard.","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JS9.0000000000002545","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: While the currently recommended minimum number of examined lymph nodes (ELNs) for colorectal cancer is 12, the applicability of this standard to colorectal mucinous adenocarcinoma (MAC), a distinct tumor entity with high metastatic potential, remains controversial. This study aimed to establish and validate the optimal ELN threshold during surgery to achieve superior survival outcomes of MAC patients.

Methods: Data from 21 Chinese medical institutions and the Surveillance, Epidemiology, and End Results (SEER) database were analyzed using Cox proportional hazards models to identify prognostic factors affecting MAC patient outcomes. Restricted cubic spline (RCS) analysis was subsequently applied to determine the optimal ELN threshold.

Results: The ELN distribution pattern demonstrated significant concordance between the Chinese cohort (n = 1086) and the SEER cohort (n = 12 343), with identical median values (17) and overlapping interquartile ranges (SEER: 12-23 vs. China: 13-22). Multivariate analyses adjusted for potential confounders established ELN quantity as an independent prognostic factor (SEER cohort: hazard ratio [HR] = 0.987, 95% confidence interval [CI]: 0.985-0.990, P < 0.001; Chinese cohort: HR = 0.975, 95% CI: 0.957-0.994, P = 0.011). The RCS models in both databases revealed a nonlinear L-shaped association between the ELN count and all-cause mortality risk, with 17 ELNs identified as the optimal threshold. Notably, patients with ≥17 ELNs exhibited significantly reduced mortality risks in both the SEER cohort (P < 0.001) and the Chinese cohort (P = 0.45), particularly in node-negative patients and those without adjuvant chemotherapy.

Conclusion: Elevated ELN counts are correlated with improved survival. Our findings strongly suggest that 17 ELNs is the optimal cutoff for evaluating surgical quality and prognostic stratification in MAC patients, challenging the conventional 12-ELN standard.

查看原文本刊更多论文

优化结直肠黏液腺癌的淋巴结评估：一项多中心和基于人群的研究。

背景：虽然目前推荐的结直肠癌最小淋巴结检查数（eln）为12个，但该标准是否适用于结直肠粘液腺癌（MAC）这一具有高转移潜力的独特肿瘤实体仍存在争议。本研究旨在建立和验证手术中最佳ELN阈值，以实现MAC患者的优越生存结果。方法：采用Cox比例风险模型分析来自中国21家医疗机构和监测、流行病学和最终结果（SEER）数据库的数据，以确定影响MAC患者预后的预后因素。随后应用限制三次样条（RCS）分析确定最佳ELN阈值。结果：ELN分布模式在中国队列（n = 1086）和SEER队列（n = 12343）之间具有显著的一致性，具有相同的中位数（17）和重叠的四分位数范围（SEER: 12-23与中国：13-22）。校正潜在混杂因素的多因素分析确定ELN数量为独立预后因素(SEER队列：风险比[HR] = 0.987, 95%可信区间[CI]: 0.985 ~ 0.990, P < 0.001；中国队列：HR = 0.975, 95% CI: 0.957-0.994, P = 0.011)。两个数据库中的RCS模型显示ELN计数与全因死亡风险之间呈非线性l型关联，其中17个ELN被确定为最佳阈值。值得注意的是，≥17个eln的患者在SEER队列（P < 0.001）和中国队列（P = 0.45）中均表现出显著降低的死亡风险，尤其是淋巴结阴性患者和未进行辅助化疗的患者。结论：ELN计数升高与生存率提高相关。我们的研究结果强烈表明，17个eln是评估MAC患者手术质量和预后分层的最佳截止点，挑战了传统的12个eln标准。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.