{"title":"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。","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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","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":"{\"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\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"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}","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}
Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study.
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.
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.
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