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Prognostic significance of lymph node yield in patients with synchronous colorectal carcinomas

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The National Comprehensive Cancer Network (NCCN) guidelines recommend examination of a minimum of 12 lymph nodes (LNs) for accurate staging of a single case of colorectal cancer. However, the guidelines do not support the examination of LNs in synchronous colorectal carcinoma (SCC). This study aimed to investigate the association between lymph node yield and the prognosis of SCC patients.

Methods

Synchronous colorectal carcinoma patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database over a 10-year interval (2004 to 2013). Systematic dichotomization for optimal cut-off point identification was performed using X-tile. The baseline for the two LNs groups generated was balanced using the propensity score matching (PSM) method.

Results

A total of 4616 patients met the inclusion criteria. The cut-off number for lymph node retrieved from a single patient was 15 and 12 for the first- and second-time diagnosis of SCC, respectively. Age, T category, N category, tumor grade, tumor site, tumor size, and radiation sequence were not balanced in the two groups. After adjusting the baseline in the two groups, the same results were observed. Age, T category, N category, tumor site had a partial effect on lymph node yield. There might be some biological characteristics of the tumor that influence lymph node yield.

Conclusions

Retrieval of fewer than 15 LNs at the first time of SCC diagnosis indicates worse SCC prognosis. Because factors such as manner of surgical examination influence SCC prognosis, specimens should be preserved for at least 6 months to enable reevaluation should there be a need.

Irb: IRB approval is not required because the SEER data are freely accessible.

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Availability of data and materials

The datasets are available in SEER database to select the eligible cases. The data are also available from the corresponding author.

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Acknowledgments

We thank all the staff in the Department of Colorectal Surgery of FMUUH and gratefully acknowledge the SEER database (established by the National Cancer Institute, USA).

Funding

This study was supported by National Clinical Key Specialty Construction Project (General Surgery) of China; Wu Jieping Medical Foundation (320.2710.1833).

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Authors and Affiliations

  1. Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, Fujian, 350001, People’s Republic of China

    YuXin Xu, Ying Huang, XiaoJie Wang, YanWu Sun, DaoXiong Ye & Pan Chi

Authors
  1. YuXin Xu
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  2. Ying Huang
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  3. XiaoJie Wang
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  4. YanWu Sun
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  5. DaoXiong Ye
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  6. Pan Chi
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Contributions

YuXin Xu processed the data and carried out computational simulations.

XiaoJie Wang, Ying Huang, DaoXiong Ye helped on data collections and analyses.

YuXin Xu, Pan Chi, XiaoJie Wang, Ying Huang, DaoXiong Ye analyzed the results.

YuXin Xu, Pan Chi, XiaoJie Wang drafted the manuscript.

Corresponding authors

Correspondence to Ying Huang or Pan Chi.

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Ethics approval and consent to participate

The datasets are selected in SEER database. Ethics approval and consent to participate are not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.

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All authors reviewed and approved the manuscript.

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Appendices

Appendix 1

Fig 6
figure 6

a and b indicate the optimal cut-off for differentiating between high- and low-risk LN groupings for the first time of SCC calculated by X-tile. c showing the optimal cut-off for distinguishing between high- and low-risk LN groupings for the first time of SCC calculated by minimum p values

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Appendix 2

Fig. 7
figure 7

a and b indicate the optimal cut-off for differentiating between high- and low-risk LN groupings for the second time of SCC calculated by X-tile. c shows the optimal cut-off for distinguishing between high- and low-risk LN groupings for the second time of SCC diagnosis calculated by minimum p values.

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Xu, Y., Huang, Y., Wang, X. et al. Prognostic significance of lymph node yield in patients with synchronous colorectal carcinomas. Int J Colorectal Dis 35, 2273–2282 (2020). https://doi.org/10.1007/s00384-020-03700-0

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