Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China.
Department of Colorectal Cancer Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 38 Guangji Road, Zhejiang, Hangzhou, China.
BMC Cancer. 2023 Jan 30;23(1):100. doi: 10.1186/s12885-023-10524-y.
The aim of this paper was to clarify the optimal minimum number of lymph node for CEA-elevated (≥ 5 ng/ml) colon cancer patients.
Thirteen thousand two hundred thirty-nine patients from the SEER database and 238 patients from the Second Affiliated Hospital of Harbin Medical University (External set) were identified. For cancer-specific survival (CSS), Kaplan-Meier curves were drawn and data were analyzed using log-rank test. Using X-tile software, the optimal cut-off lymph node count was calculated by the maximal Chi-square value method. Cox regression model was applied to perform survival analysis.
In CEA-elevated colon cancer, 18 nodes were defined as the optimal minimum node. The number of lymph node examined (< 12, 12-17 and ≥ 18) was an independent prognosticator in both SEER set (HR = 1.329, P < 0.001; HR = 1.985, P < 0.001) and External set (HR = 1.774, P < 0.032; HR = 2.741, P < 0.006). Moreover, the revised 18-node standard could identify more positive lymph nodes compared with the 12-node standard in this population.
With the purpose of favorable long-term survival and accurate nodal stage for CEA-elevated colon cancer patients, the 18-node standard could be regarded as an alternative to the 12-node standard advocated by the ASCO and NCCN guidelines.
本文旨在明确对于 CEA 升高（≥5ng/ml）结肠癌患者，获得最佳预后所需的最少淋巴结数目。
本研究纳入了 SEER 数据库中的 13239 例患者和哈尔滨医科大学第二附属医院的 238 例患者（外部数据集）。采用 Kaplan-Meier 曲线进行生存分析，Log-rank 检验进行数据比较。使用 X-tile 软件，采用最大 Chi-square 值法计算最佳淋巴结计数截断值。采用 Cox 回归模型进行生存分析。
对于 CEA 升高的结肠癌患者，18 个淋巴结被定义为最佳的最小淋巴结数目。在 SEER 数据集和外部数据集的分析中，淋巴结检查数目（<12、12-17 和≥18）均是独立的预后因素（HR=1.329，P<0.001；HR=1.985，P<0.001；HR=1.774，P<0.032；HR=2.741，P<0.006）。此外，与 12 节点标准相比，修订后的 18 节点标准在该人群中可以检测到更多阳性淋巴结。
为了获得 CEA 升高的结肠癌患者良好的长期生存和准确的淋巴结分期，18 节点标准可作为 ASCO 和 NCCN 指南推荐的 12 节点标准的替代方案。
