Bundred James, Lal Nikhil, Chan Dedrick K H, Buczacki Simon J A
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, Singapore, Singapore.
Br J Cancer. 2025 Apr;132(7):643-651. doi: 10.1038/s41416-025-02949-y. Epub 2025 Feb 14.
We interrogated two large national databases to explore the underlying mechanisms and institutional effects of the known association of enhanced survival with a higher lymph node yield (LNY) in non-metastatic colon cancer.
Clinical and pathological data for stage I-III colon adenocarcinomas were extracted from the CORECT-R (England, 2010-2020) and SEER database (USA, 2000-2020). A lymph node (LN) cut-off for the lack of clinically significant increase in nodal positivity was identified. A multivariable Cox-regression model was developed to study the effect of LNY on overall survival. Furthermore, institutional variations in LNY and their impact on survival were explored.
Patients were retrospectively included from the CORECT-R (n = 84,116) and SEER (n = 287,974) databases. No significant increase in nodal positivity was noted after a LN cut-off of 9. However, improved survival was noted in node-negative and node-positive cancers beyond this cut-off. A 1% risk-reduction concerning overall survival was reported for every node counted. We identified ten outlying institutions across England with an observed LNY greater or less than the expected, with no impact on overall survival.
We advocate incorporating LNY into patient and clinician discussions as a surrogate marker of tumour biology and prognosis rather than using LNY as a quality indicator.
我们查阅了两个大型国家数据库，以探究在非转移性结肠癌中，已知的较高淋巴结收获量（LNY）与生存改善之间关联的潜在机制和机构效应。
从CORECT - R（英国，2010 - 2020年）和SEER数据库（美国，2000 - 2020年）中提取I - III期结肠腺癌的临床和病理数据。确定了淋巴结（LN）截断值，以确定淋巴结阳性率无临床显著增加的情况。建立了多变量Cox回归模型来研究LNY对总生存的影响。此外，还探讨了LNY的机构差异及其对生存的影响。
从CORECT - R（n = 84,116）和SEER（n = 287,974）数据库中回顾性纳入患者。淋巴结截断值为9个后，未观察到淋巴结阳性率有显著增加。然而，超过该截断值，在淋巴结阴性和阳性癌症中均观察到生存改善。每多一个计数淋巴结，总生存风险降低1%。我们在英国确定了10个偏远机构，其观察到的LNY高于或低于预期，对总生存无影响。
我们主张将LNY纳入患者和临床医生的讨论中，作为肿瘤生物学和预后的替代标志物，而不是将LNY用作质量指标。
