Xiang Renshen, Yang Bo, Sun Jianfeng, Fu Jincheng, Wu Jing, Wang Jiefu, Fu Tao
Department of Colorectal Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
Department of General Surgery, The Second People's Hospital of Changzhi, Changzhi, 046000, Shanxi Province, China.
Sci Rep. 2025 Jul 16;15(1):25856. doi: 10.1038/s41598-025-03999-1.
Substantial uncertainties remain regarding the establishment of an optimal examined lymph node (ELN) count for the comprehensive management of resectable colorectal cancer (CRC). The correlation of the ELN count with cancer-specific survival (CSS) and benefit from adjuvant chemotherapy (AC) in CRC was investigated using a large database, and the minimal threshold for ELN count in LN-negative patients was determined. The data on stage I to III CRC available in the SEER database (2010-2015) were analyzed to determine the correlation of ELN count with CSS and the benefit of AC using multivariable models. The series of odds ratios (ORs) and hazard ratios (HRs) were fitted using the join-point regression analysis. External validation was performed using the data of patients with stage I to III CRC (2004 to 2009) available in the SEER database. Among LN-negative patients, both cohorts indicated that an increase in the ELN count (≤ 18) led to incremental enhancements in CSS, while no additional improvement in CSS was noted beyond an ELN count of 18. Notably, the efficacy of AC diminished gradually as the ELN count increased. Moreover, post-AC CSS was impaired when the ELN count exceeded 18 (serial HRs > 1), a trend that was accentuated with a higher ELN count. Among the LN-positive patients, two cohorts exhibited proportional increases in ELNs, from one positive LN (PLN) to 20 PLN disease, and incremental benefit from AC, as the ELN count increased (serial HRs < 1). The present study recommends an ELN threshold of 18 when evaluating the quality of prognostic stratification and guiding AC for LN-negative cases. A higher ELN count would be associated with further accurate PLN detection and incremental benefit from AC in LN-positive diseases.
对于可切除结直肠癌（CRC）的综合管理而言，确定最佳检查淋巴结（ELN）计数仍存在诸多不确定性。我们使用一个大型数据库研究了ELN计数与CRC患者癌症特异性生存（CSS）以及辅助化疗（AC）获益之间的相关性，并确定了LN阴性患者ELN计数的最低阈值。分析了SEER数据库（2010 - 2015年）中I至III期CRC的数据，使用多变量模型确定ELN计数与CSS的相关性以及AC的获益情况。采用连接点回归分析拟合一系列优势比（OR）和风险比（HR）。利用SEER数据库中I至III期CRC患者（2004年至2009年）的数据进行外部验证。在LN阴性患者中，两个队列均表明ELN计数增加（≤18个）会导致CSS逐步提高，而ELN计数超过18个后CSS未观察到进一步改善。值得注意的是，随着ELN计数增加，AC的疗效逐渐降低。此外，当ELN计数超过18个时（连续HR>1），AC后的CSS受损，且随着ELN计数升高这一趋势更加明显。在LN阳性患者中，两个队列显示随着ELN计数增加，ELN呈比例增加，从1个阳性淋巴结（PLN）到20个PLN疾病，且AC的获益增加（连续HR<1）。本研究建议在评估LN阴性病例的预后分层质量和指导AC时，ELN阈值为18个。更高的ELN计数与LN阳性疾病中更准确的PLN检测以及AC的更多获益相关。
