Tian Ye, Qiao Xinyu, Zheng Gaozan, Dan Hanjun, Dou Xinyu, Ren Guangming, Niu Liaoran, Wang Pengfei, Wang Siyuan, Wu Fengsu, Yang Yumao, Zheng Jianyong, Feng Fan
Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, 710032, China.
State Key Laboratory of Holistic, Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, 710032, China.
Eur J Med Res. 2025 Aug 14;30(1):753. doi: 10.1186/s40001-025-02990-w.
The National Comprehensive Cancer Network (NCCN) recommends that at least 12 lymph nodes (LNs) should be harvested during radical surgery of colorectal cancer (CRC). This study aims to clarify the optimal number of LNs that should be examined during the radical surgery for CRC patients with each N stage. The SEER database (n = 48,331) served as the primary cohort, while the Xijing cohort (n = 4447) was used for external validation. A Cox proportional hazards regression model was employed to evaluate risk factors associated with overall survival (OS) in CRC. Moreover, the restricted cubic splines (RCS) method was used to detect inflection points within the risk function and to investigate the correlation between the number of examined lymph nodes (ELNs) and OS. Ultimately, the optimal number of ELNs for patients at different N stages was determined and verified. The analyses from both databases consistently indicated that a higher number of ELNs is an independent prognostic factor for the OS of patients with CRC. 18 and 19 are identified as the optimal numbers of ELNs for N0, N1a, and N1b, N2a stages, respectively. The Kaplan-Meier analysis revealed that there was a statistical difference in the OS between patients in the limited group and those in the adequate group among the neighboring N subgroups. For CRC patients with different N stages, the number of LNs that needs to be cleared varies. Number of ELNs exceeded 18, 18, 19 and 19 could significantly improve the prognosis of patients with N0, N1a, N1b and N2a stages, respectively.
美国国立综合癌症网络（NCCN）建议，在结直肠癌（CRC）根治性手术期间应至少清扫12枚淋巴结（LN）。本研究旨在明确针对不同N分期的CRC患者，在根治性手术期间应检查的最佳淋巴结数量。监测、流行病学和最终结果（SEER）数据库（n = 48331）作为主要队列，而西京队列（n = 4447）用于外部验证。采用Cox比例风险回归模型评估与CRC总生存（OS）相关的危险因素。此外，使用受限立方样条（RCS）方法检测风险函数内的拐点，并研究检查淋巴结数量（ELN）与OS之间的相关性。最终，确定并验证了不同N分期患者的最佳ELN数量。两个数据库的分析均一致表明，较高的ELN数量是CRC患者OS的独立预后因素。分别确定18枚和19枚为N0、N1a以及N1b、N2a期患者的最佳ELN数量。Kaplan-Meier分析显示，在相邻的N亚组中，有限组患者与充足组患者的OS存在统计学差异。对于不同N分期的CRC患者，需要清扫的LN数量各不相同。ELN数量分别超过18枚、18枚、19枚和19枚可显著改善N0、N1a、N1b和N2a期患者的预后。
