Harvest of at least 18 lymph nodes is associated with improved survival in patients with pN0 colon cancer: a retrospective cohort study

Abstract

Purpose

To investigate the correlation between number of retrieved lymph nodes (rLNs) and prognosis and further ascertain the optimal number of rLNs with a beneficial survival impact in patients with pN0 colon cancer.

Methods

The Surveillance, Epidemiology, and End Results (SEER) database was searched for pN0 colon cancer cases. X-Tile software and Kaplan–Meier survival analysis were applied to determine the optimal number of rLNs based on the minimal probability (P) value and the largest χ2 value. Univariate analyses and Cox proportional hazard regression model were used to investigate the relationship between rLN number and overall survival. Multiple analyses were conducted to assess the prognostic predictive ability of the identified optimal rLN cut-off value under different stratifications. Nomograms were established based on the independent prognostic factors selected by the multivariate analysis to predict 3- and 5-year overall survival rates of pN0 patients.

Results

A total of 6269 pN0 colon cancer patients who underwent surgical therapy were finally included for analysis. Harvest of at least 18 lymph nodes was determined as the optimal rLN number. This cut-off rLN value (< 18 versus ≥ 18) was identified as an independent prognostic factor (P < 0.001) of overall survival via multivariate analysis. Similar findings were obtained in patients with retrieval of at least 12 lymph nodes (18 > rLNs ≥ 12 versus rLNs ≥ 18) stratified into several groups.

Conclusions

The number of rLNs was identified as an independent prognostic factor for pN0 colon cancer. Retrieval of at least 18 lymph nodes was associated with favorable prognosis in patients with pN0 colon cancer, and should, therefore, be regarded as an alternative cut-off value for survival analysis.

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Data availability

The data sets used and/or analyzed during the current study are available from the SEER database.

Abbreviations

AJCC:

American Joint Committee on Cancer

CI:

Confidence interval

HR:

Hazard ratio

pT stage:

Pathological T stage

pN stage:

Pathological N stage

pN0:

Node-negative

rLNs:

Retrieved lymph nodes

SEER:

Surveillance, Epidemiology, and End Results

TNM:

Tumor/node/metastasis

UICC:

Union for International Cancer Control

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Acknowledgements

We acknowledgment the efforts of Surveillance, Epidemiology and End Results (SEER) program tumor registries for creating SEER database (https://seer.cancer.gov/). We thank International Science Editing for their professional editing.

Funding

This work was supported, in part, by the China Scholarship Council (201908050148), Japan China Sasakawa Medical Fellowship (2017816), and National Natural Science Foundation of China (81774112).

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Contributions

Study concept and design: FN, JP, NZ, and CZ. Acquisition of data: FN, JP, NZ, and CZ. Analysis and interpretation of data: FN, JP, NZ, XZ, ZM, and CZ. Drafting of the manuscript: FN and CZ. Critical revision of the manuscript for important intellectual content: FN, JP, NZ, JW, HQ, XZ, ZM, KN, MA, and CZ. Obtained funding: CZ and ZM. Corresponding author: C.Z.

Corresponding author

Correspondence to Chun-Dong Zhang.

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SEER is a publicly available database with anonymized data; no ethical review was required.

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Cite this article

Ning, F., Pei, J., Zhang, N. et al. Harvest of at least 18 lymph nodes is associated with improved survival in patients with pN0 colon cancer: a retrospective cohort study. J Cancer Res Clin Oncol 146, 2117–2133 (2020). https://doi.org/10.1007/s00432-020-03212-y

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Keywords

  • AJCC/UICC
  • Colon cancer
  • pN0 patients
  • Retrieved lymph nodes
  • SEER