Journal of gastrointestinal oncology · 2025
Log odds of positive lymph nodes-based staging system for colorectal cancer patients with inadequate lymph nodes harvested: a potential reference for adjuvant chemotherapy.
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Wang Hongwei, Wang Linlin, Li Zhong, Zhang Jiahang, Liu Guohui
Аннотация
BACKGROUND: The current tumor node metastasis (TNM) staging manual of the American Joint Committee on Cancer (AJCC) could not satisfactorily classify colorectal cancer (CRC) patients with lymph node examined (LNE) <12. This study aims to construct a novel staging system for better predicting cancer-specific survival (CSS) in this special population.
METHODS: Medical records of 4,170 CRC patients were retrospectively reviewed, including 3,927 cases from the Surveillance, Epidemiology, and End Results (SEER) database (development set) and 243 cases from The Second Affiliated Hospital of Harbin Medical University (validation set). Survival analysis was performed using Cox regression model. The best cutoff point of log odds of positive lymph nodes (LODDS) of CSS was calculated through the X-tile software. The performance of novel stage (nStage) was appraised by concordance index (C-index), receiver operating characteristic (ROC) curves and decision curve analyses (DCA).
RESULTS: LODDS was an independent prognosticator for CSS and a novel N stage (nN stage) was built subsequently (nN0: LODDS ≤-1.1, nN1: -1.1< LODDS ≤-0.2 or cancer nodule formation and nN2: LODDS >-0.2). The C-indexes in the nStage system were higher and the 5-year ROC curves and DCA showed the superior power of the model compared with the AJCC system. Besides, in nStage C-E but not A-B CRC, patients who were treated with adjuvant chemotherapy posed a better prognosis.
CONCLUSIONS: The nStage system demonstrated superiority over the AJCC staging system for CRC patients with LNE <12. And the proposed nStage system might provide clinicians with a potential reference for selecting patients who might benefit from adjuvant chemotherapy.
METHODS: Medical records of 4,170 CRC patients were retrospectively reviewed, including 3,927 cases from the Surveillance, Epidemiology, and End Results (SEER) database (development set) and 243 cases from The Second Affiliated Hospital of Harbin Medical University (validation set). Survival analysis was performed using Cox regression model. The best cutoff point of log odds of positive lymph nodes (LODDS) of CSS was calculated through the X-tile software. The performance of novel stage (nStage) was appraised by concordance index (C-index), receiver operating characteristic (ROC) curves and decision curve analyses (DCA).
RESULTS: LODDS was an independent prognosticator for CSS and a novel N stage (nN stage) was built subsequently (nN0: LODDS ≤-1.1, nN1: -1.1< LODDS ≤-0.2 or cancer nodule formation and nN2: LODDS >-0.2). The C-indexes in the nStage system were higher and the 5-year ROC curves and DCA showed the superior power of the model compared with the AJCC system. Besides, in nStage C-E but not A-B CRC, patients who were treated with adjuvant chemotherapy posed a better prognosis.
CONCLUSIONS: The nStage system demonstrated superiority over the AJCC staging system for CRC patients with LNE <12. And the proposed nStage system might provide clinicians with a potential reference for selecting patients who might benefit from adjuvant chemotherapy.