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Log odds of positive lymph nodes show better predictive performance on the prognosis of early-onset colorectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

As the incidence of colorectal cancer tends to be younger, early-onset colorectal cancer (EOCRC) has attracted more attention in recent years. We aimed to assess the optimal lymph node staging system among EOCRC patients, and then, establish informative assessment models for prognosis prediction.

Methods

Data of EOCRC were retrieved from the Surveillance, Epidemiology, and End Results database. Survival prediction ability of three lymph node staging systems including N stage of the tumor node metastasis (TNM) staging system, lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) was assessed and compared using Akaike information criterion (AIC), Harrell’s concordance index (C-index), and likelihood ratio (LR) test. Univariate and multivariate Cox regression analyses were conducted to identify the prognostic predictors for overall survival (OS) and cancer-specific survival (CSS). Effectiveness of the model was demonstrated by receiver operative curve and decision curve analysis.

Results

A total of 17,535 cases were finally included in this study. All three lymph node staging systems showed significant performance in survival prediction (p < 0.001). Comparatively, LODDS presented a better ability of prognosis prediction with lower AIC (OS: 70,510.99; CSS: 60,925.34), higher C-index (OS: 0.6617; CSS: 0.6799), and higher LR test score (OS: 998.65; CSS: 1103.09). Based on independent factors identified from Cox regression analysis, OS and CSS nomograms for EOCRC were established and validated.

Conclusions

LODDS shows better predictive performance than N stage or LNR among patients with EOCRC. Novel validated nomograms based on LODDS could effectively provide more prognostic information than the TNM staging system.

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Data availability

The data generated and analyzed during the current study are available in the SEER database, which could be obtained via the SEER*Stat software (http://seer.cancer.gov/seerstat/) from the latest version of the SEER database of the National Cancer Institute (NCI).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People’s Republic of China

    Zongyu Liang, Deyu Xiang, Haina Lyu, Zhu Li, Qingshui Yang & Xiaobin Zhang

  2. Department of Proctology Surgery (Second Department of General Surgery), The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, 528000, People’s Republic of China

    Jiahao Feng, Guangzhi Mai & Wanchuan Wang

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  1. Zongyu Liang
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Deyu Xiang, Jiahao Feng, and Haina Lyu. Data analyses were performed by Zongyu Liang, Zhu Li, and Guangzhi Mai. Figures and tables were prepared by Qingshui Yang and Wanchuan Wang. The first draft of the manuscript was written by Zongyu Liang and Xiaobin Zhang. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaobin Zhang.

Ethics declarations

Ethics approval

Permission was obtained to retrieve SEER data files with the reference number 19019-Nov2021. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No ethics approval was declared because the SEER is a publicly available database.

Consent to participate

As patient data were recorded in the SEER database without involving any individual identification, the present study was dispensed with signing informed consent forms.

Competing interests

The authors declare no competing interests.

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Zongyu Liang, Deyu Xiang, Jiahao Feng, and Haina Lyu are co-first authors and contributed equally to the work.

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Liang, Z., Xiang, D., Feng, J. et al. Log odds of positive lymph nodes show better predictive performance on the prognosis of early-onset colorectal cancer. Int J Colorectal Dis 38, 192 (2023). https://doi.org/10.1007/s00384-023-04490-x

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