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A Modified Tumor-Node-Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined

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Abstract

Background

To construct a modified tumor-node-metastasis (TNM) staging system for stage I-III colon cancer patients with lymph nodes examined (LNE) < 12.

Methods

The clinicopathological and survival data of 3870 stage I-III colon cancer patients with LNE < 12 from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 (development cohort) and 126 stage I-III patients with LNE < 12 from the Second Affiliated Hospital of Harbin Medical University between 2011 and 2015 (validation cohort) were identified. The optimal stratification of LNR for cancer-specific survival (CSS) was achieved using X-tile software. The predictive accuracy of the modified stage (mStage) was determined by the concordance index (C-index).

Results

The modified N stage (mN stage) was built based on the LNR (mN0: LNR = 0, mN1: 0 < LNR < 0.4 or cancer nodule formation and mN2: 0.4 ≤ LNR ≤ 1). Preferable C-indices could be found for mStage compared with TNM stage in both development (0.750 vs 0.727) and validation cohorts (0.682 vs 0.646). Besides, patients with mStage A and B diseases could not benefit from adjuvant chemotherapy, while in patients with mStage C-F diseases, those receiving radical surgery plus adjuvant chemotherapy presented better CSS than those with radical surgery alone.

Conclusions

The mStage system could predict the prognosis of colon cancer patients with LNE < 12 accurately and showed superior predictive power compared with conventional TNM staging system. Moreover, adjuvant chemotherapy might play inequable roles in patients with different mStage diseases.

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Data availability

The study data of development cohort are available from the SEER database.

Abbreviations

LNR:

Lymph node ratio

LNE:

Lymph nodes examined

TNM:

Tumor-node-metastasis

mStage:

Modified stage

SEER:

Surveillance, epidemiology, and end results

CSS:

Cancer-specific survival

ROC:

Receiver operating characteristic

AJCC:

American joint committee on cancer

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence intervals

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Acknowledgements

The authors acknowledge the efforts of the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER database.

Funding

None.

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Authors and Affiliations

  1. Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China

    Hao Zhang, Yunxiao Liu, Chunlin Wang, Zilong Guan, Hang Yu, Chao Xu, Mingyu Zheng, Yuliuming Wang, Hanqing Hu, Rui Huang & Guiyu Wang

  2. Department of Colorectal Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou, Zhejiang, China

    Guiyu Wang

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  1. Hao Zhang
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  2. Yunxiao Liu
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  4. Zilong Guan
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  5. Hang Yu
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  6. Chao Xu
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  8. Yuliuming Wang
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  11. Guiyu Wang
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Corresponding author

Correspondence to Guiyu Wang.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

This study was approved by the Second Affiliated Hospital of Harbin Medical University and Zhejiang Cancer Hospital. The study used de-identified data and adhered to World Medical Association’s Declaration of Helsinki for Ethical Human Research. The informed consent was not required according to personal identifying information was not included.

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Zhang, H., Liu, Y., Wang, C. et al. A Modified Tumor-Node-Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined. World J Surg 45, 2601–2609 (2021). https://doi.org/10.1007/s00268-021-06141-0

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  • DOI: https://doi.org/10.1007/s00268-021-06141-0

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