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Stage migration resulting from inadequate number of examined lymph nodes impacts prognosis in stage II colon cancer after radical surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

We evaluated the impact of examined lymph node (ELN) number on the prognosis of stage II colon cancer after radical surgery and developed a novel prognostic scoring system by combining primary tumor extension (pT) and ELN number for reclassification of stage II colon cancer.

Methods

Three cohorts of patients diagnosed with colon cancer between 2004 and 2010 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to evaluate the relationship between factors and patients’ survival including cause-specific survival (CSS) and overall survival (OS). Survival curves from subgroups were plotted by the Kaplan-Meier method and compared by the log-rank test.

Results

Cohort 1 and cohort 2 consisted of 13,960 and 5312 stage II colon cancer patients, respectively. Cohort 3 consisted of 4713 stage III patients. Factors including ELN, age, and pT were found to be associated with patients’ survival in cohorts 1 and 2. Patients who were older or with smaller tumors were more likely to experience inadequate ELN. Patients with a higher score, as calculated by the novel scoring system, showed worse survival. Compared with stage III colon cancer patients, stage II patients with high scores had a comparable or even worse survival than stage IIIA and IIIB patients.

Conclusion

Inadequate ELN leads to understaging in stage II colon cancer and predicts inferior prognosis. Our analyses show that the novel prognostic scoring system, consisting of combined pT and ELN, quantified stage migration effect and can be applied to the reclassification of stage II colon cancer.

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Data availability

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

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Acknowledgments

We thank Darleny Lizardo (Department of Pharmacology and Chemical Biology, UPMC Hillman Cancer Centre, Pittsburgh) for critically reading the manuscript. The authors acknowledge the efforts of the Surveillance, Epidemiology, and End Results (SEER) Program in the creation and maintenance of the SEER database (https://seer.cancer.gov/).

Funding

This work was supported by the China Scholarship Council (201806370121).

Author information

Authors and Affiliations

  1. Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China

    Di Xie

  2. Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, People’s Republic of China

    Xiangping Song

  3. Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, People’s Republic of China

    Lingling Tong

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  1. Di Xie
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  2. Xiangping Song
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Contributions

Xiangping Song and Di Xie carried out the concept and designed the study. Xiangping Song, Di Xie, and Lingling Tong had the responsibility for the integrity and accuracy of data analysis. Di Xie and Xiangping Song wrote the manuscript and all the authors approved the final version.

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Correspondence to Xiangping Song.

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The authors declare that they have no conflict of interest.

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

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Fig. S1:

Inadequate ELN is associated with inferior prognosis of stage II patients with different age ranges. (A, D) Among patients with age ≤ 60, those with smaller ELN numbers had both worse cause-specific and overall survival. (B, E) Among patients with age range from 61 to 79, those with smaller ELN numbers had both worse cause-specific and overall survival. (C, F) Among patients with age ≥ 80, those with smaller ELN numbers had both worse cause-specific and overall survival. (DOCX 2844 kb).

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Xie, D., Song, X. & Tong, L. Stage migration resulting from inadequate number of examined lymph nodes impacts prognosis in stage II colon cancer after radical surgery. Int J Colorectal Dis 36, 959–969 (2021). https://doi.org/10.1007/s00384-020-03794-6

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