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Evaluation of the prognostic performance of different cutoff values of lymph node ratio staging system for stage III colorectal cancer

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Abstract

This study attempted to compare the prognostic performance of lymph node ratio (LNR) staging system with different cutoff values relative to American Joint Committee on Cancer (AJCC) pN staging system in stage III colorectal cancer (CRC). Overall, 45,069 patients from the SEER dataset and 69 patients from the Second Affiliated Hospital of Nanjing Medical University (the External set) who underwent surgical resection of the primary tumor and were diagnosed with stage III CRC by postoperative pathology were included. Patients were divided into three subgroups based on the LNR cutoff used in previous studies, Kaplan–Meier curves were plotted, and log-rank test was used to compare the differences among groups in terms of cancer-specific survival (CSS). Cox regression model was applied for survival analysis. To evaluate the discriminatory power of different lymph node staging systems, Harrell’s C statistic(C-index) and Akaike’s Information Criterion (AIC) were applied. A set of optimal cutoff values (0.11; 0.36; 0.66) of LNR staging system with the most considerable discriminatory power to the prognosis in patients with stage III CRC (SEER set: C-index = 0.714; AIC = 58,942.46, External set: C-index = 0.809; AIC = 164.36) were obtained, and both were superior to the AJCC pN staging system (SEER set: C-index = 0.708; AIC = 59,071.20, External set: C-index = 0.788; AIC = 167.06). For evaluating the prognostic efficacy of patients with stage III colorectal cancer, the cutoff value (0.11; 0.36; 0.66) of LNR staging system had the best discrimination and prognostic ability, which was superior to LNR staging system under other cutoff values and AJCC pN staging system.

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Data availability

The datasets used in this study are accessible to the corresponding author upon reasonable request.

Abbreviations

CRC:

Colorectal cancer

PLNs:

Positive lymph nodes

ELNs:

Examined lymph nodes

LNR:

Lymph node ratio

AIC:

Akaike’s Information Criterion

SEER:

The Surveillance, Epidemiology, and End Results

C-index:

Harrell’s concordance index

CSS:

Cancer-specific survival

AJCC:

American Joint Committee on Cancer

LODDS:

Log odds of positive lymph nodes

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Acknowledgements

Not applicable.

Funding

The research was funded by the following grants: General Program of National Natural Science Foundation of China (No.82373293); Research project of Jiangsu Commission of Health (No. ZD2022063); The fifth phase of the "333 Project" scientific research project of Jiangsu Province (No. BRA2020091); Primary Research and Development Plan of Jiangsu Province (No. BE2019759); the National Key Research and Development Program of China (No. 2018YFE0127300).

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Author notes

  1. Yimin E, Chen Lu and Zijun Wang contributed equally as co-first authors. Chunzhao Yu is the first corresponding author of this article.

Authors and Affiliations

  1. Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China

    Yimin E, Zijun Wang, Xiagang Luo, Chaoshun Chu & Chunzhao Yu

  2. Department of General Surgery, Sir Run Run Hospital Nanjing Medical University, Nanjing, China

    Chen Lu, Pengcheng Ji & Chunzhao Yu

  3. Department of Anorectal Surgery, Suzhou Xiangcheng People’s Hospital, Suzhou, China

    Yicheng Huang

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  1. Yimin E
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Contributions

YE: data curation (lead); writing—original draft (lead); writing—review and editing (lead); visualization (lead); formal analysis (lead). CL: investigation (equal); methodology (equal); writing—original draft (equal). PJ: formal analysis (equal); methodology (equal). YH: methodology (equal); visualization (equal). XL: data curation (equal); formal analysis (equal). ZW: validation (equal); writing—review and editing (equal). CC: resources (equal); funding acquisition (equal); supervision (equal); investigation (equal); methodology (lead); writing—review and editing (lead). CY: data curation (equal); methodology (equal); validation (equal); writing—review and editing (equal). YE, CL and ZW should be considered as co-first authors. CY is the first corresponding author of this article.

Corresponding authors

Correspondence to Chaoshun Chu or Chunzhao Yu.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study was reviewed and approved by the Medical Ethics Committee of the Second Affiliated Hospital of Nanjing Medical University.

Patient consent

As a retrospective study, this study did not require written informed consent from the patients.

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E, Y., Lu, C., Wang, Z. et al. Evaluation of the prognostic performance of different cutoff values of lymph node ratio staging system for stage III colorectal cancer. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01770-1

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