Finding the minimum number of retrieved lymph nodes in Node-negative colorectal cancer using Real-world Data and the SEER database

Abstract

Background: Current clinical guidelines recommend the removal of at least 12 lymph nodes (LNs) in resectable colorectal cancer (CRC). With advancements in lymphadenectomy technologies, the number of retrieved lymph nodes (rLNs) has markedly increased. This study aimed to investigate the lowest number of rLNs in node-negative patients. Materials and Methods: A total of 1103 N0 and 208 N1a stage patients were enrolled in our cohort, while 8503 N0 and 1276 N1a patients from the Surveillance, Epidemiology, and End Results CRC database were included. Propensity score matching and multivariate Cox regression analyses were performed to mitigate the influence of selection bias and control for potential confounding variables. Results: The median number of rLNs in N0 patients increased from 13.5 (interquartile range [IQR]: 9-18) in 2013 to 17 (IQR: 15-20) in 2019. The restrictive cubic spline illustrated a nonlinear relationship between rLNs and prognosis (nonlinearity, P=0.009), with a threshold (N=16) influencing clinical outcomes. Patients at either N0 or N1a stage with sufficient rLNs (≥ 16) demonstrated superior prognoses to those with a limited rLNs (<16). After adjusting for clinical confounders, similar prognoses were observed in N0 limited and N1a adequate populations. Furthermore, Kaplan-Meier curves revealed N0 limited patients who received chemotherapy exhibited better outcomes than those who did not. Conclusions: Among patients with node-negative CRC, it is crucial to remove 16 or more LNs effectively. Fewer than 16 rLNs should be regarded as an independent risk factor, implying the need for adjuvant chemotherapy.

A commentary on the article entitled ‘Finding the minimum number of retrieved lymph nodes in node-negative colorectal cancer using Real-world Data and the SEER database’

“…We were highly interested in the article entitled ‘Finding the minimum number of retrieved lymph nodes in node-negative colorectal cancer using Real-world Data and the SEER database’, which was published in the International Journal of Surgery 1 . The NCCN (National Comprehensive Cancer Network) Guidelines for colon and rectal cancer recommend the examination of a minimum of 12 lymph nodes (LNs) to accurately identify the status of lymph node metastases (LNM).…”