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Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer

BACKGROUND: Lymph node ratio (LNR) has advantages in predicting prognosis compared with American Joint Committee on Cancer (AJCC) pathological N stage. However, the prognostic value of a novel T stage-lymph node ratio (TLNR) classification for colon cancer combining LNR and pathological primary tumo...

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Autores principales: Pei, Jun-Peng, Zhang, Rui, Zhang, Nan-Nan, Zeng, Yong-Ji, Sun, Zhe, Ma, Si-Ping, Zhou, Jian-Guo, Li, Xin-Xiang, Fan, Jin, Zhu, Ji, Abe, Masanobu, Mei, Zu-Bing, Shi, Gang, Zhang, Chun-Dong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576719/
https://www.ncbi.nlm.nih.gov/pubmed/34790719
http://dx.doi.org/10.21037/atm-21-3170
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author Pei, Jun-Peng
Zhang, Rui
Zhang, Nan-Nan
Zeng, Yong-Ji
Sun, Zhe
Ma, Si-Ping
Zhou, Jian-Guo
Li, Xin-Xiang
Fan, Jin
Zhu, Ji
Abe, Masanobu
Mei, Zu-Bing
Shi, Gang
Zhang, Chun-Dong
author_facet Pei, Jun-Peng
Zhang, Rui
Zhang, Nan-Nan
Zeng, Yong-Ji
Sun, Zhe
Ma, Si-Ping
Zhou, Jian-Guo
Li, Xin-Xiang
Fan, Jin
Zhu, Ji
Abe, Masanobu
Mei, Zu-Bing
Shi, Gang
Zhang, Chun-Dong
author_sort Pei, Jun-Peng
collection PubMed
description BACKGROUND: Lymph node ratio (LNR) has advantages in predicting prognosis compared with American Joint Committee on Cancer (AJCC) pathological N stage. However, the prognostic value of a novel T stage-lymph node ratio (TLNR) classification for colon cancer combining LNR and pathological primary tumor stage (T stage) is currently unknown. METHODS: We included 62,294 patients with stage I–III colon cancer from the Surveillance, Epidemiology, and End Results Program as a training cohort. External validation was performed in 3,327 additional patients. A novel LNR stage was established and combined with T stage in a novel TLNR classification. Patients with similar survival were grouped according to T and LNR stages, with T1LNR1 as a reference. RESULTS: We developed a novel TLNR classification as follows: stages I (T1LNR1-2, T1LNR4), IIA (T1LNR3, T2LNR1-2, T3LNR1), IIB (T1LNR5, T2LNR3-4, T3LNR2, T4aLNR1), IIC (T2LNR5, T3LNR3-4, T4aLNR2, T4bLNR1), IIIA (T3LNR5, T4aLNR3-4, T4bLNR2), IIIB (T4aLNR5, T4bLNR3-4), and IIIC (T4bLNR5). In the training cohort, the novel TLNR classification had better prognostic discrimination (area under receiver operating characteristic curve, 0.621 vs. 0.608, two-sided P<0.001), superior model-fitting ability for predicting overall survival (Akaike information criteria, 561,129 vs. 562,052), and better net benefits compared with the AJCC 8(th) tumor/node/metastasis classification. Similar results were found in the validation cohort for predicting both overall and disease-free survival. CONCLUSIONS: This novel TLNR classification may provide better prognostic discrimination, model-fitting ability, and net benefits than the AJCC 8(th) TNM classification, for potentially better stratification of patients with operable stage I–III colon cancer; however, further studies are required to validate the novel TLNR classification.
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spelling pubmed-85767192021-11-16 Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer Pei, Jun-Peng Zhang, Rui Zhang, Nan-Nan Zeng, Yong-Ji Sun, Zhe Ma, Si-Ping Zhou, Jian-Guo Li, Xin-Xiang Fan, Jin Zhu, Ji Abe, Masanobu Mei, Zu-Bing Shi, Gang Zhang, Chun-Dong Ann Transl Med Original Article BACKGROUND: Lymph node ratio (LNR) has advantages in predicting prognosis compared with American Joint Committee on Cancer (AJCC) pathological N stage. However, the prognostic value of a novel T stage-lymph node ratio (TLNR) classification for colon cancer combining LNR and pathological primary tumor stage (T stage) is currently unknown. METHODS: We included 62,294 patients with stage I–III colon cancer from the Surveillance, Epidemiology, and End Results Program as a training cohort. External validation was performed in 3,327 additional patients. A novel LNR stage was established and combined with T stage in a novel TLNR classification. Patients with similar survival were grouped according to T and LNR stages, with T1LNR1 as a reference. RESULTS: We developed a novel TLNR classification as follows: stages I (T1LNR1-2, T1LNR4), IIA (T1LNR3, T2LNR1-2, T3LNR1), IIB (T1LNR5, T2LNR3-4, T3LNR2, T4aLNR1), IIC (T2LNR5, T3LNR3-4, T4aLNR2, T4bLNR1), IIIA (T3LNR5, T4aLNR3-4, T4bLNR2), IIIB (T4aLNR5, T4bLNR3-4), and IIIC (T4bLNR5). In the training cohort, the novel TLNR classification had better prognostic discrimination (area under receiver operating characteristic curve, 0.621 vs. 0.608, two-sided P<0.001), superior model-fitting ability for predicting overall survival (Akaike information criteria, 561,129 vs. 562,052), and better net benefits compared with the AJCC 8(th) tumor/node/metastasis classification. Similar results were found in the validation cohort for predicting both overall and disease-free survival. CONCLUSIONS: This novel TLNR classification may provide better prognostic discrimination, model-fitting ability, and net benefits than the AJCC 8(th) TNM classification, for potentially better stratification of patients with operable stage I–III colon cancer; however, further studies are required to validate the novel TLNR classification. AME Publishing Company 2021-10 /pmc/articles/PMC8576719/ /pubmed/34790719 http://dx.doi.org/10.21037/atm-21-3170 Text en 2021 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Pei, Jun-Peng
Zhang, Rui
Zhang, Nan-Nan
Zeng, Yong-Ji
Sun, Zhe
Ma, Si-Ping
Zhou, Jian-Guo
Li, Xin-Xiang
Fan, Jin
Zhu, Ji
Abe, Masanobu
Mei, Zu-Bing
Shi, Gang
Zhang, Chun-Dong
Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer
title Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer
title_full Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer
title_fullStr Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer
title_full_unstemmed Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer
title_short Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer
title_sort screening and validation of a novel t stage-lymph node ratio classification for operable colon cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576719/
https://www.ncbi.nlm.nih.gov/pubmed/34790719
http://dx.doi.org/10.21037/atm-21-3170
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