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Examining More Lymph Nodes May Improve the Prognosis of Patients With Right Colon Cancer: Determining the Optimal Minimum Lymph Node Count
OBJECTIVES: The objective is to determine the optimal minimum lymph node examination number for right colon cancer (RCC) patients. METHODS: We comprehensively analysed the Surveillance, Epidemiology and End Results database data from 2004 to 2016 to determine the 13-year trend in the number of lymph...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728779/ https://www.ncbi.nlm.nih.gov/pubmed/34928724 http://dx.doi.org/10.1177/10732748211064034 |
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author | Wu, Wentao Li, Daning Ma, Wen Zheng, Shuai Han, Didi Xu, Fengshuo Yan, Hong Lyu, Jun |
author_facet | Wu, Wentao Li, Daning Ma, Wen Zheng, Shuai Han, Didi Xu, Fengshuo Yan, Hong Lyu, Jun |
author_sort | Wu, Wentao |
collection | PubMed |
description | OBJECTIVES: The objective is to determine the optimal minimum lymph node examination number for right colon cancer (RCC) patients. METHODS: We comprehensively analysed the Surveillance, Epidemiology and End Results database data from 2004 to 2016 to determine the 13-year trend in the number of lymph nodes examined among 108,703 left colon cancer and 165,937 RCC patients. 133,137 RCC patients eligible for inclusion were used to determine the optimal minimum for lymph node examination. We used restricted cubic splines to analyse the dose-response relationship between the number of lymph nodes examined and prognosis. X-tiles and decision trees were used to determine the optimal cutoff for the number of lymph nodes based on the survival outcomes of patients with RCC. The Kaplan–Meier method and COX model were used to estimate the overall survival and independent prognostic factors, and a prediction model was constructed. The C-index, calibration curve, net reclassification improvement and integrated discrimination improvement were used to determine the predictive performance of the model, and decision curve analysis was used to evaluate the benefits. RESULTS: Lymph node examinations were common among colon cancer patients over the 13-year study period. It is generally agreed that at least 12 lymph nodes must be examined to ensure proper dissection and accurate staging of RCC; however, the optimal number of lymph nodes to be examined is controversial. The dose-response relationship indicated that 12 was not the optimal minimum number of lymph nodes for RCC patients. X-tile and survival decision-tree analysis indicated that 20 nodes was the optimal number. Survival analysis indicated that <20 nodes examined was a risk factor for poor prognosis, and the classification performance was superior for 20 nodes compared to 12 nodes. CONCLUSION: Lymph node examination in RCC patients should be altered. Our research suggests that a 20-node measure may be more suitable for RCC patients. |
format | Online Article Text |
id | pubmed-8728779 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-87287792022-01-06 Examining More Lymph Nodes May Improve the Prognosis of Patients With Right Colon Cancer: Determining the Optimal Minimum Lymph Node Count Wu, Wentao Li, Daning Ma, Wen Zheng, Shuai Han, Didi Xu, Fengshuo Yan, Hong Lyu, Jun Cancer Control Original Research Article OBJECTIVES: The objective is to determine the optimal minimum lymph node examination number for right colon cancer (RCC) patients. METHODS: We comprehensively analysed the Surveillance, Epidemiology and End Results database data from 2004 to 2016 to determine the 13-year trend in the number of lymph nodes examined among 108,703 left colon cancer and 165,937 RCC patients. 133,137 RCC patients eligible for inclusion were used to determine the optimal minimum for lymph node examination. We used restricted cubic splines to analyse the dose-response relationship between the number of lymph nodes examined and prognosis. X-tiles and decision trees were used to determine the optimal cutoff for the number of lymph nodes based on the survival outcomes of patients with RCC. The Kaplan–Meier method and COX model were used to estimate the overall survival and independent prognostic factors, and a prediction model was constructed. The C-index, calibration curve, net reclassification improvement and integrated discrimination improvement were used to determine the predictive performance of the model, and decision curve analysis was used to evaluate the benefits. RESULTS: Lymph node examinations were common among colon cancer patients over the 13-year study period. It is generally agreed that at least 12 lymph nodes must be examined to ensure proper dissection and accurate staging of RCC; however, the optimal number of lymph nodes to be examined is controversial. The dose-response relationship indicated that 12 was not the optimal minimum number of lymph nodes for RCC patients. X-tile and survival decision-tree analysis indicated that 20 nodes was the optimal number. Survival analysis indicated that <20 nodes examined was a risk factor for poor prognosis, and the classification performance was superior for 20 nodes compared to 12 nodes. CONCLUSION: Lymph node examination in RCC patients should be altered. Our research suggests that a 20-node measure may be more suitable for RCC patients. SAGE Publications 2021-12-20 /pmc/articles/PMC8728779/ /pubmed/34928724 http://dx.doi.org/10.1177/10732748211064034 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Article Wu, Wentao Li, Daning Ma, Wen Zheng, Shuai Han, Didi Xu, Fengshuo Yan, Hong Lyu, Jun Examining More Lymph Nodes May Improve the Prognosis of Patients With Right Colon Cancer: Determining the Optimal Minimum Lymph Node Count |
title | Examining More Lymph Nodes May Improve the Prognosis of Patients With
Right Colon Cancer: Determining the Optimal Minimum Lymph Node
Count |
title_full | Examining More Lymph Nodes May Improve the Prognosis of Patients With
Right Colon Cancer: Determining the Optimal Minimum Lymph Node
Count |
title_fullStr | Examining More Lymph Nodes May Improve the Prognosis of Patients With
Right Colon Cancer: Determining the Optimal Minimum Lymph Node
Count |
title_full_unstemmed | Examining More Lymph Nodes May Improve the Prognosis of Patients With
Right Colon Cancer: Determining the Optimal Minimum Lymph Node
Count |
title_short | Examining More Lymph Nodes May Improve the Prognosis of Patients With
Right Colon Cancer: Determining the Optimal Minimum Lymph Node
Count |
title_sort | examining more lymph nodes may improve the prognosis of patients with
right colon cancer: determining the optimal minimum lymph node
count |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728779/ https://www.ncbi.nlm.nih.gov/pubmed/34928724 http://dx.doi.org/10.1177/10732748211064034 |
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