Optimal number of the examined lymph nodes for different N stages in colorectal cancer
Abstract The National Comprehensive Cancer Network (NCCN) recommends that at least 12 lymph nodes (LNs) should be harvested during radical surgery of colorectal cancer (CRC). This study aims to clarify the optimal number of LNs that should be examined during the radical surgery for CRC patients with...
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| Language: | English |
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BMC
2025-08-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-025-02990-w |
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| author | Ye Tian Xinyu Qiao Gaozan Zheng Hanjun Dan Xinyu Dou Guangming Ren Liaoran Niu Pengfei Wang Siyuan Wang Fengsu Wu Yumao Yang Jianyong Zheng Fan Feng |
| author_facet | Ye Tian Xinyu Qiao Gaozan Zheng Hanjun Dan Xinyu Dou Guangming Ren Liaoran Niu Pengfei Wang Siyuan Wang Fengsu Wu Yumao Yang Jianyong Zheng Fan Feng |
| author_sort | Ye Tian |
| collection | DOAJ |
| description | Abstract The National Comprehensive Cancer Network (NCCN) recommends that at least 12 lymph nodes (LNs) should be harvested during radical surgery of colorectal cancer (CRC). This study aims to clarify the optimal number of LNs that should be examined during the radical surgery for CRC patients with each N stage. The SEER database (n = 48,331) served as the primary cohort, while the Xijing cohort (n = 4447) was used for external validation. A Cox proportional hazards regression model was employed to evaluate risk factors associated with overall survival (OS) in CRC. Moreover, the restricted cubic splines (RCS) method was used to detect inflection points within the risk function and to investigate the correlation between the number of examined lymph nodes (ELNs) and OS. Ultimately, the optimal number of ELNs for patients at different N stages was determined and verified. The analyses from both databases consistently indicated that a higher number of ELNs is an independent prognostic factor for the OS of patients with CRC. 18 and 19 are identified as the optimal numbers of ELNs for N0, N1a, and N1b, N2a stages, respectively. The Kaplan–Meier analysis revealed that there was a statistical difference in the OS between patients in the limited group and those in the adequate group among the neighboring N subgroups. For CRC patients with different N stages, the number of LNs that needs to be cleared varies. Number of ELNs exceeded 18, 18, 19 and 19 could significantly improve the prognosis of patients with N0, N1a, N1b and N2a stages, respectively. |
| format | Article |
| id | doaj-art-6fc764fb43c146f39ae5b8d64edd9c58 |
| institution | Kabale University |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj-art-6fc764fb43c146f39ae5b8d64edd9c582025-08-20T04:01:53ZengBMCEuropean Journal of Medical Research2047-783X2025-08-0130111010.1186/s40001-025-02990-wOptimal number of the examined lymph nodes for different N stages in colorectal cancerYe Tian0Xinyu Qiao1Gaozan Zheng2Hanjun Dan3Xinyu Dou4Guangming Ren5Liaoran Niu6Pengfei Wang7Siyuan Wang8Fengsu Wu9Yumao Yang10Jianyong Zheng11Fan Feng12Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Gastroenterology, The 989, Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation ArmyDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of General Surgery, Air Force 986(Th) Hospital, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical UniversityAbstract The National Comprehensive Cancer Network (NCCN) recommends that at least 12 lymph nodes (LNs) should be harvested during radical surgery of colorectal cancer (CRC). This study aims to clarify the optimal number of LNs that should be examined during the radical surgery for CRC patients with each N stage. The SEER database (n = 48,331) served as the primary cohort, while the Xijing cohort (n = 4447) was used for external validation. A Cox proportional hazards regression model was employed to evaluate risk factors associated with overall survival (OS) in CRC. Moreover, the restricted cubic splines (RCS) method was used to detect inflection points within the risk function and to investigate the correlation between the number of examined lymph nodes (ELNs) and OS. Ultimately, the optimal number of ELNs for patients at different N stages was determined and verified. The analyses from both databases consistently indicated that a higher number of ELNs is an independent prognostic factor for the OS of patients with CRC. 18 and 19 are identified as the optimal numbers of ELNs for N0, N1a, and N1b, N2a stages, respectively. The Kaplan–Meier analysis revealed that there was a statistical difference in the OS between patients in the limited group and those in the adequate group among the neighboring N subgroups. For CRC patients with different N stages, the number of LNs that needs to be cleared varies. Number of ELNs exceeded 18, 18, 19 and 19 could significantly improve the prognosis of patients with N0, N1a, N1b and N2a stages, respectively.https://doi.org/10.1186/s40001-025-02990-wColorectal cancerLymph nodesPrognosis |
| spellingShingle | Ye Tian Xinyu Qiao Gaozan Zheng Hanjun Dan Xinyu Dou Guangming Ren Liaoran Niu Pengfei Wang Siyuan Wang Fengsu Wu Yumao Yang Jianyong Zheng Fan Feng Optimal number of the examined lymph nodes for different N stages in colorectal cancer European Journal of Medical Research Colorectal cancer Lymph nodes Prognosis |
| title | Optimal number of the examined lymph nodes for different N stages in colorectal cancer |
| title_full | Optimal number of the examined lymph nodes for different N stages in colorectal cancer |
| title_fullStr | Optimal number of the examined lymph nodes for different N stages in colorectal cancer |
| title_full_unstemmed | Optimal number of the examined lymph nodes for different N stages in colorectal cancer |
| title_short | Optimal number of the examined lymph nodes for different N stages in colorectal cancer |
| title_sort | optimal number of the examined lymph nodes for different n stages in colorectal cancer |
| topic | Colorectal cancer Lymph nodes Prognosis |
| url | https://doi.org/10.1186/s40001-025-02990-w |
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