Abstract
Background and Objectives: Currently, the United States Joint Commission on Cancer (AJCC) N staging, lymph node positive rate (LNR), and log odds of positive lymph nodes (LODDS) are the main lymph node (LN) staging systems. However, the type of LN staging system that is more accurate in terms of prognostic performance remains controversial. We compared the prognostic accuracy of the three staging systems in patients with CRC and determine the best choice for clinical applications.Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, 56,747 patients were identified who were diagnosed with CRC between 2004 and 2013. Akaike's Information Criterion (AIC) and Harrell's Consistency Index (c-index) were used to assess the relative discriminative abilities of different LN staging systems.Results: In 56,747 patients, when using classification cut-off values for evaluation, the LNR of Rosenberg et al. showed significantly better predictive power, especially when the number of dissected lymph nodes (NDLN) were insufficient. When analyzed as a continuous variable, the LODDS staging system performed the best and was not affected by the NDLN.Conclusions: We suggest that the LNR of Rosenberg et al. should be introduced into the AJCC system as a supplement when the NDLN is insufficient until the optimal LODDS cut-off values are calculated.
Highlights
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in men and women in the United States [1]
Among the 90,529 patients diagnosed with CRC between these years, patients with the following characteristics were included: (a) the patients were over 18 years old; (b) CRC was the first and only malignant tumor; (c) surgical resection was performed; (d) there was complete staging information; and (e) no neoadjuvant chemoradiation was used in treatment
The mean ± standard deviation of NDLN and number of positive lymph nodes (NPLN) in the whole cohort were 16.9 ± 9.8 and 1.6 ± 3.3, respectively. 10,613 (18.7%) subjects had tumor located in the rectum and 46,134 (81.3%) were in the colon
Summary
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in men and women in the United States [1]. The most representative of these LN staging systems are the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) eighth edition N staging [3], lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS). The goal of cancer staging systems is to group patients with similar prognosis. The United States Joint Commission on Cancer (AJCC) N staging, lymph node positive rate (LNR), and log odds of positive lymph nodes (LODDS) are the main lymph node (LN) staging systems. We compared the prognostic accuracy of the three staging systems in patients with CRC and determine the best choice for clinical applications
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