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Prognostic accuracy of different lymph node staging system in predicting overall survival in stage IV colon cancer.

Abstract：

PURPOSE:With emphasis of surgical management, the lymph node (LN) status has been advocated to predict prognosis in colon cancer with distant metastatic. Therefore, we tend to compare the prognostic performance of American Joint Committee on Cancer (AJCC) N-staging relative to lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS), and N-score in stage IV colon cancer. METHODS:About 20,961 patients who underwent primary surgical resection for stage IV colon cancer were extracted from Surveillance, Epidemiology, and End Results (SEER) Program database. Harrell's C statistic (C-index) and Akaike's Information Criterion (AIC) were used to distinguish the prognostic performance of the different LN-staging schemes. RESULTS:Of the 20,961 patients, 17,043 (81.3%) had been with lymph node metastasis, and the median number of examined lymph nodes (ELNs) was 15. When assessed as continuous values, the LODDS shown as the best system with greatest discriminatory power (C-index, 0.6241; AIC, 29114.29) generally and each subgroups divided by ELNs. When modeled as categorical cutoff variables for further clinical usage, the 8th AJCC N-stage outperformed the other three schemes with either ELNs less than 12 (C-index, 0.5770; AIC, 8992.638), between 12 and 25 (C-index, 0.6084; AIC, 13905.72), or more than 25(C-index, 0.6192; AIC, 3138.018) with increasing C-index and less AIC value. CONCLUSIONS:When assessed as categorical variables, N-stage performed superiorly regardless of ELNs. When assessed as a continuous variable, LODDS exhibited good discriminative ability and goodness of fit in predicting survival for colon cancer patients regardless of ELNs.

journal_name

Int J Colorectal Dis

journal_title

International journal of colorectal disease

authors

Han L,Mo S,Xiang W,Li Q,Wang R,Xu Y,Dai W,Cai G

doi

10.1007/s00384-019-03486-w

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

317-322

issue

2

eissn

0179-1958

issn

1432-1262

pii

10.1007/s00384-019-03486-w

journal_volume

35

pub_type

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