Lymph node yield does not affect the cancer-specific survival of patients with T1 colorectal cancer: a population-based retrospective study of the U.S. database and a Chinese registry.

Abstract

Purpose: This study aimed to investigate the association between lymph node yield (LNY) and cancer-specific survival (CSS) in patients with T1 colorectal cancer (CRC) via data from two large cohorts.

Methods: We analyzed data from 4186 patients in the SEER cohort (2010-2015) and 533 patients from CHCAMS (2014-2019). Patients were categorized into two groups based on whether their LNY was above or below the guideline-recommended threshold of 12 nodes. Propensity score matching was used to adjust for confounding factors, and survival analysis was conducted using Kaplan-Meier and Cox proportional hazards models.

Results: No significant difference in CSS was found between patients with LNY ≥ 12 and those with LNY < 12 in either the SEER or CHCAMS cohorts (log-rank P > 0.05 for both). After multivariate adjustment, LNY was not independently associated with CSS. Factors such as age, tumor location, elevated preoperative CEA levels, and adjuvant chemotherapy were significant prognostic factors in the SEER cohort. In the CHCAMS cohort, lymph node metastasis (LNM) emerged as the sole independent predictor of CSS.

Conclusion: Our findings suggest that LNY is not significantly associated with CSS in patients with T1 CRC, challenging the necessity of adhering to the 12-node benchmark for early-stage disease. Instead, factors such as tumor biology, LNM, and patient demographics may be more relevant in determining survival outcomes. Further prospective studies are needed to validate these findings and refine guidelines for lymph node assessment in early-stage CRC.