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Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study.
Qiying Yin1,2, Yanlai Sun3, Changqing Jing4
1Department of Clinical Medicine, Jining Medical University, Jining, China.
International Journal of Surgery (London, England)
|May 20, 2025
Summary
For colorectal mucinous adenocarcinoma (MAC), examining 17 lymph nodes (ELNs) is superior to the standard 12. This higher threshold improves survival outcomes and aids in prognostic stratification for MAC patients.
Area of Science:
- Oncology
- Surgical Pathology
- Cancer Research
Background:
- Colorectal mucinous adenocarcinoma (MAC) is a distinct subtype with high metastatic potential.
- The current standard of 12 examined lymph nodes (ELNs) for colorectal cancer may not be optimal for MAC.
- This study addresses the controversy surrounding the appropriate ELN threshold for MAC.
Purpose of the Study:
- To establish and validate the optimal ELN threshold for colorectal mucinous adenocarcinoma (MAC) surgery.
- To improve survival outcomes for MAC patients through optimized lymph node examination.
- To challenge the conventional 12-ELN standard for MAC.
Main Methods:
- Analysis of data from 21 Chinese medical institutions and the SEER database.
- Utilized Cox proportional hazards models to identify prognostic factors for MAC.
- Applied Restricted Cubic Spline (RCS) analysis to determine the optimal ELN threshold.
Main Results:
- ELN quantity is an independent prognostic factor for MAC patients in both cohorts.
- A nonlinear, L-shaped association was observed between ELN count and mortality risk.
- 17 ELNs was identified as the optimal threshold, significantly reducing mortality risk, especially in node-negative patients.
Conclusions:
- Elevated ELN counts correlate with improved survival in MAC patients.
- The optimal ELN cutoff for evaluating surgical quality and prognosis in MAC is 17.
- Findings challenge the conventional 12-ELN standard, advocating for a higher threshold for MAC.
