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Log odds of positive lymph nodes-based staging system for colorectal cancer patients with inadequate lymph nodes harvested: a potential reference for adjuvant chemotherapy

  • 0Department of General Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
Journal of Gastrointestinal Oncology +

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July 17, 2025

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July 17, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

A new colorectal cancer (CRC) staging system, the novel stage (nStage), improves survival prediction for patients with fewer than 12 lymph nodes examined (LNE). This system offers better accuracy than the current AJCC staging manual.

Area Of Science

  • Oncology
  • Cancer Research
  • Clinical Staging

Background

  • Current American Joint Committee on Cancer (AJCC) TNM staging manual inadequately classifies colorectal cancer (CRC) patients with fewer than 12 lymph nodes examined (LNE).
  • This limitation necessitates a refined staging system for improved prognostic accuracy in this specific CRC patient cohort.

Purpose Of The Study

  • To develop and validate a novel staging system for colorectal cancer (CRC) patients with limited lymph node examination (LNE <12).
  • To enhance the prediction of cancer-specific survival (CSS) in this patient group.

Main Methods

  • Retrospective review of 4,170 CRC patient records from SEER database and a single institution.
  • Survival analysis using Cox regression and X-tile software to determine optimal cutoff for log odds of positive lymph nodes (LODDS).
  • Performance evaluation of the novel stage (nStage) system using concordance index (C-index), ROC curves, and decision curve analyses (DCA) against the AJCC system.

Main Results

  • Log odds of positive lymph nodes (LODDS) identified as an independent prognosticator for CSS.
  • A novel N stage (nN stage) was constructed based on LODDS values.
  • The nStage system demonstrated superior predictive performance (higher C-indexes, better 5-year ROC curves and DCA) compared to the AJCC staging system.
  • Adjuvant chemotherapy showed improved prognosis in specific nStage subgroups (C-E) but not others (A-B).

Conclusions

  • The developed nStage system offers superior accuracy over the AJCC staging system for CRC patients with LNE <12.
  • The nStage system may assist clinicians in identifying CRC patients who could benefit from adjuvant chemotherapy.

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