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Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study

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作者：
Yin Qiying[1,2] * ; Sun Yanlai[3] * ; Jing Changqing[4] ; Liang Benjia[4] ; Guan Xu[5] ; Zhang Peng[6] ; Tao Kaixiong[6] ; Sun Yueming[7] ; Zhang Yifei[8] ; Ning Shanglei[9] ; Yu Minhao[10] ; Lv Yanfeng[11] ; Wang Lei[12] ; Sun Qi[13] ; Liu Jiangang[14] ; Jiao Meng[14] ; Zhang Zhao[15] ; Jiang Congqing[16] ; Ren Xianghai[16] ; Yu Guodong[17] ; Ma Bin[18] ; Ye Zhibin[19] ; Li Jun[20] ; Liu Dongning[21] ; Kong Xiangheng[22] ; Chen Jingbo[2] ; Zhang Guangyong[2] ; Yang Hui[2] ;
机构： [1]Department of Clinical Medicine, Jining Medical University, Jining 272067, China [2]Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan 250000, Shandong, China. [3]Department of General Surgery, Affiliated Cancer Hospital of Shandong First Medical University, Jinan 250000, Shandong, China. [4]Department of General Surgery, Shandong First Medical University Affiliated Provincial Hospital, Jinan 250000, Shandong, China. [5]Department of General Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Chaoyang,100020, Beijing, China. [6]Department of General Surgery, Union Hospital affiliated to Huazhong University of Scienceand Technology, Wuhan 430000, Hubei, China. [7]Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu, China. [8]Department of General Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China. [9]Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250000, Shandong, China. [10]Department of General Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Huangpu, 200001, Shanghai, China. [11]Department of General Surgery, Second Hospital of Shandong University, Jinan 250000, Shandong, China. [12]Department of General Surgery, Jinan Central Hospital, Jinan 250000, Shandong, China. [13]Department of General Surgery, The First Affiliated Hospital of Xi 'an Jiaotong University, Xian, 710000, Shanxi, China. [14]Department of General Surgery, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, Shandong, China. [15]Department of General Surgery, Tianjin People's Hospital, Hongqiao, 300131, Tianjin, China. [16]Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. [17]Department of General Surgery, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, China. [18]Department of General Surgery, Liaoning Cancer Hospital and Institute. Shenyang, 110000, Liaoning, China. [19]Department of General Surgery, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China. [20]Department of General Surgery, Ningxia Medical University General Hospital, Yinchuang, 750000, Ningxia, China. [21]Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi,China. [22]Department of General Surgery, Liaocheng People's Hospital, Liaocheng, 252000, Shandong,China.
出处：
DOI： 10.1097/JS9.0000000000002545
ISSN：

摘要：
While the currently recommended minimum number of examined lymph nodes (ELNs) for colorectal cancer is 12, the applicability of this standard to colorectal mucinous adenocarcinoma (MAC), a distinct tumor entity with high metastatic potential, remains controversial. This study aimed to establish and validate the optimal ELN threshold during surgery to achieve superior survival outcomes of MAC patients.Data from 21 Chinese medical institutions and the Surveillance, Epidemiology, and End Results (SEER) database were analyzed using Cox proportional hazards models to identify prognostic factors affecting MAC patient outcomes. Restricted cubic spline (RCS) analysis was subsequently applied to determine the optimal ELN threshold.The ELN distribution pattern demonstrated significant concordance between the Chinese cohort (n = 1086) and the SEER cohort (n = 12 343), with identical median values (17) and overlapping interquartile ranges (SEER: 12-23 vs. China: 13-22). Multivariate analyses adjusted for potential confounders established ELN quantity as an independent prognostic factor (SEER cohort: hazard ratio [HR] = 0.987, 95% confidence interval [CI]: 0.985-0.990, P < 0.001; Chinese cohort: HR = 0.975, 95% CI: 0.957-0.994, P = 0.011). The RCS models in both databases revealed a nonlinear L-shaped association between the ELN count and all-cause mortality risk, with 17 ELNs identified as the optimal threshold. Notably, patients with ≥17 ELNs exhibited significantly reduced mortality risks in both the SEER cohort (P < 0.001) and the Chinese cohort (P = 0.45), particularly in node-negative patients and those without adjuvant chemotherapy.Elevated ELN counts are correlated with improved survival. Our findings strongly suggest that 17 ELNs is the optimal cutoff for evaluating surgical quality and prognostic stratification in MAC patients, challenging the conventional 12-ELN standard.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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大类 | 2 区 医学
小类 | 2 区 外科
第一作者：
第一作者机构： [1]Department of Clinical Medicine, Jining Medical University, Jining 272067, China [2]Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan 250000, Shandong, China.
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推荐引用方式(GB/T 7714)：
Yin Qiying,Sun Yanlai,Jing Changqing,et al.Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study[J].International Journal Of Surgery (London, England).2025,doi:10.1097/JS9.0000000000002545.
APA：
Yin Qiying,Sun Yanlai,Jing Changqing,Liang Benjia,Guan Xu...&Yang Hui.(2025).Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study.International Journal Of Surgery (London, England),,
MLA：
Yin Qiying,et al."Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study".International Journal Of Surgery (London, England) .(2025)

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