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Prognostic impact of the number of lymph nodes examined in different stages of colorectal mucinous adenocarcinoma

Authors Ma Y, Luo YQ, Lin N, Lv YZ, Zhou Y, Li B, Han KN, Jiang S, Gao JJ

Received 19 January 2018

Accepted for publication 25 April 2018

Published 25 June 2018 Volume 2018:11 Pages 3659—3670

DOI https://doi.org/10.2147/OTT.S163076

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Carlos E Vigil


Yong Ma,* Yiqian Luo,* Nan Lin, Yongzhu Lv, Yang Zhou, Bing Li, Kunna Han, Song Jiang, Jianjun Gao

Department of General Surgery, 210 Hospital of Chinese People’s Liberation Army, Dalian 116000, Liaoning, China

*These authors contributed equally to this work

Background:
Mucinous adenocarcinoma (MC) is a special kind of colorectal adenocarcinoma that occurs more frequently in young patients and females, but the prognostic effect of lymph nodes in MC patients is unclear. This population-based study was conducted to analyze the prognostic value of the number of lymph nodes examined in different stages of colorectal MC.
Methods:
We included 17,001 MC patients from the Surveillance, Epidemiology, and End Results program database between 2003 and 2013, of which 12,812 (75%) had >12 lymph nodes examined.
Results: Compared to the group with insufficient lymph nodes examined, patients with more lymph nodes (>12) examined tended to come from east and central America, were more frequently female and young, were diagnosed after 2008, had larger-sized tumors of less differentiated grade and in later stages, had not received radiation therapy and had more positive nodal status. Patients with more lymph nodes (>12) examined demonstrated significantly better survival than those with insufficient lymph nodes examined only in stages II and III (stage II: overall, P<0.001; cancer-specific, P<0.001; stage III: overall, P=0.093; cancer-specific, P=0.032), even though the overall (P<0.001) and cancer-specific survival (P<0.001) showed significant differences between the two groups. Both univariate (overall, HR=0.739, 95% CI=0.703–0.777, P<0.001; cancer-specific, HR=0.742, 95% CI=0.698–0.788, P<0.001) and multivariate (overall, HR=0.601, 95% CI=0.537–0.673, P<0.001; cancer-specific, HR=0.582, 95% CI=0.511–0.664, P<0.001) Cox proportional hazards models verified the association between >12 lymph nodes examined and better survival.
Conclusion:
More number of lymph nodes >12) examined significantly increased the survival probability of MC patients in stages II and III, but had no significant influence on patients in stages I and IV, indicating the effect of number of lymph nodes examined was a stage-dependent prognostic factor in clinical utility.

Keywords: number of lymph nodes examined, stages, mucinous carcinoma

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