Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2024; 16(5): 1745-1755
Published online May 15, 2024. doi: 10.4251/wjgo.v16.i5.1745
Different lymph node staging systems for predicting the prognosis of colorectal neuroendocrine neoplasms
Yuan-Yi Zhang, Yue-Wei Cai, Xia Zhang
Yuan-Yi Zhang, Department of Pathology, Zhaoqing Medical College, Zhaoqing 526020, Guangdong Province, China
Yue-Wei Cai, Department of Emergency, Zhaoqing Second People’s Hospital, Zhaoqing 526020, Guangdong Province, China
Xia Zhang, Department of Pathology and Physiology, Zhaoqing Medical College, Zhaoqing 526020, Guangdong Province, China
Author contributions: Zhang YY conceived and designed the study; Zhang YY, Cai YW, and Zhang X collected the data, analyzed, and interpreted the data; Zhang YY wrote the manuscript, and provided critical revisions that are important for the intellectual content; and all authors approved the final version of the manuscript.
Supported by the Zhaoqing Science and Technology Innovation Guidance Project, No. 2022040314032.
Institutional review board statement: SEER database belongs to public databases, the patients involved in the database have obtained ethical approval, users can download relevant data for free for research and publish relevant articles, and our study is based on open-source data, and the Zhaoqing Medical College do not require research using publicly available data to be submitted for review to their ethics committee, so there are no ethical issues and other conflicts of interest.
Informed consent statement: The informed consent was waived from the patients since the SEER database belongs to public databases.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Yi Zhang, MM, Department of Pathology, Zhaoqing Medical College, No. 12 Fengle Road, Zhaoqing New District, Zhaoqing 526020, Guangdong Province, China. yyzhang_zqmedco@163.com
Received: November 15, 2023
Peer-review started: November 15, 2023
First decision: January 30, 2024
Revised: February 20, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: May 15, 2024
Abstract
BACKGROUND

Colorectal neuroendocrine neoplasms (NENs) are a rare malignancy that primarily arises from the diffuse distribution of neuroendocrine cells in the colon and rectum. Previous studies have pointed out that the status of lymph node may be used to predict the prognosis.

AIM

To investigate the predictive values of lymph node ratio (LNR), positive lymph node (PLN), and log odds of PLNs (LODDS) staging systems on the prognosis of colorectal NENs treated surgically, and compare their predictive values.

METHODS

This cohort study included 895 patients with colorectal NENs treated surgically from the Surveillance, Epidemiology, and End Results database. The endpoint was mortality of patients with colorectal NENs treated surgically. X-tile software was utilized to identify most suitable thresholds for categorizing the LNR, PLN, and LODDS. Participants were selected in a random manner to form training and testing sets. The prognosis of surgically treating colorectal NENs was examined using multivariate cox analysis to assess the associations of LNR, PLN, and LODDS with the prognosis of colorectal NENs. C-index was used for assessing the predictive effectiveness. We conducted a subgroup analysis to explore the different lymph node staging systems’ predictive values.

RESULTS

After adjusting all confounding factors, PLN, LNR and LODDS staging systems were linked with mortality in patients with colorectal NENs treated surgically (P < 0.05). We found that LODDS staging had a higher prognostic value for patients with colorectal NENs treated surgically than PLN and LNR staging systems. Similar results were obtained in the different G staging subgroup analyses. Furthermore, the area under the receiver operating characteristic curve values for LODDS staging system remained consistently higher than those of PLN or LNR, even at the 1-, 2-, 3-, 4-, 5- and 6-year follow-up periods.

CONCLUSION

LNR, PLN, and LODDS were found to significantly predict the prognosis of patients with colorectal NENs treated surgically.

Keywords: Positive lymph node, Lymph node ratio, Log odds of positive lymph nodes, Prognosis, Colorectal neuroendocrine neoplasms

Core Tip: The present study utilized data extracted from a publicly available Surveillance, Epidemiology, and End Results database and employed multivariate cox analysis, revealing that lymph node ratio (LNR), positive lymph node (PLN), and log odds of PLNs (LODDS) staging systems was significantly related to mortality among patients with colorectal neuroendocrine neoplasms treated surgically. Additionally, the LODDS staging demonstrated a higher prognostic value compared to the PLN and LNR staging systems.