Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based study Article Swipe
Qingsong Yin
,
Yanlai Sun
,
Changqing Jing
,
Benjia Liang
,
Xu Guan
,
Pengfei Zhang
,
Kaixiong Tao
,
Yueming Sun
,
Yifei Zhang
,
Shanglei Ning
,
Minhao Yu
,
Yanfeng Lv
,
Yaohui Wang
,
Qi Sun
,
Jiangang Liu
,
Jiao Meng
,
Zhao Zhang
,
Congqing Jiang
,
Xianghai Ren
,
Guodong Yu
,
Bin Ma
,
Zhibin Ye
,
Jie Li
,
Dongning Liu
,
Xiangheng Kong
,
Jingbo Chen
,
Guangyong Zhang
,
Hui Yang
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1097/js9.0000000000002545
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1097/js9.0000000000002545
Background: 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. Methods: 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. Results: 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 = 0.045), particularly in node-negative patients and those without adjuvant chemotherapy. Conclusion: 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.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1097/js9.0000000000002545
- OA Status
- diamond
- References
- 28
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4410511323
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4410511323Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1097/js9.0000000000002545Digital Object Identifier
- Title
-
Optimizing lymph node evaluation in colorectal mucinous adenocarcinoma: a multicenter and population-based studyWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-05-20Full publication date if available
- Authors
-
Qingsong Yin, Yanlai Sun, Changqing Jing, Benjia Liang, Xu Guan, Pengfei Zhang, Kaixiong Tao, Yueming Sun, Yifei Zhang, Shanglei Ning, Minhao Yu, Yanfeng Lv, Yaohui Wang, Qi Sun, Jiangang Liu, Jiao Meng, Zhao Zhang, Congqing Jiang, Xianghai Ren, Guodong Yu, Bin Ma, Zhibin Ye, Jie Li, Dongning Liu, Xiangheng Kong, Jingbo Chen, Guangyong Zhang, Hui YangList of authors in order
- Landing page
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https://doi.org/10.1097/js9.0000000000002545Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
diamondOpen access status per OpenAlex
- OA URL
-
https://doi.org/10.1097/js9.0000000000002545Direct OA link when available
- Concepts
-
Medicine, Colorectal adenocarcinoma, Lymph node, Adenocarcinoma, Population, Multicenter study, Colorectal cancer, Oncology, General surgery, Internal medicine, Randomized controlled trial, Cancer, Environmental healthTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- References (count)
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28Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.patients | 210, 239 |
| abstract_inverted_index.quantity | 150 |
| abstract_inverted_index.revealed | 188 |
| abstract_inverted_index.standard | 21 |
| abstract_inverted_index.strongly | 256 |
| abstract_inverted_index.superior | 52 |
| abstract_inverted_index.surgical | 267 |
| abstract_inverted_index.survival | 53 |
| abstract_inverted_index.validate | 43 |
| abstract_inverted_index.13–22). | 141 |
| abstract_inverted_index.affecting | 85 |
| abstract_inverted_index.all-cause | 198 |
| abstract_inverted_index.currently | 3 |
| abstract_inverted_index.databases | 187 |
| abstract_inverted_index.determine | 98 |
| abstract_inverted_index.establish | 41 |
| abstract_inverted_index.exhibited | 214 |
| abstract_inverted_index.identical | 129 |
| abstract_inverted_index.mortality | 199, 217 |
| abstract_inverted_index.nonlinear | 190 |
| abstract_inverted_index.outcomes. | 88 |
| abstract_inverted_index.patients, | 274 |
| abstract_inverted_index.patients. | 57 |
| abstract_inverted_index.potential | 146 |
| abstract_inverted_index.standard. | 279 |
| abstract_inverted_index.survival. | 253 |
| abstract_inverted_index.threshold | 47 |
| abstract_inverted_index.Restricted | 89 |
| abstract_inverted_index.colorectal | 13, 23 |
| abstract_inverted_index.confidence | 164 |
| abstract_inverted_index.correlated | 250 |
| abstract_inverted_index.evaluating | 266 |
| abstract_inverted_index.identified | 204 |
| abstract_inverted_index.metastatic | 33 |
| abstract_inverted_index.potential, | 34 |
| abstract_inverted_index.prognostic | 83, 154, 270 |
| abstract_inverted_index.threshold. | 102, 208 |
| abstract_inverted_index.Background: | 0 |
| abstract_inverted_index.Conclusion: | 245 |
| abstract_inverted_index.association | 192 |
| abstract_inverted_index.challenging | 275 |
| abstract_inverted_index.concordance | 110 |
| abstract_inverted_index.confounders | 147 |
| abstract_inverted_index.established | 148 |
| abstract_inverted_index.independent | 153 |
| abstract_inverted_index.overlapping | 134 |
| abstract_inverted_index.recommended | 4 |
| abstract_inverted_index.significant | 109 |
| abstract_inverted_index.Multivariate | 142 |
| abstract_inverted_index.conventional | 277 |
| abstract_inverted_index.demonstrated | 108 |
| abstract_inverted_index.distribution | 106 |
| abstract_inverted_index.institutions | 64 |
| abstract_inverted_index.particularly | 236 |
| abstract_inverted_index.proportional | 78 |
| abstract_inverted_index.subsequently | 95 |
| abstract_inverted_index.Epidemiology, | 68 |
| abstract_inverted_index.Surveillance, | 67 |
| abstract_inverted_index.applicability | 18 |
| abstract_inverted_index.chemotherapy. | 244 |
| abstract_inverted_index.interquartile | 135 |
| abstract_inverted_index.node-negative | 238 |
| abstract_inverted_index.significantly | 215 |
| abstract_inverted_index.0.957–0.994, | 178 |
| abstract_inverted_index.0.985–0.990, | 167 |
| abstract_inverted_index.adenocarcinoma | 25 |
| abstract_inverted_index.controversial. | 36 |
| abstract_inverted_index.stratification | 271 |
| cited_by_percentile_year | |
| countries_distinct_count | 1 |
| institutions_distinct_count | 28 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8799999952316284 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.28915431 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |