Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer.
Pei JP, Zhang R, Zhang NN, Zeng YJ, Sun Z, Ma SP, Zhou JG, Li XX, Fan J, Zhu J, Abe M, Mei ZB, Shi G, Zhang CD (2021)
Publication Type: Journal article
Publication year: 2021
Journal
Book Volume: 9
Journal Issue: 20
DOI: 10.21037/atm-21-3170
Abstract
Background: Lymph node ratio (LNR) has advantages in predicting prognosis compared with American Joint Committee on Cancer (AJCC) pathological N stage. However, the prognostic value of a novel T stage-lymph node ratio (TLNR) classification for colon cancer combining LNR and pathological primary tumor stage (T stage) is currently unknown. Methods: We included 62,294 patients with stage I-III colon cancer from the Surveillance, Epidemiology, and End Results Program as a training cohort. External validation was performed in 3,327 additional patients. A novel LNR stage was established and combined with T stage in a novel TLNR classification. Patients with similar survival were grouped according to T and LNR stages, with T1LNR1 as a reference. Results: We developed a novel TLNR classification as follows: stages I (T1LNR1-2, T1LNR4), IIA (T1LNR3, T2LNR1-2, T3LNR1), IIB (T1LNR5, T2LNR3-4, T3LNR2, T4aLNR1), IIC (T2LNR5, T3LNR3-4, T4aLNR2, T4bLNR1), IIIA (T3LNR5, T4aLNR3-4, T4bLNR2), IIIB (T4aLNR5, T4bLNR3-4), and IIIC (T4bLNR5). In the training cohort, the novel TLNR classification had better prognostic discrimination (area under receiver operating characteristic curve, 0.621 vs. 0.608, two-sided P<0.001), superior model-fitting ability for predicting overall survival (Akaike information criteria, 561,129 vs. 562,052), and better net benefits compared with the AJCC 8th tumor/node/metastasis classification. Similar results were found in the validation cohort for predicting both overall and disease-free survival. Conclusions: This novel TLNR classification may provide better prognostic discrimination, model-fitting ability, and net benefits than the AJCC 8th TNM classification, for potentially better stratification of patients with operable stage I-III colon cancer; however, further studies are required to validate the novel TLNR classification.
Involved external institutions
Fudan University / 复旦大学
China (CN)
China Medical University (CMU) / 中國醫藥大學
Taiwan (TW)
Fourth Military Medical University (FMMU) / 第四军医大学
China (CN)
University of Nebraska Medical Center (UNMC)
United States (USA) (US)
Zunyi Medical University
China (CN)
University of Tokyo
Japan (JP)
Shanghai University of Traditional Chinese Medicine (SHUTCM) / 上海中医药大学
China (CN)
China (CN)
China Medical University (CMU) / 中國醫藥大學
Taiwan (TW)
Fourth Military Medical University (FMMU) / 第四军医大学
China (CN)
University of Nebraska Medical Center (UNMC)
United States (USA) (US)
Zunyi Medical University
China (CN)
University of Tokyo
Japan (JP)
Shanghai University of Traditional Chinese Medicine (SHUTCM) / 上海中医药大学
China (CN)
How to cite
APA:
Pei, J.-P., Zhang, R., Zhang, N.-N., Zeng, Y.-J., Sun, Z., Ma, S.-P.,... Zhang, C.-D. (2021). Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer. Annals of Translational Medicine, 9(20). https://dx.doi.org/10.21037/atm-21-3170
MLA:
Pei, Jun-Peng, et al. "Screening and validation of a novel T stage-lymph node ratio classification for operable colon cancer." Annals of Translational Medicine 9.20 (2021).
BibTeX: Download