Different lymph node staging systems for predicting the prognosis of colorectal neuroendocrine neoplasms

Yuan-Yi Zhang; Yue-Wei Cai; Xia Zhang

doi:10.4251/wjgo.v16.i5.1745

Different lymph node staging systems for predicting the prognosis of colorectal neuroendocrine neoplasms

World J Gastrointest Oncol. 2024 May 15;16(5):1745-1755. doi: 10.4251/wjgo.v16.i5.1745.

Authors

Yuan-Yi Zhang¹, Yue-Wei Cai², Xia Zhang³

Affiliations

¹ Department of Pathology, Zhaoqing Medical College, Zhaoqing 526020, Guangdong Province, China. yyzhang_zqmedco@163.com.
² Department of Emergency, Zhaoqing Second People's Hospital, Zhaoqing 526020, Guangdong Province, China.
³ Department of Pathology and Physiology, Zhaoqing Medical College, Zhaoqing 526020, Guangdong Province, China.

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: Colorectal neuroendocrine neoplasms; Log odds of positive lymph nodes; Lymph node ratio; Positive lymph node; Prognosis.