KEY TAKEAWAYS
- The study aimed to investigate the prognostic significance of NLC in patients with MSI-H CRC.
- Researchers noticed that reduced NLC is a stronger prognostic factor for MSI-H CRC than the N stage, TLN, and LNR.
Microsatellite instability-high (MSI-H) tumors, characterized by elevated tumor mutational burden and neoantigen expression, form a unique immune-activated subgroup in colorectal cancer (CRC). These tumors are marked by a pronounced lymph node reaction, locally advanced disease, and a higher number of total lymph nodes harvested (TLN), yet they exhibit fewer metastatic lymph nodes and a lower incidence of stages III-IV.
Despite these features, current staging systems such as the N stage and lymph-node ratio (LNR) have limitations in predicting prognosis for patients with MSI-H. Negative lymph node count (NLC) offers a more accurate measure of immune activation and tumor metastasis.
Xuan Dai and the team aimed to assess the prognostic significance of NLC in patients with MSI-H CRC and compare it with traditional measures including N stage, TLN, and LNR.
They performed an inclusive analysis of retrospective data from 190 patients with consecutive MSI-H CRC who underwent curative resection. Survival analyses were conducted using the Kaplan-Meier method. Clinicopathological variables, including NLC, N stage, TLN, and LNR, were evaluated through both univariate and multivariate COX regression analyses.
Additionally, ROC (receiver operating characteristic) curves and concordance index were utilized to compare the predictive efficacy of NLC, N stage, TLN, and LNR.
In patients with increased NLC, there was a significantly improved 5-year disease-free survival (DFS) and overall survival (OS) observed in Kaplan-Meier analysis, univariate analysis, and multivariate analysis, independent of potential confounders examined.
Increased NLC was associated with elevated 5-year DFS and 5-year OS rates. The area under the curve (AUC) and concordance index for NLC in predicting DFS and OS were both significantly higher compared to the N stage, TLN, and LNR.
The study concluded that NLC is an important independent prognostic factor for patients with MSI-H. Reduced NLC is associated with tumor recurrence and poor survival, and it serves as a stronger prognostic indicator compared to N stage, TLN, and LNR.
The study was supported by the National Natural Science Foundation of China and, the Natural Science Foundation of Shanghai.
Source: https://pubmed.ncbi.nlm.nih.gov/39030562/
Dai X, Dai Z, Fu J, et al. (2024). “Prognostic significance of negative lymph node count in microsatellite instability-high colorectal cancer.” World J Surg Oncol. 2024 Jul 19;22(1):186. doi: 10.1186/s12957-024-03469-4. PMID: 39030562.
