Nonlinear association between number of lymph nodes resected and survival in T1N0M0 colorectal cancer: a SEER-based analysis.

Authors

Jinyi Xu, Taiwei Ye, Haoliang Ni, Xihan Jin, Jianping Wang, Bin Lai, Xiaoqiang Niu

Published in

Updates in surgery. Sep 10, 2026. Epub Sep 10, 2026.

Abstract

The number of lymph nodes retrieved (NLNR) is a key prognostic factor in colorectal cancer (CRC), yet its relationship with outcomes in early-stage (T1N0M0) disease remains unclear. We performed a retrospective cohort study using SEER data (2010-2022) including 8,012 T1N0M0 CRC patients treated with radical resection. Patients were dichotomized by NLNR (< 12 vs. ≥ 12) and propensity score matching (PSM) was applied. Survival was evaluated by Kaplan-Meier analysis; multivariable Cox regression examined NLNR as a continuous predictor of overall survival (OS). Restricted cubic spline (RCS) modelling explored nonlinear associations, including within subgroups defined by tumor location: right-sided colon, transverse colon, left-sided colon, and rectal cancer. Subgroup analyses were also performed. Before PSM, the ≥ 12-node group showed superior OS and cancer-specific survival (CSS) (both p < 0.001); after PSM differences were no longer statistically significant (OS p = 0.059; CSS p = 0.090). In multivariable Cox analysis NLNR was independently associated with improved OS (HR 0.992, 95% CI 0.985-0.998). RCS revealed a significant nonlinear relationship with OS (P for nonlinearity = 0.019): each additional node below 25 conferred reduced mortality (HR 0.982 per node, 95% CI 0.972-0.993, p < 0.001), whereas benefit plateaued beyond 25 nodes (HR 1.001, p = 0.343). The nonlinear association between NLNR and OS remained significant in the left-sided colon and rectal cancer subgroups but was not statistically significant among patients with right-sided or transverse colon cancer. Subgroup analyses were broadly consistent; a significant interaction with sex was observed (P for interaction = 0.012). In T1N0M0 CRC, NLNR is an independent predictor of long-term survival and exhibits a distinct threshold effect. This effect is more pronounced in left-sided colon and rectal cancers.

PMID:
42720902
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.