ArticleUpdates in surgery2026
Nonlinear association between number of lymph nodes resected and survival in T1N0M0 colorectal cancer: a SEER-based analysis.
Article in Updates in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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