Log odds of positive lymph nodes show better predictive performance on the prognosis of early-onset colorectal cancer.

BACKGROUND: As the incidence of colorectal cancer tends to be younger, early-onset colorectal cancer (EOCRC) has attracted more attention in recent years. We aimed to assess the optimal lymph node staging system among EOCRC patients, and then, establish informative assessment models for prognosis prediction. METHODS: Data of EOCRC were retrieved from the Surveillance, Epidemiology, and End Results database. Survival prediction ability of three lymph node staging systems including N stage of the tumor node metastasis (TNM) staging system, lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) was assessed and compared using Akaike information criterion (AIC), Harrell's concordance index (C-index), and likelihood ratio (LR) test. Univariate and multivariate Cox regression analyses were conducted to identify the prognostic predictors for overall survival (OS) and cancer-specific survival (CSS). Effectiveness of the model was demonstrated by receiver operative curve and decision curve analysis. RESULTS: A total of 17,535 cases were finally included in this study. All three lymph node staging systems showed significant performance in survival prediction (p < 0.001). Comparatively, LODDS presented a better ability of prognosis prediction with lower AIC (OS: 70,510.99; CSS: 60,925.34), higher C-index (OS: 0.6617; CSS: 0.6799), and higher LR test score (OS: 998.65; CSS: 1103.09). Based on independent factors identified from Cox regression analysis, OS and CSS nomograms for EOCRC were established and validated. CONCLUSIONS: LODDS shows better predictive performance than N stage or LNR among patients with EOCRC. Novel validated nomograms based on LODDS could effectively provide more prognostic information than the TNM staging system.

The role of neoadjuvant chemotherapy in patients with locally advanced colon cancer: A systematic review and meta-analysis.

Background: Controversy persists about neoadjuvant chemotherapy (NAC) within the field of locally advanced colon cancer (LACC). The purpose of this study was to assess the existing and latest literature with high quality to determine the role of NAC in various aspects. Methods: A comprehensive literature search of the PubMed, Embase, Web of Science, and the Cochrane Library databases was conducted from inception to April 2022. Review Manager 5.3 was applied for meta-analyses with a random-effects model whenever possible. Results: Overall, 8 studies were included in this systematic review and meta-analysis, comprising 4 randomized controlled trials (RCTs) and 4 retrospective studies involving 40,136 participants. The 3-year overall survival (OS) (HR: 0.90, 95% CI: 0.66-1.23, P = 0.51) and 5-year OS (HR: 0.89, 95% CI: 0.53-1.03, P = 0.53) were comparable between two groups. Mortality in 30 days was found less frequent in the NAC group (OR: 0.43, 95% CI: 0.20-0.91, P = 0.03), whereas no significant differences were detected concerning other perioperative complications, R0 resection, or adverse events. In terms of subgroup analyses for RCTs, less anastomotic leak (OR: 0.51, 95% CI: 0.31-0.86, P = 0.01) and higher R0 resection rate (OR: 2.35, 95% CI: 1.04-5.32, P = 0.04) were observed in the NAC group. Conclusions: NAC is safe and feasible for patients with LACC, but no significant survival benefit could be demonstrated. The application of NAC still needs to be prudent until significant evidence supporting the oncological outcomes is presented. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier (CRD42022333306).