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Meta-Analysis
. 2023 Dec 22;13(12):e072244.
doi: 10.1136/bmjopen-2023-072244.

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Qianqian Liu #  1   2 , Min Huang #  1   2 , Jing Yang  1   2 , Mengyuan Jiang  1   2 , Ziru Zhao  1   2 , Haitong Zhao  3 , Tingting He  1   2 , Yuping Bai  4 , Rui Zhang  1   2 , Min Zhang  5
Affiliations
Meta-Analysis

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Qianqian Liu et al. BMJ Open. .

Abstract

Objective: Clinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.

Design: Systematic review and meta-analysis of primary studies.

Data sources: PubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.

Eligibility criteria for selecting studies: Studies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.

Data extraction and synthesis: OR with 95% conference intervals was extracted and pooled.

Results: A total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph-vascular invasion were not significantly associated with the lymph node yield.

Conclusions: The study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.

Keywords: gastrointestinal tumours; public health; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the study selection. BMI, body mass index; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
The forest of factors associated with the number of lymph node yield in colorectal cancer. BMI, body mass index.
Figure 3
Figure 3
The forest of factors associated with the number of lymph node yield in colon cancer.
Figure 4
Figure 4
The funnel plot of gender in colorectal cancer.
See this image and copyright information in PMC

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