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A absolute of 39155 CRC patients were calm from the Surveillance, Epidemiology, and End After-effects (SEER) database, including 2863 patients with TDs and 36292 patients after TDs. There were no cogent differences amid the TD ( ) accumulation and the TD (−) accumulation apropos the characteristics of sex and race. In the TD ( ) group, 1819 patients (63.5%) were ages <70 years, 2668 patients (93.2%) were classified as T3/T4, 1007 patients (35.2%) were classified as N2, 776 patients (27.1%) had brand III/IV tumour, 201 patients (7.0%) had mucinous adenocarcinoma, 37 patients (1.4%) had blazonry arena corpuscle blight and 859 patients (30.0%) were classified as M1; the accommodation of these characteristics were acutely college than those in the counterparts of the TD (−) group. In addition, colon blight patients accounted for 72.3% of the TD ( ) group, which was a lower allotment than that of the TD (−) group. Detailed advice is listed in Table 1.



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The CRC patients were disconnected into three subgroups: patients after mLN, patients with 1–3 mLNs, and patients with ≥4 mLNs. Then, the cancer-specific adaptation (CSS) was compared amid TD ( ) and TD (−) patients amid these three subgroups. Here, the after-effects showed that the 3- and 5-year CCS ante of TD ( ) patients were acutely lower than those of TD (−) patients in the three subgroups (P < 0.0001) (Fig. 1A–C). Furthermore, the 5-year CSS ante were decidedly decreased in those patients with accretion numbers of TDs (Fig. 1D). This aftereffect adumbrated that TD was not alone an important anxiety agency for CRC patients, but additionally TD calculation should be absolutely advised in the appraisal of the TD status.

Survival comparisons amid TD ( ) and TD (−) patients. (A) Adaptation allegory amid TD ( ) and TD (−) patients after mLNs. (B) Adaptation allegory amid TD ( ) and TD (−) patients with 1–3 mLNs. (C) Adaptation allegory amid TD ( ) and TD (−) patients with ≥4 mLNs. (D) Adaptation allegory amid patients with altered numbers of TDs. HR: hazard ratio.

Due to the access of counting TDs on the prognosis, we chip the cardinal of TDs into the TNM staging arrangement to acting the accepted “N1c” to added authorize a added accurate and reasonable TNM staging system. However, it is capital to analyze the anxiety alternation amid the cardinal of mLNs and the cardinal of TDs. First, we declared that the anxiety bulk of one TD was agnate to that of one mLN. To appraise whether one TD possesses the aforementioned weight as one mLN in agreement of prognosis, we compared the CSS amid patients with TDs and patients after TDs in the new N category. Here, the absolute cardinal of mLNs was according to the sum of absolute mLNs and TDs. The after-effects showed that the CSS of TD ( ) patients was decidedly worse than that of TD (−) patients (Fig. 2), which adumbrated that the arrangement of 1:1 for mLNs to TDs did not accurately ascertain the anxiety bulk of TDs for CRC patients.



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Survival comparisons amid TD ( ) and TD (−) patients with the aforementioned cardinal of mLNs. The cardinal of mLNs is according to the sum of absolute mLNs and TDs. (A) Adaptation allegory amid TD ( ) and TD (−) patients with 1 mLN. (B) Adaptation allegory amid TD ( ) and TD (−) patients with 2–3 mLNs. (C) Adaptation allegory amid TD ( ) and TD (−) patients with 4–6 mLNs. (D) Adaptation allegory amid TD ( ) and TD (−) patients with ≥7 mLNs.

To added analyze the anxiety weight of TDs, we declared afresh that the anxiety bulk of one TD was according to that of two mLNs. Then, we compared the CSS amid patients with TDs and patients after TDs in anniversary atypical N category. Here, the after-effects showed that the CSS ante of patients with TDs and after TDs were constant amid these subgroups (Fig. 3). This appropriate that the anxiety bulk of one TD was agnate to that of two mLNs.

Survival comparisons amid TD ( ) and TD (−) patients with the aforementioned cardinal of mLNs. The cardinal of mLNs is according to the sum of the cardinal of absolute mLNs and bifold the cardinal of TDs. (A) Adaptation allegory amid TD ( ) and TD (−) patients with 2–3 mLNs. (B) Adaptation allegory amid TD ( ) and TD (−) patients with 4–6 mLNs. (C) Adaptation allegory amid TD ( ) and TD (−) patients with ≥7 mLNs.

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To added verify the anxiety bulk of TDs, we anon and alone compared the CSS ante amid patients with alone 1 TD and patients with alone 2 mLNs, amid patients with alone 2 TDs and patients with alone 4 mLNs, amid patients with alone 3 TDs and patients with alone 6 mLNs. We begin no adaptation differences amid TDs and mLNs amid these compared groups (Fig. 4).

Validating the anxiety bulk of TDs. (A) Adaptation allegory amid patients with alone 1 TD and patients with alone 2 mLNs. (B) Adaptation allegory amid patients with alone 2 TDs and patients with alone 4 mLNs. (C) Adaptation allegory amid patients with alone 3 TDs and patients with alone 6 mLNs.

Although the anxiety bulk of one TD actuality agnate to two mLNs has been determined, belief one TD as three or four mLNs was still performed to draw a cessation added cautiously. Supplementary Fig. S1 shows that the CSS ante of patients with TDs were constant with those of patients after TDs. Nevertheless, Supplementary Fig. S2 shows that the cast of 2 TDs was above to that of 6 mLNs and the cast of 3 TDs was above to that of 9 mLNs. Apropos the application of one TD as four mLNs, the CSS of the TD ( ) accumulation was decidedly college than that of the TD (−) accumulation (Supplementary Figs. S3, S4). Therefore, the role of TDs on cast was abstract by belief one TD as three or four mLNs. Belief one TD as two mLNs is the best ratio.

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To exclude the access of T date on N stage, adaptation comparisons were alone performed in every T category. The after-effects showed that the CSS ante of patients with TDs were according to those after TDs amid these six subgroups, which added accepted that the anxiety bulk of one TD actuality according to that of two mLNs was reasonable and accurate (Fig. 5).

Survival allegory amid TD ( ) and TD (−) patients in every T class with the aforementioned bulk of mLNs. The cardinal of mLNs is according to the sum of the cardinal of absolute mLNs and bifold the cardinal of TDs. (A) Adaptation allegory amid TD ( ) and TD (−) T1/T2 patients with 2–3 mLNs. (B) Adaptation allegory amid TD ( ) and TD (−) T3/T4 patients with 2–3 mLNs. (C) Adaptation allegory amid TD ( ) and TD (−) T1/T2 patients with 4–6 mLNs. (D) Adaptation allegory amid TD ( ) and TD (−) T3/T4 patients with 4–6 mLNs. (E) Adaptation allegory amid TD ( ) and TD (−) T1/T2 patients with ≥7 mLNs. (F) Adaptation allegory amid TD ( ) and TD (−) T3/T4 patients with ≥7 mLNs.

To exclude the access of tumour area on TDs, adaptation comparisons were alone performed for colon blight and abdominal cancer. In the acceptable N staging adjustment of colon cancer, there was a cogent aberration amid the TD ( ) and TD (−) groups (P < 0.0001) (Supplementary Fig. S5). However, amalgam the TD calculation into the N class with the arrangement of TDs to mLNs of 1:2 alone the anxiety aberration amid the two groups (Supplementary Fig. S6). The aforementioned aftereffect was acquired for abdominal blight (Supplementary Figs. S7, S8). Therefore, it is achievable and all-important to attention a TD as two mLNs in both colon and abdominal cancers.

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Due to the anxiety bulk of 1 TD actuality agnate to that of 2 mLNs, the cardinal of TDs was chip into the N date with a arrangement of TDs to mLNs of 1:2. Therefore, the atypical N date was accustomed as follows: nN0 (no mLNs and no TDs), nN1a (1 mLN), nN1b (the sum of mLNs and bifold the cardinal of TDs is according to 2 or 3), nN2a (the sum of mLNs and bifold the cardinal of TDs is according to 4–6), and nN2b (the sum of mLNs and bifold the cardinal of TDs is greater than 6); the capacity are apparent in Fig. 6.

The atypical N staging system.

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