Background
Methods
Statistical analysis
Results
Patient characteristics
Patients characteristics | Full cohort (N = 63,243 | Right-sided (N = 39,024) | Left-sided (N = 24,219) | |||
---|---|---|---|---|---|---|
Total number of lymph nodes < 12 | Total number of lymph nodes ≥12 | Total number of lymph nodes < 12 | Total number of lymph nodes ≥12 | Total number of lymph nodes < 12 | Total number of lymph nodes ≥12 | |
16,127 (25.5%) | 47,116 (74.5%) | 8370 (21.4%) | 30,654 (78.6%) | 7757 (32.0%) | 16,462 (68.0%) | |
Age at diagnosis | ||||||
< 40 | 277 (1.7%) | 1800 (3.8%) | 93 (1.1%) | 885 (2.9%) | 184 (2.4%) | 915 (5.6%) |
40–49 | 872 (5.4%) | 3631 (7.7%) | 291 (3.5%) | 1792 (5.8%) | 581 (7.5%) | 1839 (11.2%) |
50–59 | 2473 (15.3%) | 8658 (18.4%) | 889 (10.6%) | 4658 (15.2%) | 1584 (20.4%) | 4000 (24.3%) |
60–69 | 3664 (22.7%) | 10,934 (23.2%) | 1719 (20.5%) | 6984 (22.8%) | 1945 (25.1%) | 3950 (24.0%) |
> 70 | 8841 (54.8%) | 22,093 (46.9%) | 5378 (64.3%) | 16,335 (53.3%) | 3463 (44.6%) | 5758 (35.0%) |
Gender | ||||||
Male | 8011 (49.7%) | 22,422 (47.6%) | 3828 (45.7%) | 13,797 (45.0%) | 4183 (53.9%) | 8625 (52.4%) |
Female | 8116 (47.6%) | 24,694 (52.4%) | 4542 (54.3%) | 16,857 (55.0%) | 3574 (46.1%) | 7837 (47.6%) |
Race | ||||||
Black | 2144 (13.3%) | 5796 (12.3%) | 1113 (13.3%) | 3805 (12.4%) | 1031 (34.1%) | 1991 (12.1%) |
White | 12,446 (77.2%) | 37,081 (78.7%) | 6691 (79.9%) | 24,651 (80.4%) | 5755 (74.2%) | 12,430 (75.5%) |
Hispanic/Latino | 119 (0.7%) | 296 (0.6%) | 69 (0.8%) | 181 (0.6%) | 50 (0.6%) | 115 (0.7%) |
Asian or Pacific Islander and others | 1378 (8.5%) | 3784 (8.0%) | 484 (5.8%) | 1922 (6.3%) | 894 (11.5%) | 1862 (11.3%) |
Unknown | 40 (0.2%) | 159 (0.3%) | 13 (0.2%) | 95 (0.3%) | 27 (0.3%) | 64 (0.4%) |
Hispanic | ||||||
No | 14,460 (89.7%) | 42,480 (90.2%) | 7579 (90.5%) | 27,800 (90.7%) | 6881 (88.7%) | 14,680 (89.2%) |
Yes | 1667 (10.3%) | 4636 (9.8%) | 791 (9.5%) | 2854 (9.3%) | 876 (11.3%) | 1782 (10.8%) |
T stage | ||||||
T0–T2 (0, 2, 3) | 2723 (16.9%) | 5553 (11.8%) | 1144 (13.7%) | 3437 (11.2%) | 1579 (20.4%) | 2116 (12.9%) |
T3–T4 (4, 5) | 13,376 (82.9%) | 41,503 (88.1%) | 7216 (86.2%) | 27,181 (88.7%) | 6160 (79.4%) | 14,322 (87.0%) |
TX (6) | 28 (0.2%) | 60 (0.1%) | 10 (0.1%) | 36 (0.1%) | 18 (0.2%) | 24 (0.1%) |
N stage | ||||||
N1 | 12,005 (74.4%) | 29,678 (63.0%) | 6057 (72.4%) | 19,100 (62.3%) | 5948 (76.7%) | 1809 (23.3%) |
N2 | 4122 (25.6%) | 17,438 (37.0%) | 2313 (27.6%) | 11,554 (37.7%) | 10,578 (64.3%) | 5884 (35.7%) |
Chemotherapy | ||||||
No | 8200 (50.8%) | 19,558 (41.5%) | 4640 (55.4%) | 13,549 (44.6%) | 3560 (45.9%) | 6009 (36.5%) |
Yes | 7927 (49.2%) | 27,558 (58.5%) | 3730 (44.6%) | 17,105 (55.8%) | 4197 (54.1%) | 10,453 (63.5%) |
Radiotherapy | ||||||
No | 37 (0.2%) | 88 (0.2%) | 18 (0.2%) | 57 (0.2%) | 19 (0.2%) | 31 (0.2%) |
Yes | 343 (2.1%) | 868 (1.8%) | 107 (1.3%) | 298 (1.0%) | 236 (3.0%) | 570 (3.5%) |
Unknown | 15,747 (97.6%) | 46,160 (98.0%) | 8245 (98.5%) | 30,299 (98.8%) | 7502 (96.7%) | 15,861 (96.3%) |
Marital status | ||||||
Single, separated, divorced, | 3574 (22.2%) | 11,237 (23.8%) | 1734 (20.7%) | 6932 (22.6%) | 1840 (23.7%) | 4305 (26.2%) |
Married (including common law) | 8568 (53.1%) | 25,176 (53.4%) | 4223 (50.5%) | 15,937 (52.0%) | 4345 (56.0%) | 9239 (56.1%) |
Widowed | 3362 (20.8%) | 8714 (18.5%) | 2053 (24.5%) | 6469 (21.1%) | 1309 (16.9%) | 2245 (13.6%) |
Unknown | 623 (3.9%) | 1989 (4.2%) | 360 (4.3%) | 1316 (4.3%) | 263 (3.4%) | 673 (4.1%) |
Pathology grade | ||||||
Well-differentiated | 999 (6.2%) | 2440 (5.2%) | 483 (5.8%) | 1539 (5.0%) | 516 (6.7%) | 901 (5.5%) |
Moderately differentiated | 10.677 (66.2%) | 29,917 (63.5%) | 5042 (60.2%) | 18,005 (58.7%) | 5635 (72.6%) | 11,912 (72.4%) |
Poorly differentiated | 3619 (22.4%) | 11,956 (25.4%) | 2338 (27.9%) | 8995 (29.3%) | 1281 (16.5%) | 2961 (18.0%) |
Undifferentiated | 401 (2.5%) | 1802 (3.8%) | 274 (3.3%) | 1431 (4.7%) | 127 (1.6%) | 371 (2.3%) |
Unknown | 431 (2.7%) | 1.001 (2.1%) | 233 (2.8%) | 684 (2.2%) | 198 (2.6%) | 317 (1.9%) |
Positive lymph node | ||||||
0 | 421 (2.6%) | 971 (2.1%) | 193 (2.3%) | 576 (1.9%) | 228 (2.9%) | 395 (2.4%) |
1 | 6032 (37.4%) | 14,198 (30.1%) | 3050 (36.4%) | 9165 (29.9%) | 2982 (38.4%) | 5033 (30.6%) |
2–3 | 5483 (34.0%) | 14,244 (30.2%) | 2776 (33.2%) | 9176 (29.9%) | 2707 (34.9%) | 5068 (30.8%) |
4–6 | 3023 (18.7%) | 9226 (19.6%) | 1621 (19.4%) | 6008 (19.6%) | 1402 (18.1%) | 3218 (19.5%) |
≥ 7 | 1168 (7.2%) | 8477 (18.0%) | 730 (8.7%) | 5729 (18.7%) | 438 (5.6%) | 2748 (16.7%) |
Lymph nodes ratio | ||||||
< 0.07 | 421 (2.6%) | 14,484 (30.7%) | 193 (2.3%) | 9518 (31.0%) | 228 (2.9%) | 4966 (30.2%) |
0.07–0.25 | 7089 (44.0%) | 20,189 (42.8%) | 3673 (43.9%) | 12,965 (42.3%) | 3416 (44.0%) | 7224 (43.9%) |
0.25–0.50 | 4645 (28.8%) | 7954 (16.9%) | 2361 (28.2%) | 5172 (16.9%) | 2284 (29.4%) | 2782 (16.9%) |
0.50–1.0 | 3972 (24.6%) | 4489 (9.5%) | 2143 (25.6%) | 2999 (9.8%) | 1829 (23.6%) | 1490 (9.1%) |
Tumor site | ||||||
Right-sided | 8370 (51.9%) | 30,654 (65.1%) | ||||
Left-sided | 7757 (48.1%) | 16,462 (34.9%) |
Univariate and multivariate cox regression analysis
Patients Characteristics | Full cohort | Right-sided | Left-sided | |||
---|---|---|---|---|---|---|
HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | |
Age at diagnosis | < 0.001 | < 0.001 | < 0.001 | |||
< 40 | 1.000 | 1.000 | 1.000 | |||
40–49 | 1.101 (0.987–1.229) | 0.319 | 1.080 (0.928–1.258) | 0.319 | 1.126 (0.961–1.320) | 0.143 |
50–59 | 1.158 (1.048–1.279) | 0.007 | 1.205 (1.051–1.381) | 0.007 | 1.086 (0.938–1.256) | 0.270 |
60–69 | 1.557 (1.414–1.716) | < 0.001 | 1.499 (1.313–1.711) | < 0.001 | 1.523 (1.321–1.757) | < 0.001 |
> 70 | 3.364 (3.063–3.695) | < 0.001 | 2.999 (2.636–3.411) | < 0.001 | 3.646 (3.178–4.183) | < 0.001 |
Gender | ||||||
Female vs. Male | 0.989 (0.960–1.019) | 0.018 | 0.475 | 0.875 | 0.839–0.913 | < 0.001 |
Race | < 0.001 | < 0.001 | < 0.001 | |||
Black | 1.000 | 1.000 | 1.000 | |||
White | 0.994 (0.959–1.031) | 0.756 | 1.056 (1.010–1.105) | 0.017 | 0.879 (0.827–0.935) | < 0.001 |
Hispanic/Latino | 0.861 (0.730–1.016) | 0.077 | 0.913 (0.743–1.122) | 0/388 | 0.793 (0.601–1.046) | 0.101 |
Asian or Pacific Islander and others | 0.699 (0.659–0.742) | < 0.001 | 0.766 (0.708–0.828) | < 0.001 | 0.671 (0.614–0.734) | < 0.001 |
Unknown | 0.445 (0.320–0.618) | < 0.001 | 0.449 (0.295–0.684) | < 0.001 | 0.449 (0.265–0.761) | 0.003 |
Hispanic | ||||||
Yes vs. No | 0.834 (0.799–0.871) | < 0.001 | 0.838 (0.793–0.885) | < 0.001 | 0.857 (0.798–0.921) | < 0.001 |
T stage | < 0.001 | < 0.001 | < 0.001 | |||
T0–T2 (0, 2, 3) | 1.000 | 1.000 | 1.000 | |||
T3–T4 (4, 5) | 1.973 (1.889–2.061) | < 0.001 | 1.784 (1.690–1.883) | < 0.001 | 2.212 | 2.055–2.381 |
TX (6) | 1.315 (0.900–1.922) | 0.157 | 1.188 (0.714–1.976) | 0.507 | 1.575 (0.891–2.786) | 0.118 |
N stage | ||||||
N2 vs. N1 | 1.581 (1.543–1.620) | < 0.001 | 1.657 (1.608–1.707) | < 0.001 | 1.415 (1.355–1.477) | < 0.001 |
Chemotherapy | ||||||
Yes vs. No | 0.408 (0.398–0.418) | < 0.001 | 0.430 (0.417–0.443) | < 0.001 | 0.386 (0.370–0.403) | < 0.001 |
Radiotherapy | < 0.001 | < 0.001 | 0.001 | |||
No | 1.000 | 1.000 | 1.000 | |||
Yes | 0.517 (0.410–0.654) | < 0.001 | 0.637 (0.469–0.865) | 0.004 | 0.508 (0.351–0.735) | < 0.001 |
Unknown | 0.524 (0.421–0.651) | < 0.001 | 0.515 (0.390–0.680) | < 0.001 | 0.506 (0.356–0.721) | < 0.001 |
Marital status | < 0.001 | < 0.001 | < 0.001 | |||
Single, separated, divorced, | 1.000 | 1.000 | 1.000 | |||
Married (including common law) | 0.843 (0.818–0.870) | < 0.001 | 0.872 (0.839–0.907) | < 0.001 | 0.788 (0.748–0.829) | < 0.001 |
Widowed | 1.681 (1.623–1.740) | < 0.001 | 1.592 (1.524–1.659) | < 0.001 | 1.746 (1.643–1.856) | < 0.001 |
Unknown | 1.065 (0.996–1.139) | 0.065 | 1.082 (0.998–1.173) | 0.056 | 0.984 (0.873–1.110) | 0.792 |
Pathology grade | < 0.001 | < 0.001 | < 0.001 | |||
Well-differentiated | 1.000 | 1.000 | 1.000 | |||
Moderately differentiated | 1.119 (1.056–1.186) | < 0.001 | 1.197 (1.112–1.289) | < 0.001 | 1.020 (0.930–1.119) | 0.669 |
Poorly differentiated | 1.635 (1.540–1.736) | < 0.001 | 1.673 (1.551–1.804) | < 0.001 | 1.436 (1.300–1.586) | < 0.001 |
Undifferentiated | 1.981 (1.825–2.150) | < 0.001 | 1.988 (1.802–2.192) | < 0.001 | 1.735 (1.476–2.040) | < 0.001 |
Unknown | 1.308 (1.188–1.439) | < 0.001 | 1.403 (1.247–1.578) | < 0.001 | 1.113 (0.942–1.315) | 0.208 |
Positive lymph node | < 0.001 | < 0.001 | < 0.001 | |||
0 | 1.000 | 1.000 | 1.000 | |||
1 | 0.943 (0.851–1.045) | 0.265 | 0.933 (0.819–1.062) | 0.293 | 0.932 (0.787–1.105) | 0.418 |
2–3 | 1.085 (0.979–1.202) | 0.121 | 1.082 (0.951–1.232) | 0.232 | 1.058 (0.893–1.253) | 0.514 |
4–6 | 1.347 (1.215–1.495) | < 0.001 | 1.385 (1.216–1.578) | < 0.001 | 1.236 (1.041–1.467) | 0.015 |
≥ 7 | 2.012 (1.814–2.232) | < 0.001 | 2.101 (1.844–2.393) | < 0.001 | 1.713 (1.441–2.035) | < 0.001 |
Lymph nodes ratio | < 0.001 | < 0.001 | < 0.001 | |||
< 0.07 | 1.000 | 1.000 | 1.000 | |||
0.07–0.25 | 1.312 (1.267–1.360) | < 0.001 | 1.375 (1.318–1.435) | < 0.001 | 1.245 (1.168–1.327) | < 0.001 |
0.25–0.50 | 1.771 (1.704–1.842) | < 0.001 | 1.942 (1.853–2.036) | < 0.001 | 1.597 (1.490–1.711) | < 0.001 |
0.50–1.0 | 2.873 (2.761–2.990) | < 0.001 | 3.302 (3.147–3.466) | < 0.001 | 2.446 (2.279–2.625) | < 0.001 |
Tumor site | ||||||
Left-sided vs. Right-sided | 0.716 (0.698–0.734) | < 0.001 | ||||
aTotal number of lymph node | ||||||
≥ 12 vs. < 12 | 0.758 (0.739–0.778) | < 0.001 | 0.692 (0.670–0.715) | < 0.001 | 0.765 (0.733–0.798) | < 0.001 |
bTotal number of lymph node | 0.985 (0.983–0.986) | < 0.001 | 0.980 (0.978–0.982) | < 0.001 | 0.986 (0.983–0.988) | < 0.001 |
cTotal number of lymph nodes | ||||||
≥ 11 vs. < 11 | 0.742 (0.706–0.779) | < 0.001 |
Patients Characteristics | Full cohort | Right-sided | Left-sided | |||
---|---|---|---|---|---|---|
HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | |
Age at diagnosis | < 0.001 | < 0.001 | < 0.001 | |||
< 40 | 1.000 | 1.000 | 1.000 | |||
40–49 | 1.074 (0.962–1.199) | 0.201 | 1.019 (0.875–1.187) | 0.809 | 1.146 (0.977–1.343) | 0.094 |
50–59 | 1.144 (1.035–1.264) | .0.008 | 1.162 (1.014–1.333) | 0.031 | 1.107 (0.956–1.281) | 0.174 |
60–69 | 1.466 (1.330–1.616) | < 0.001 | 1.422 (1.245–1.624) | < 0.001 | 1.462 (1.266–1.688) | < 0.001 |
> 70 | 2.516 (2.287–2.769) | < 0.001 | 2.265 (1.987–2.581) | < 0.001 | 2.878 (2.500–3.312) | < 0.001 |
Sex | ||||||
Female vs. Male | 0.804 (0.784–0.825) | < 0.001 | 0.796 (0.762–0.833) | < 0.001 | ||
Race | < 0.001 | < 0.001 | < 0.001 | |||
Black | 1.000 | 1.000 | 1.000 | |||
White | 0.866 (0.834–0.898) | < 0.001 | 0.907 (0.866–0.950) | < 0.001 | 0.797 (0.749–0.848) | < 0.001 |
Hispanic/Latino | 0.848 (0.718–1.001) | 0.051 | 0.856 (0.696–1.052) | 0.140 | 0.825 (0.625–1.090) | 0.175 |
Asian or Pacific Islander and others | 0.687 (0.647–0.729) | < 0.001 | 0.699 (0.646–0.757) | < 0.001 | 0.663 (0.606–0.726) | < 0.001 |
Unknown | 0.471 (0.339–0.654) | < 0.001 | 0.482 (0.317–0.734) | 0.001 | 0.462 (0.273–0.783) | 0.004 |
Hispanic | ||||||
Yes vs. No | 0.920 (0.881–0.962) | < 0.001 | 0.906 (0.857–0.958) | < 0.001 | ||
T stage | < 0.001 | < 0.001 | ||||
T0-T2 (0, 2, 3) | 1.000 | 1.00 | 1.000 | |||
T3-T4 (4, 5) | 1.703 (1.629–1.780) | < 0.001 | 1.540 (1.458–1.627) | < 0.001 | 1.984 (1.841–2.138) | < 0.001 |
TX (6) | 1.366 (0.933–1.999) | 0.109 | 1.155 (0.693–1.926) | 0.580 | 1.756 (0.991–3.112) | 0.054 |
N stage | ||||||
N2 vs. N1 | 1.139 (1.097–1.181) | < 0.001 | 1.157 (1.105–1.211) | < 0.001 | 1.063 (1.005–1.124) | 0.033 |
Chemotherapy | ||||||
Yes vs. No | 0.499 (0.486–0.513) | < 0.001 | 0.501 (0.485–0.517) | < 0.001 | 0.491 (0.469–0.513) | < 0.001 |
Radiotherapy | < 0.001 | |||||
No | 1.000 | 1.000 | 1.000 | |||
Yes | 1.286 (1.017–1.626) | 0.036 | 1.402 (1.031–1.906) | 0.031 | 1.253 (0.865–1.816) | 0.233 |
Unknown | 0.866 (0.696–1.077) | 0.196 | 0.851 (0.644–1.123) | 0.254 | 0.886 (0.623–1.262) | 0.503 |
Marital status | < 0.001 | < 0.001 | < 0.001 | |||
Single, separated, divorced, | 1.000 | 1.000 | 1.000 | |||
Married (including common law) | 0.785 (0.761–0.811) | < 0.001 | 0.844 (0.811–0.878) | < 0.001 | 0.733 (0.695–0.773) | < 0.001 |
Windowed | 1.078 (1.039–1.120) | < 0.001 | 1.051 (1.005–1.099) | < 0.001 | 1.029 (0.963–1.099) | 0.399 |
Unknown | 0.875 (0.818–0.936) | < 0.001 | 0.904 (0.834–0.981) | 0.015 | 0.812 (0.720–0.916) | 0.001 |
Pathology grade | < 0.001 | < 0.001 | < 0.001 | |||
Well-differentiated | 1.000 | 1.000 | 1.000 | |||
Moderately differentiated | 1.086 (1.025–1.151) | 0.005 | 1.145 (1.063–1.233) | < 0.001 | 1.003 (0.915–1.101) | 0.942 |
Poorly differentiated | 1.340 (1.262–1.424) | < 0.001 | 1.378 (1.276–1.487) | < 0.001 | 1.282 (1.160–1.417) | < 0.001 |
Undifferentiated | 1.636 (1.507–1.777) | < 0.001 | 1.658 (1.502–1.830) | < 0.001 | 1.639 (1.393–1.928) | < 0.001 |
Unknown | 1.228 (1.115–1.352) | < 0.001 | 1.275 (1.133–1.435) | < 0.001 | 1.157 (0.979–1.368) | 0.087 |
Tumor site | ||||||
Left-sided vs. Right-sided | 0.847 (0.824–0.870) | < 0.001 | ||||
Lymph nodes ratio | < 0.001 | < 0.001 | < 0.001 | |||
< 0.07 | 1.000 | 1.000 | 1.000 | |||
0.07–0.25 | 1.277 (1.229–1.325) | < 0.001 | 1.294 (1.236–1.354) | < 0.001 | 1.245 (1.167–1.328) | < 0.001 |
0.25–0.50 | 1.602 (1.523–1.685) | < 0.001 | 1.663 (1.563–1.770) | < 0.001 | 1.514 (1.402–1.636) | < 0.001 |
0.50–1.0 | 2.494 (2.357–2.640) | < 0.001 | 2.671 (2.491–2.863) | < 0.001 | 2.282 (2.100–2.480) | < 0.001 |
aTotal number of lymph nodes (without Lymph nodes ratio) | ||||||
≥ 12 vs. < 12 | 0.747 (0.728–0.766) | < 0.001 | 0.706 (0.683–0.730) | < 0.001 | 0.780 (0.747–0.815) | < 0.001 |
Total number of lymph nodes (with Lymph nodes ratio) | ||||||
≥ 12 vs. < 12 | 0.938 (0.909–0.967) | < 0.001 | 0.902 (0.886–0.957) | < 0.001 | 0.968 (0.919–1.020) | 0.223 |
bTotal number of lymph nodes (without Lymph nodes ratio) | 1.000 (0.998–1.001) | 0.694 | 0.981 (0.980–0.983) | < 0.001 | 0.985 (0.982–0.987) | < 0.001 |
Total number of lymph nodes (with Lymph nodes ratio) | 1.004 (1.003–1.006) | < 0.001 | 0.994 (0.992–0.997) | < 0.001 | 0.996 (0.993–1.000) | 0.033 |
cTotal number of lymph nodes (without Lymph nodes ratio) | ||||||
≥ 11 vs. < 11 | 0.704 (0.669–0.740) | < 0.001 | ||||
Total number of lymph nodes (with Lymph nodes ratio) | ||||||
≥ 11 vs. < 11 | 0.868 (0.813–0.927) | < 0.001 |