Can Lymph Node Ratio Take the Place of pN Categories in the UICC/AJCC TNM Classification System for Colorectal Cancer?

Tong, L.; Gao, Peng; Wang, Zhenning; Song, Yongxi; Xu, Yingying; Sun, Zhe; Xing, Chengzhong; Wang, Xin; Xu, Hui

doi:10.1245/s10434-011-1687-2

Cited by 36 publications

(26 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to the total number of lymph nodes examined, the absolute number of metastatic lymph nodes and LNR of metastatic to total number of lymph nodes examined have been recognized as new prognostic factors for the survival in rectal cancer similar to other malignancies including breast, pancreas and gastric carcinoma (4,11,12,(44)(45)(46). Moreover, LNR has been identified superior than pN stage in rectal cancer in view of reflecting the response of preoperative therapy as well as regulating the administration of post-operative adjuvant treatment (47)(48)(49).…”

Section: Discussionmentioning

confidence: 99%

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Gurawalia¹,

Dev²,

Nayak³

et al. 2016

J. Gastrointest. Oncol.

View full text Add to dashboard Cite

Background: The number of lymph node retrieved in the surgical specimen is important for tumor staging and has paramount impact on prognosis in colorectal cancer and imitates the adequacy of lymph node surgical clearance. The paucity of lymph node yields in patients undergoing resection after preoperative chemo radiotherapy (CRT) in rectal cancer has seen. Lower total number of lymph nodes in the total mesoractal excision (TME) specimen after CRT, could a marker of better tumor response. Methods: We retrospectively reviewed the prospectively managed data of patients underwent excision for rectal cancer, who treated by neoadjuvant radiotherapy with or without chemotherapy in locally advanced rectal cancer. From 2010 to 2014, 364 patients underwent rectal cancer surgery, of which ninety-one treated with neoadjuvant treatment. Standard surgical and pathological protocols were followed. Patients were categorized into two groups based on the number of total harvested lymph nodes with group 1, having 12 or more nodes harvested, and group 2 including patients who had <12 lymph nodes harvested. The total number of lymph nodes retrieved from the surgical specimen was correlated with grade of tumor regression with neoadjuvant treatment. Results: Out of 91 patients, 38 patients (42%) had less than 12 lymph nodes examined in specimen. The difference in median number of lymph nodes was observed significantly as 9 (range, 2-11) versus 16 (range, 12-32), in group 2 and 1, respectively (P<0.01). Patients with fewer lymph node group were comparable with respect to age, BMI, pre-operative staging, neoadjuvant treatment. Pathological complete response in tumor pCR was seen with significantly higher rate (40% vs. 26%, P<0.05) in group 2. As per Mandard criteria, there was significant difference in tumor regression grade (TRG) between both the groups (P<0.05). Among patients with metastatic lymph nodes, median LNR was lower in <12 lymph nodes group at 0.167 (range, 0.09-0.45) versus 0.187 (range, 0.05-0.54), difference was not statistically significant (P=0.81).Conclusions: Retrieval of fewer than 12 lymph nodes in surgical specimen of rectal cancer who had received neo-adjuvant radiotherapy with or without chemotherapy should be considered as a good indicator of tumor response with better local disease control, and a good prognostic factor, rather than as a pointer of poor diligence of the surgical and pathological assessment.

show abstract

Section: Discussionmentioning

confidence: 99%

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Gurawalia¹,

Dev²,

Nayak³

et al. 2016

J. Gastrointest. Oncol.

View full text Add to dashboard Cite

show abstract

“…Previous study that evaluated the association between LNR and prognosis in patients with rectal cancer after preoperative chemoradiation reported various cutoff point for LNR chosen by various methods, but all of them found it as a powerful predictor of outcome and sometimes even more powerful than nodal status (Chin et al, 2009;Manilich et al, 2011;Tong et al, 2011). relationship between LNR s and survival rate in rectal cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…These neoadjuvant therapies result in a lymph nodes (Wichmann et al, 2002;Baxter et al, 2005) are not infrequent among locally advanced rectal cancer patients who need an additional prognostic index for their adjuvant treatment decisions. Recent studies showed LNR which means the ratio of involved to the total resected lymph nodes is a better prognosis predictor than pathological node (pN) and sometimes it has been found as an important predictive factor of mortality and recurrence (Rosenberg et al, 2008;Ainsworth et al, 2010;Qiu et al, 2011;Tong et al, 2011). So the aim of the this study was to investigate the impact of LNR on prognosis,recurrence and survival of locally advanced rectal cancers patients in the presence of preoperative chemoradiation effect on the number of retrieved lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

Nadoshan¹,

Omranipour²,

Beiki³

et al. 2013

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

“…This classification does in fact make it possible to select categories with poor prognoses for which checks-up and targeted therapies can be provided [11]. Several prognostic factors have in fact so far been considered in the clinical domain and, among them, both the number of lymph nodes sampled and the number of metastatic lymph nodes [9,10,[12][13][14][15], the latter already used by Jass in the 80's [16], are today increasingly highlighted [5].…”

Section: Discussionmentioning

confidence: 99%

“…In order to avoid stratification according to arbitrary classification, the 108 in stage III patients were divided, as has been reported by other authors [7][8][9][10] Within each quartile we recorded the incidence of patients without or with hepatic metastases.…”

Section: Methodsmentioning

confidence: 99%

Lymph Node Ratio and Liver Metachronous Metastases in Colorectal Cancer

Destri

Privitera

Greca

et al. 2016

International Surgery

View full text Add to dashboard Cite

Abstract:Objective The authors seek to assess whether the LNR could predict the risk of metachronous liver metastases. Background data Using the goal of sampling 12 lymph nodes for a proper staging of colorectal cancer is often "uncommon" and the lymph node ratio (LNR) is what allows for a better prognosis selection of patients. Methods A homogeneous group of 280 patients, followed-up for at least 5 years, was evaluated. In order to highlight the groups with the highest risk of metachronous liver metastases, patients were divided into four quartiles groups in relation to the LNR. Results The number of lymph nodes sampled in group "stage I" was significantly lower. Even if statistical significance between the global LNR and the development of liver metastases has not been reached, the subdivision into quartiles has made it possible to highlight that in the more advanced ratio groups, a higher incidence of metachronous liver metastases (p <0.028) was registered and was a different distribution of patients with or without liver metastasis in function of quartiles (P =0.01).Conclusions The LNR has enabled us to prognosticate patients who are at greater risk of developing metachronous liver metastases. The lower lymph node sampling in the patients with less advanced staging (I) and in patients with node-negative cancer (I+II) who developed liver metastases, leads us to believe that some patients have been understaged. We believe that the LNR, especially in cases of adequate lymph node sampling, is a useful gauge to better sub-stratify "node-positive" patients. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationCover LetterClick here to access/download Cover Letter cover letter.pdf

show abstract

Can Lymph Node Ratio Take the Place of pN Categories in the UICC/AJCC TNM Classification System for Colorectal Cancer?

Abstract: rN categories have more potential for predicting patient outcomes and are superior to the UICC/AJCC pN categories. We recommend rN categories for prognostic assessment and rN categories should be reported routinely in histopathological reports.

Cited by 36 publications

References 20 publications

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

Lymph Node Ratio and Liver Metachronous Metastases in Colorectal Cancer

Contact Info

Product

Resources

About