Dukes C colorectal cancer: is the metastatic lymph node ratio important?

Thomas, Matthew B.; Biswas, S.; Mohamed, Faheez; Chandrakumaran, Kandiah; Jha, Madan K.; Wilson, Robert

doi:10.1007/s00384-011-1340-3

Cited by 13 publications

(5 citation statements)

References 36 publications

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“…Therefore, we picked 142 stage III colon cancer patients from a cohort of 939 colorectal cancer patients who were operated on over a 10-year period. In comparison to other reports [6], the fraction, Stage III patients in comparison to all (I to IV) patients) is rather small but the number of examined lymph nodes is rather high [8,10] as is the percentage of patients receiving adjuvant chemotherapy [17]. …”

Section: Discussionmentioning

confidence: 72%

“…By doing so, there is no superiority in predicting disease-free and overall survival of the lymph node ratio to the N category of the TNM system. Other authors split patient cohorts by random or percentiles rather than calculating groups [6,7,9,11]. By using more groups, the lymph node ratio gains in precision of prognosis [6,7,11], but if more subgroups were established in the N category, precision would presumably rise there as well.…”

Section: Discussionmentioning

confidence: 99%

“…So far, indication for adjuvant therapy is based on the TNM system and therefore basically on the lymph node status. Several recent studies propose superiority of the lymph node ratio (ln ratio) to the TNM system in prognosis of colorectal cancer [6-11]. The ln ratio is the ratio of the number of positive nodes to the total number of nodes excised.…”

Section: Introductionmentioning

confidence: 99%

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Is the lymph node ratio superior to the Union for International Cancer Control (UICC) TNM system in prognosis of colon cancer?

et al. 2013

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BackgroundDecision making for adjuvant chemotherapy in stage III colon cancer is based on the TNM system. It is well known that prognosis worsens with higher pN classification, and several recent studies propose superiority of the lymph node ratio (ln ratio) to the TNM system. Therefore, we compared the prognosis of ln ratio to TNM system in our stage III colon cancer patients.MethodsA total of 939 patients underwent radical surgery for colorectal cancer between January 2000 and December 2009. From this pool of patients, 142 colon cancer stage III patients were identified and taken for this analysis. Using martingale residuals, this cohort could be separated into a group with a low ln ratio and one with a high ln ratio. These groups were compared to pN1 and pN2 of the TNM system.ResultsFor ln ratio, the cutoff was calculated at 0.2. There was a good prognosis of disease-free and cancer-related survival for the N-category of the TNM system as well as for the lymph node ratio. There was no statistical difference between using the N-category of the TNM system and the ln ratio.ConclusionsThere might not be a benefit in using the lymph node ratio rather than the N category of the TNM system as long as the number of subgroups is not increased. In our consideration, there is no need to change the N categorization of the TNM system to the ln ratio.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is the lymph node ratio superior to the Union for International Cancer Control (UICC) TNM system in prognosis of colon cancer?

et al. 2013

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“…In a retrospective study, Thomas et al performed a multivariate analysis to find out independent prognostic factors in 1098 patients, which had undergone colorectal cancer resections. They concluded that the presence of positive lymph nodes may not be an accurate indicator for stage III colorectal cancer; and the evaluation of ratio of lymph nodes is a more important prognostic factor in these patients (35). Various cut-off points were considered for the total examined lymph nodes (range 6-40) and lymph nodes ratio (range 0.07-0.69) by researchers in the literature (13 , 36).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer

et al. 2013

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Background:The extent of lymph node involvement is the most significant prognostic indicator in resected locoregional colorectal cancer. Objectives: This study aimed to investigate the prognostic value of total lymph nodes identified and ratio of lymph nodes in resected colorectal cancer. Patients and Methods: Two hundred seventy five patients with histologically proven resected locoregional invasive colorectal adenocarcinoma from 2003 to 2011 were included. All patients were treated with standard surgical resection for their colorectal cancer. Patients with incomplete data, or unresectable tumors or distant metastases were excluded from the study. All potential prognostic variables were evaluated for their impact on the local control, disease-free, and overall survival rates. Results: Of the 275 patients, 162 were men and 113 were women with a median age of 54 (range 23-84) years. The mean total lymph nodes were significantly higher in colon cancer than rectal cancer (11 versus 7.5, P = 0.001). In node positive (stage III) patients, the mean lymph nodes ratio was 0.5 for rectal cancers and 0.37 for colon cancers respectively showing a nonsignificant (P = 0.05) trend toward higher lymph nodes ratio in rectal cancer patients. In univariate analysis, the mean total number of lymph node identified was a prognostic factor for 5-year disease free (P = 0.04) and overall survival (P = 0.02) rates. In node positive patients, lymph nodes ratio was a prognostic factor for 5-year local control (P = 0.04), disease free survival (P = 0.01), and overall survival (P = 0.01) rates. On multivariate analysis, advanced primary tumor stage, rectal primary site and the presence of perineural invasion were independent adverse prognostic factors for overall survival. Conclusions: Total lymph nodes identified and ratio of lymph nodes are associated with oncological outcomes outcomes in patients with colorectal cancer.

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“…In addition, many recent studies investigated the prognostic impact of total lymph node identified and ratio of lymph nodes in resected colorectal cancer [2,9]. In another review, Ghahramani et al [10] found the higher number of assessed lymph nodes as a favorable prognostic factor for overall survival in 10 out of 11 studies on node negative colorectal cancer.…”

Section: Editorialmentioning

confidence: 99%

Staging Accuracy in Colorectal Cancer: A Pathologic and Therapeutic Dilemma

Mohammadianpanah¹

2014

JCPCR

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Dukes C colorectal cancer: is the metastatic lymph node ratio important?

Abstract: Current evaluation of positive lymph nodes may not accurately stage Dukes C colorectal cancer. The assessment of the LNR is a useful prognostic method in this heterogenous group of patients.

Cited by 13 publications

References 36 publications

Is the lymph node ratio superior to the Union for International Cancer Control (UICC) TNM system in prognosis of colon cancer?

Is the lymph node ratio superior to the Union for International Cancer Control (UICC) TNM system in prognosis of colon cancer?

Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer

Staging Accuracy in Colorectal Cancer: A Pathologic and Therapeutic Dilemma

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