Impact of lymph node ratio on survival of colorectal cancer patients

Rausei, Stefano; Iovino, Domenico; Tenconi, Silvia; Mangano, Alberto; Inversini, Davide; Boni, Luigi; Rovera, Francesca; Dionigi, Gianlorenzo; Dionigi, Renzo

doi:10.1016/s1743-9191(13)60026-6

Cited by 14 publications

(15 citation statements)

References 20 publications

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“…The specificity and sensitivity are not given, but it would be reasonable to deduce that this may improve sensitivity at the cost of decreased specificity . Most studies reporting that the LNR is superior to the N classification did not compare sensitivity , but others showed that the LNR did not provide a significant advantage over the N1/N2 classification and supported the present findings .…”

Section: Discussionsupporting

confidence: 76%

“… first applied the LNR concept to the outcome of colorectal cancer in 2005. Several subsequent studies have established that the LNR is predictive of outcome , but it has not been established whether the LNR is superior to N1/N2 staging. Wang et al .…”

Section: Introductionmentioning

confidence: 99%

“…and Schiffman et al . examined patients with Stage III colon cancer . Several studies have included patients with Stage IV disease .…”

Section: Introductionmentioning

confidence: 99%

“…It has been proposed as an alternative to the current N1/N2 system as it reflects the nodal harvest as well as the positive nodes. Berger et al [5] first applied the LNR concept to the outcome of colorectal cancer [4][5][6][7][8][9][10][11][12][13], but it has not been established whether the LNR is superior to N1/N2 staging. Wang et al [14] advocated adoption of the LNR into the AJCC staging system instead of the current pN classification, while others have questioned whether the LNR provides additional prognostic information because of considerable heterogeneity in its analysis and reporting [8,15,16].…”

Section: Introductionmentioning

confidence: 99%

“…There is wide variability between studies in the cut-off point used. [4,12,15,[19][20][21][22]. Several studies have included patients with Stage IV disease [9,15,23].…”

Section: Introductionmentioning

confidence: 99%

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The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer

et al. 2017

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

“…and Schiffman et al . examined patients with Stage III colon cancer . Several studies have included patients with Stage IV disease .…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…There is wide variability between studies in the cut-off point used. [4,12,15,[19][20][21][22]. Several studies have included patients with Stage IV disease [9,15,23].…”

Section: Introductionmentioning

confidence: 99%

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The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer

et al. 2017

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Carnoy's solution fixation with compression significantly increases the number of lymph nodes yielded from colorectal cancer specimens

Flynn

Burchette

Ghassemi

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Carnoy's fixation and compression represents a novel technique to enhance lymph node evaluation and accuracy of staging after colorectal cancer resection. Methods This study was performed in all adults undergoing colorectal cancer operations by Kaiser Permanente surgeons at two separate facilities. Patients were assigned to either location based upon surgeon and patient availability. One group of patients had their lymph nodes examined with current standard manual technique (MT). The other group had their specimens fixed with Carnoy's solution and then compressed (CT) to assess for lymph nodes. Results A total of 157 patients were enrolled. Seventy‐eight patient specimens underwent MT and 79 patient specimens underwent the new compression technique (CT). CT resulted in a significant increase in total lymph node yield per specimen (37.6 ± 18.5 nodes with CT vs 18.9 ± 8.8 nodes with MT; P < 0.0001). CT also resulted in sufficient lymph node sampling (>12 nodes) in all 79 patients in the group compared with 13 of 78 patients (17%) with an insufficient lymph node evaluation in the MT group ( P = 0.0002). Conclusion This study demonstrated that Carnoy's fixation with compression can significantly increase lymph node yields in colorectal cancer specimens and allow for a higher rate of adequate lymph node sampling.

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A Modified Tumor‐Node‐Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined

et al. 2021

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Background To construct a modified tumor‐node‐metastasis (TNM) staging system for stage I‐III colon cancer patients with lymph nodes examined (LNE) < 12. Methods The clinicopathological and survival data of 3870 stage I‐III colon cancer patients with LNE < 12 from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 (development cohort) and 126 stage I‐III patients with LNE < 12 from the Second Affiliated Hospital of Harbin Medical University between 2011 and 2015 (validation cohort) were identified. The optimal stratification of LNR for cancer‐specific survival (CSS) was achieved using X‐tile software. The predictive accuracy of the modified stage (mStage) was determined by the concordance index (C‐index). Results The modified N stage (mN stage) was built based on the LNR (mN0: LNR = 0, mN1: 0 < LNR < 0.4 or cancer nodule formation and mN2: 0.4 ≤ LNR ≤ 1). Preferable C‐indices could be found for mStage compared with TNM stage in both development (0.750 vs 0.727) and validation cohorts (0.682 vs 0.646). Besides, patients with mStage A and B diseases could not benefit from adjuvant chemotherapy, while in patients with mStage C‐F diseases, those receiving radical surgery plus adjuvant chemotherapy presented better CSS than those with radical surgery alone. Conclusions The mStage system could predict the prognosis of colon cancer patients with LNE < 12 accurately and showed superior predictive power compared with conventional TNM staging system. Moreover, adjuvant chemotherapy might play inequable roles in patients with different mStage diseases.

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Impact of lymph node ratio on survival of colorectal cancer patients

Abstract: NR is a simple and reliable tool to stratify survival of colorectal cancer patients and it seems to have a higher prognostic power than the current pN system, because it is less dependent on the extent of lymphadenectomy.

Cited by 14 publications

References 20 publications

The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer

The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer

Carnoy's solution fixation with compression significantly increases the number of lymph nodes yielded from colorectal cancer specimens

A Modified Tumor‐Node‐Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined

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