&lt;p&gt;Exploration of exact significance of lymph node ratio and construction of a novel stage in colon cancer with no distant metastasis&lt;/p&gt;

Lv, Yang; Feng, Qi Sheng; Lin, Songbin; Mao, Yihao; Xu, Yu; Zheng, Peng; Liu, Yang; He, Guodong; Xu, Jiacheng

doi:10.2147/cmar.s203533

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…Berger et al first reported the prognostic role of mLNR in CRC [16], though no detailed information regarding the criteria for high mLNR is currently available. Recently, the mLNR has been explored as a prognostic factor on survival outcomes and time to progression for patients with colon cancer [17,18,19,20,21,22,23,24,25,26].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Implication of Metastatic Lymph Node Ratio in Colorectal Cancers: Comparison Depending on Tumor Location

Pyo

Shin

Kang

2019

JCM

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Background: The proportion of the number of involved lymph nodes (LNs) to the number of examined LNs—defined as metastatic LN ratio (mLNR)—has been considered as a prognostic parameter. This study aims to elucidate the prognostic implication of the mLNR in colorectal cancer (CRC) according to the tumor location. Methods: We evaluated the correlation between prognoses and the involved and examined LNs as well as mLNR according to the tumor location in 266 surgically resected human CRCs. Besides, to evaluate the optimal cutoff for high and low mLNRs, we investigated the correlation between mLNR and survival according to the various cutoffs. Results: LN metastasis was found in 146 cases (54.9%), and colon and rectal cancers were found in 116 (79.5%) and 30 (20.5%) of the cases, respectively. The mean mLNRs were significantly higher in rectal cancer than in colon cancer (0.38 ± 0.28 vs. 0.21 ± 0.24, P = 0.003). Besides this, the number of involved LNs in rectal cancer was significantly high compared to colon cancer (11.83 ± 10.92 vs. 6.37 ± 7.78, P = 0.014). However, there was no significant difference in the examined LNs between the rectal and colon cancers (31.90 ± 12.28 vs. 36.60 ± 18.11, P = 0.181). In colon cancer, a high mLNR was significantly correlated with worse survival for all cutoffs (0.1, 0.2, 0.3, and 0.4). However, rectal cancer only showed a significant correlation between high mLNR and worse survival in the subgroup with a cutoff of 0.2. Conclusions: Our results showed that high mLNR was significantly correlated with worse survival. The number of involved LNs and mLNRs were significantly higher in rectal cancer than in colon cancer. The cutoff of 0.2 can be useful for the differentiation of prognostic groups, regardless of tumor location.

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Section: Introductionmentioning

confidence: 99%

Prognostic Implication of Metastatic Lymph Node Ratio in Colorectal Cancers: Comparison Depending on Tumor Location

Pyo

Shin

Kang

2019

JCM

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“…The LNR has been investigated as an important parameter, and the LNR can be used to estimate prognosis and identify high-risk patients [ 35 ]. The LNR was an independent value for discriminating survival outcomes and was even more precise than the classic N stage [ 36 ]. Our study showed that 4.9% and 52.8% were the cut-off values of LNR, and the range of LNR varied according to the type and site of tumour [ 37 – 39 ], suggesting that the value should be individualized.…”

Section: Discussionmentioning

confidence: 99%

Development and external validation of a novel nomogram for predicting cancer-specific survival in patients with ascending colon adenocarcinoma after surgery: a population-based study

Zhang

Qian

2022

World J Surg Onc

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Background This study aimed to develop and validate a novel nomogram to predict the cancer-specific survival (CSS) of patients with ascending colon adenocarcinoma after surgery. Methods Patients with ascending colon adenocarcinoma were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2015 and randomly divided into a training set (5930) and a validation set (2540). The cut-off values for age, tumour size and lymph node ratio (LNR) were calculated via X-tile software. In the training set, independent prognostic factors were identified using univariate and multivariate Cox analyses, and a nomogram incorporating these factors was subsequently built. Data from the validation set were used to assess the reliability and accuracy of the nomogram and then compared with the 8th edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system. Furthermore, external validation was performed from a single institution in China. Results A total of 8470 patients were enrolled from the SEER database, 5930 patients were allocated to the training set, 2540 were allocated to the internal validation set and a separate set of 473 patients was allocated to the external validation set. The optimal cut-off values of age, tumour size and lymph node ratio were 73 and 85, 33 and 75 and 4.9 and 32.8, respectively. Univariate and multivariate Cox multivariate regression revealed that age, AJCC 8th edition T, N and M stage, carcinoembryonic antigen (CEA), tumour differentiation, chemotherapy, perineural invasion and LNR were independent risk factors for patient CSS. The nomogram showed good predictive ability, as indicated by discriminative ability and calibration, with C statistics of 0.835 (95% CI, 0.823–0.847) and 0.848 (95% CI, 0.830–0.866) in the training and validation sets and 0.732 (95% CI, 0.664–0.799) in the external validation set. The nomogram showed favourable discrimination and calibration abilities and performed better than the AJCC TNM staging system. Conclusions A novel validated nomogram could effectively predict patients with ascending colon adenocarcinoma after surgery, and this predictive power may guide clinicians in accurate prognostic judgement.

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“…Jiang et al also revealed that LNR allowed superior prognostic stratification of patients, especially for those with LNE < 12 [11]. Recently, Lv et al even constructed a novel stage in colon cancer without distant metastasis, which was based on LNR and AJCC T stage and found to be capable of differentiating patients with varied prognosis more effectively [19]. The LNR‐based nodal staging seems to be more available and provides a more accurate prognostic evaluation to clinicians compared with conventional N stage.…”

Section: Discussionmentioning

confidence: 99%

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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<p>Exploration of exact significance of lymph node ratio and construction of a novel stage in colon cancer with no distant metastasis</p>

Cited by 9 publications

References 20 publications

Prognostic Implication of Metastatic Lymph Node Ratio in Colorectal Cancers: Comparison Depending on Tumor Location

Prognostic Implication of Metastatic Lymph Node Ratio in Colorectal Cancers: Comparison Depending on Tumor Location

Development and external validation of a novel nomogram for predicting cancer-specific survival in patients with ascending colon adenocarcinoma after surgery: a population-based study

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

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