Lymph Node Ratio is an Independent Prognostic Factor in Node Positive Rectal Cancer Patients Treated with Preoperative Chemoradiotherapy Followed by Curative Resection

Abstract

Background: The lymph node ratio (LNR) has been shown to be an important prognostic factor for colorectal cancer. However, studies focusing on the prognostic impact of LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) followed by curative resection have been limited. The aim of this study was to investigate LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy harvested LNs, and as well as in those ≥12 harvested LNs (p<0.05). In addition, LNR had a prognostic impact on both OS and DFS in patients with N1 staging (p<0.001). Conclusions: LNR is an independent prognostic factor in ypN-positive rectal cancer patients, both in patients with <12 harvested LNs, and as well as in those ≥12 harvested LNs. LNR provides better prognostic value than pN staging. Therefore, it should be used as an additional prognostic indicator in ypN-positive rectal cancer patients.

Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: A meta‐analysis

“…The remaining 21 studies were reviewed with full texts, among which two studies had unclear reporting of neoadjuvant therapy, one lacked endpoint data, and five lacked comparison between LNR groups. Finally, 13 studies with 4023 participants were included in the meta‐analysis, and all were published in recent years (from 2011 up to now). Table offers the baseline characteristics of all included studies.…”

“…OS, as the primary outcome, was extracted from 11 studies with available data. Among them, eight studies reported high and low LNRs with one cut‐off value, and a pooled HR of 2.94 (95% CI:1.97 to 3.91, P < 0.001) demonstrated that a high LNR is a predictor of poor OS in rectal cancer after neoadjuvant therapy (Figure ). Minor heterogeneity (I 2 < 0.0%, P = 0.949) was found, and a fixed‐effects model was used.…”

“…OS, as the primary outcome, was extracted from 11 studies 25,26,[28][29][30][31][32][33][35][36][37] with available data. Among them, eight studies 25,26,29,32,33,[35][36][37] was found, and a fixed-effects model was used. The other three studies 28,30,31 reported two cut-off values dividing the participants into low, medium, and high LNR groups, and the studies showed that medium and high LNRs were related to poor OS compared with low LNRs (HR:1.31, 95% CI:1.08 to 1.54, P < 0.001; HR:1.68, 95% CI:1.31 to 2.04, P < 0.001, respectively).…”

Comparison of Stage and Lymph Node Ratio in Young and Older Patients with Colorectal Cancer Operated in a Tertiary Hospital in Nepal

“…20 In a meta-analysis of 75,838 node positive patients with colorectal cancer, LNR was observed to have significant weight in the prognosis of patients with colorectal cancer and they recommend LNR to be incorporated in a future staging system for colorectal cancer.…”

Can Induction Chemotherapy before Concurrent Chemoradiation Impact Circumferential Resection Margin Positivity and Survival in Low Rectal Cancers?

“…Neoadjuvant chemoradiation followed by TME is the current standard of care for locally advanced on node positive rectal cancer (Zeng et al, 2014). After preoperative chemoradiation, positive CRM rate can vary between 3-14% Kellokumpu et al, 2012;Kenelley et al, 2013;Rullier et al, 2013;Calvo et al, 2014).…”