Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

Abstract

Background: Metastatic lymph node ratio (MLR) is defined as the ratio of number of positive lymph nodes (LNs) or LNM to total nodes harvested (LNH). Recent studies have suggested that MLR is more accurate in predicting overall survival and recurrence-free survival rate compared to the number of positive nodes alone. Materials and methods: Total 58 cases of primary organ malignancy were evaluated from June 2018 to June 2019 including Head and neck (HN), Breast, Gastrointestinal tract (GIT) and Genitourinary tract (GUT) malignancy. Age, gender, LNH, LNM, MLR, tumor stage and tumor grade were accessed for each of the cases. Results: Out of total 58, there were 12, 33, 11 and 2 cases each of HN, Breast, GIT and GUT malignancy respectively. M:F ratio was 1:2.2. Maximum cases (39.6%) were seen in the age group of 35-45 years. 186 out of 530 LNs showed metastasis. Mean MLR for lymph node-positive cases were 0.3. Majority of HN malignancy cases (41.6%) were found in T1/T2 stage, breast malignancy cases (42.4%) in T2 stage, GIT malignancy cases (63.6%) in T3 stage, 50% of GUT malignancy cases in T3 and 50% were in T4 stage. Maximum well-differentiated (10, 83.3%) cases belonged to HN, moderately (15, 45.4%) and poorly differentiated (18, 54.5%) to breast respectively. We found significant association of MLR with tumor stage and tumor grade. (p-value < 0.001) Conclusion: The routine inclusion of MLR in tumor reporting by pathologists may become a prognostic aid for clinicians along with TNM staging system.