Metastatic Lymph Node Ratio as a better Prognostic Tool than The TNM System in Colorectal Cancer

Macedo, Filipa; Sequeira, Hugo; Ladeira, Kátia; Bonito, Nuno; Viana, Charlene; Martins, Sandra

doi:10.2217/fon-2020-0993

Cited by 14 publications

(12 citation statements)

References 40 publications

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“…This was also reported by [ 40 , 50 ]. Surprisingly, other potentially significant factors, such as Duke’s stage, tumour stage, tumour grading, tumour location, and tumour histology, which were believed to influence the relationships between response to treatment and survival time of CRC, were not shown by the present study as decisive prognostic factors, and similar results were reported by [ 51 , 52 ]. This was contrary to some pre-existing findings that uphold this former fact [ 30 , 45 , 53 ]; they revealed that, regarding tumour location, patients with CRC located in the colon have a better survival estimate than those with cancer located in the rectum, while CRC patients with an advanced pathological tumour stage, such as stage 4 or Duke D, or poor tumour grade have poor survival outcomes.…”

Section: Discussionsupporting

confidence: 84%

The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study

et al. 2022

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Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients’ life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan–Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients’ disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50–69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan–Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, “Gender” (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56–7.81, p-value = 0.040), “Presence of metastases” (HR: 3.76; 95% CI: 1.89–7.32, p-value = 0.010), “Metastasis site: Liver” (HR: 5.04; 95% CI: 1.71–19.05, p-value = 0.039), “Lymphovascular permeation” (HR: 2.94; 95% CI: 1.99–5.92, p-value = 0.021), and “CEA-level” (HR: 2.43; 95% CI: 1.49–5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient’s comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC.

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Section: Discussionsupporting

confidence: 84%

The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study

et al. 2022

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“…Zhou et al (10) pointed out that the LNR was an important prognostic factor for non-small-cell lung cancer. Macedo et al (11) indicated that the LNR was a better prognostic tool than the TNM system in colorectal cancer. Our previous study demonstrated that it was an important predictor of poor survival in pancreatic neuroendocrine tumours (12).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of lymph node ratio-based nomograms for primary duodenal adenocarcinoma after surgery

Shi

Liu²,

Cao³

et al. 2022

Front. Oncol.

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BackgroundThe prediction models for primary duodenal adenocarcinoma (PDA) are deficient. This study aimed to determine the predictive value of the lymph node ratio (LNR) in PDA patients and to establish and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) for PDAs after surgical resection.MethodsWe extracted the demographics and clinicopathological information of PDA patients between 2004 and 2018 from the Surveillance, Epidemiology and End Results database. After screening cases, we randomly divided the enrolled patients into training and validation groups. X-tile software was used to obtain the best cut-off value for the LNR. Univariate and multivariate Cox analyses were used in the training group to screen out significant variables to develop nomograms. The predictive accuracy of the nomograms was evaluated by the concordance index (C-index), calibration curves, area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). Finally, four risk groups were created based on quartiles of the model scores.ResultsA total of 978 patients were included in this study. The best cut-off value for the LNR was 0.47. LNR was a negative predictive factor for both OS and CSS. Age, sex, grade, chemotherapy and LNR were used to construct the OS nomogram, while age, grade, chemotherapy, the number of lymph nodes removed and LNR were incorporated into the CSS nomogram. The C-index, calibration curves and AUC of the training and validation sets revealed their good predictability. DCA showed that the predictive value of the nomograms was superior to that of the American Joint Committee on Cancer (AJCC) TNM staging system (8th edition). In addition, risk stratification demonstrated that patients with higher risk correlated with poor survival.ConclusionsThe LNR was an adverse prognostic determinant for PDAs. The nomograms provided an accurate and applicable tool to evaluate the prognosis of PDA patients after surgery.

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“…Although it had the effect of lowering the survival rate of high-stage patients [ 14 ], it is difficult to predict the prognosis in detail by observing patients with N1b PTC after treatment. To better predict prognosis in patients with N1b PTC, we introduced the concept of LNR, which is known to be a prognostic factor in various types of solid tumors [ 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma

Kang

Kim

Park

et al. 2022

Cancers

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The lymph node ratio (LNR) indicates the number of metastatic lymph nodes (LNs) to the total number of LNs. The prognostic value of LNR in papillary thyroid carcinoma (PTC) and other solid tumors is known. This study aimed to investigate the relationship between LNR and disease-free survival (DFS) in patients with PTC with lateral LN metastases (N1b PTC). A total of 307 patients with N1b PTC who underwent total thyroidectomy and therapeutic central and lateral LN dissection were retrospectively analyzed. The DFS and recurrence risk in the patients with LNR, central-compartment LNR (CLNR), and lateral-compartment LNR (LLNR) were compared. The mean follow-up duration was 93.6 ± 19.9 months. Eleven (3.6%) patients experienced recurrence. Neither LNR nor LLNR affected the recurrence rate in our analysis (p = 0.058, p = 0.106, respectively). However, there was a significant difference in the recurrence rates between the patients with low and high CLNR (2.1% vs. 8.8%, p = 0.017). In the multivariate analysis, CLNR ≥ 0.7 and perineural invasion were independent predictors of tumor recurrence. High CLNR was associated with an increased risk of recurrence, and was shown to be a significant predictor of prognosis in patients with N1b PTC.

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Metastatic Lymph Node Ratio as a better Prognostic Tool than The TNM System in Colorectal Cancer

Cited by 14 publications

References 40 publications

The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study

The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study

Development and validation of lymph node ratio-based nomograms for primary duodenal adenocarcinoma after surgery

Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma

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