Metastatic lymph node ratio in stage III rectal cancer; prognostic significance in addition to the 7th edition of the TNM classification

Dekker, Jan Willem T.; Peeters, Koen; Putter, Hein; Vahrmeijer, Alexander L.; Velde, Cornelis J.H. van de

doi:10.1016/j.ejso.2010.09.007

Cited by 51 publications

(43 citation statements)

References 41 publications

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“…LN burden is dependent upon the extent of surgical resection and is also influenced by the extent of pathological scrutiny. The concept of LN burden or ratio has been studied in other cancers [60][61][62][63] including oral and cutaneous squamous cell carcinoma of the head and neck [64,65]. However, the prognostic impact of LN burden has not been well explored in thyroid cancer [27,29].…”

Section: Ln Burdenmentioning

confidence: 99%

Nodal Metastases in Thyroid Cancer: Prognostic Implications and Management

Wang

Ganly

2016

Future Oncol.

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The significance of cervical lymph node metastases in differentiated thyroid cancer has been controversial and continues to evolve. Current staging systems consider nodal metastases to confer a poorer prognosis, particularly in older patients. Increasingly, the literature suggests that characteristics of the metastatic lymph nodes such as size and number are also prognostic. There is a growing trend toward less aggressive treatment of low-volume nodal disease. The aim of this review is to summarize the current literature and discuss prognostic and management implications of lymph node metastases in differentiated thyroid cancer.

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Section: Ln Burdenmentioning

confidence: 99%

Nodal Metastases in Thyroid Cancer: Prognostic Implications and Management

Wang

Ganly

2016

Future Oncol.

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“…Less easy to explain, numerous articles underscore that the more LNs removed and examined, the better the outcome in patients, both with and without positive nodes. [1][2][3] However, questions arise as to what is the minimal number of LNs to examine in order not to miss any LN deposits. Three recent articles [4][5][6] have shed some (hued) light on these disconcerting questions.…”

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confidence: 99%

“…Increasing data today point to the number of lymph nodes (LNs) removed and examined as an important parameter in LN staging 1,2 : The more LNs gathered and examined, the greater the likelihood of identifying positive LNs. Less easy to explain, numerous articles underscore that the more LNs removed and examined, the better the outcome in patients, both with and without positive nodes.…”

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confidence: 99%

What Counts Most in the Lymph Node Count for Colorectal Cancer?

Fingerhut¹

2012

Surg Innov

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The adequate number of lymph nodes that should be examined to correctly stage colorectal cancer is still debated. Even though the guidelines state that 12 should be the minimum, there is ongoing concern that this might not be enough. Moreover, many studies have shown that this cut-off is far from universally obtained in many surgical series, whether via laparotomy or via laparoscopy. Arguments in favor of sticking to the cutoff value of 12 are weak: certainly, culling and examining as many lymph nodes as possible should increase the chances of correct staging and the consequent therapeutic consequences, decrease local recurrence and, perhaps, also increase survival (although this is not the direct consequence of gathering and examining as many lymph nodes as possible). Laparoscopy should be no different from open surgery: the same rational prevails for laparoscopic oncologic clearance to increase patient well-being and ensure good practice. What is most important, however, is to make surgeons and pathologists realize that this issue is important and that all of us should strive, in close collaboration, to achieve these goals, for the good of the patient, the person for whom the lymph node count counts most.

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“…[4][5][6][7][8] Peng and colleagues 8 were the first to demonstrate the association between LNR and survival rate in patients with rectal cancer. The mean LNR was 0.34, and they reported that LNR was an independent risk factor for local recurrence, DFS and OS.…”

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confidence: 99%

“…The mean LNR was 0.34, and they reported that LNR was an independent risk factor for local recurrence, DFS and OS. In these studies, [4][5][6][7][8] 9 According to the seventh edition of the TNM classification, patients with stage III cancer are classified based on the number of positive nodes. Intuitively, it seems safe to believe that the prognostic significance of 5 positive nodes out of a total of 5 will be completely different from 5 positive nodes out of a total of 30.…”

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confidence: 99%

Prognostic value of lymph node ratio in survival of patients with locally advanced rectal cancer

Zhou

Bai

et al. 2015

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Background:The lymph node ratio (LNR) has been shown to be an important prognostic factor in patients with gastric, breast, pancreatic and colorectal cancer. We investigated the prognostic impact of the LNR in addition to TNM classification in patients with locally advanced rectal cancer. Methods:We retrospectively analyzed patients who underwent curative resection for locally advanced rectal cancer between July 2005 and December 2010. We determined the LNR cutoff value using a receiver operating characteristic curve. The Kaplan-Meier method was used to estimate survival curves, while Cox regression analyses were used to evaluate the relationship between LNR and survival. Results:We included 180 patients aged 28-83 years with median follow-up of 41.8 months. The median number of lymph nodes examined and lymph nodes involved were 11.5 and 4, respectively, and the median LNR was 0.366. An LNR of 0.19 (19%) was the cutoff point to separate patients with regard to median overall survival. Median overall survival was 64.2 months for patients with an LNR of 0, 59.1 for an LNR of 0.19 or less and 37.6 for an LNR greater than 0.19 (p = 0.004). The median disease-free survival was 32.9 months for patients with an LNR of 0, 30.4 for an LNR of 0.19 or less and 17.8 for an LNR greater than 0.19 (p = 0.002). Conclusion:Our results suggest that LNR should be considered an additional prognostic factor in patients with locally advanced rectal cancer.Contexte : Il a été démontré que le ratio de ganglions lymphatiques positifs est un important facteur pronostique chez les patients atteints de cancer de l'estomac, de cancer du sein, de cancer du pancréas et de cancer colorectal. Nous avons étudié l'incidence pronostique de l'utilisation de ce ratio en plus de la classification TNM chez les patients présentant un cancer du rectum localement avancé.Méthodes : Nous avons analysé rétrospectivement des patients ayant subi une résec-tion curative visant à traiter un cancer du rectum localement avancé entre juillet 2005 et décembre 2010. Nous avons déterminé la valeur seuil du ratio de ganglions lymphatiques positifs à l'aide d'une courbe caractéristique de la performance. La méthode de Kaplan-Meyer a été utilisée pour estimer les courbes de survie, tandis que le modèle de régression des hasards proportionnels de Cox a servi à évaluer la corréla-tion entre le ratio à l'étude et la survie.Résultats : Notre étude a porté sur 180 patients de 28 à 83 ans dont la durée mé diane du suivi était de 41,8 mois. Les nombres médians de ganglions lymphatiques examinés et de ganglions lymphatiques positifs étaient de 11,5 et 4, respectivement, et le ratio médian de ganglions lymphatiques positifs était de 0,366. Nous avons utilisé une valeur seuil de 0,19 (19 %) pour séparer les patients en ce qui a trait à la survie globale médiane. Cette mesure était de 64,2 mois pour les patients présentant un ratio de 0, de 59,1 mois pour ceux présentant un ratio de 0,19 ou moins, et de 37,6 mois pour ceux dont le ratio était supérieur à 0,19 (p = 0,004). La survi...

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Metastatic lymph node ratio in stage III rectal cancer; prognostic significance in addition to the 7th edition of the TNM classification

Cited by 51 publications

References 41 publications

Nodal Metastases in Thyroid Cancer: Prognostic Implications and Management

Nodal Metastases in Thyroid Cancer: Prognostic Implications and Management

What Counts Most in the Lymph Node Count for Colorectal Cancer?

Prognostic value of lymph node ratio in survival of patients with locally advanced rectal cancer

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