Nodal stage of stage III colon cancer: The impact of metastatic lymph node ratio

Park, In Ja; Choi, Gyu–Seog; Jun, Soo Han

doi:10.1002/jso.21273

Cited by 49 publications

(32 citation statements)

References 24 publications

(29 reference statements)

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“…In the literature on the number of LNs retrieved, as shown in Table 1, 12 of 17 articles assessed 12 or more nodes [26,28,34,5053,5761] . In many studies that were reviewed in this editorial, more than 12 LNs were investigated.…”

Section: Resultsmentioning

confidence: 99%

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Impact of metastatic lymph node ratio in node-positive colorectal cancer

Noura

Ohue²,

Kano³

et al. 2010

WJGS

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Colorectal cancer (CRC) is one of the most common malignant diseases in the world. Presently, the most widely used staging system for CRC is the tumor nodes metastasis classification system, which classifies patients into prognostic groups according to the depth of the primary tumor, presence of regional lymph node (LN) metastases, and evidence of distant metastatic spread. The number of LNs with confirmed metastasis is related to the severity of the disease, but this number depends on the number of LNs retrieved, which varies depending on patient age, tumor grade, surgical extent, and tumor site. Numerous studies and a recent structured review have demonstrated associated improvements in the survival of CRC patients with increasing numbers of LNs retrieved for examination. Hence, the impact of lymph node ratio (LNR), defined as the number of metastatic LNs divided by the number of LNs retrieved, has been investigated in various malignancies, including CRC. In this editorial, we review the literature demonstrating the clinicopathological significance of LNR in CRC pati ents. Some reports have indicated the advantage of considering the LNR compared to the number of LNs retrieved and/or LN status. When the LNR is taken into consideration for survival analysis, the number of LNs retrieved and/or the LN status is not always found to be a prognostic factor. The cutoff points for LNRs were proposed in numerous studies. However, optimal thresholds for LNRs have not yet received consensus. It is still unclear whether the LNR has more prognostic validity than N stage. For all these reasons, the potential advantages of LNRs in the staging system should be investigated in large prospective data sets.

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Section: Resultsmentioning

confidence: 99%

“…In 2009, numerous studies on LNRs in CRC patients were published [28,34,5761] . Vather et al [57] reported the significance of LN evaluation in 4309 stage Ⅱ and stage Ⅲ colon cancer patients.…”

Section: Lnr In Crcmentioning

confidence: 99%

Impact of metastatic lymph node ratio in node-positive colorectal cancer

Noura

Ohue²,

Kano³

et al. 2010

WJGS

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“…Among these, the LNR is probably the best investigated and particularly pertains to substaging of stage III disease [15,18,19,20,21,22,23,24,25,26]. The LNR, defined as the ratio of the number of positive nodes over the total number of examined nodes, was proposed to stratify outcome in stage III patients.…”

Section: Resultsmentioning

confidence: 99%

Qualitative and Quantitative Issues of Lymph Nodes as Prognostic Factor in Colon Cancer

Veen¹,

Nedrebø²,

Stormark³

et al. 2013

Dig Surg

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For patients undergoing curative resections for colon cancer, the nodal status represents the strongest prognostic factor, yet at the same time the most disputed issue as well. Consequently, the qualitative and quantitative aspects of lymph node evaluation are thus being scrutinized beyond the blunt distinction between ‘node positive' (pN+) and ‘node negative' (pN0) disease. Controversy ranges from a minimal or ‘least-unit' strategy as exemplified by the ‘sentinel node' to a maximally invasive or ‘all inclusive' approach by extensive surgery. Ranging between these two extremes of node sampling strategies are factors of quantitative and qualitative value, which may be subject to modification. Qualitative issues may include aspects of lymph node harvest reflected by surgeon, pathologist and even hospital performance, which all may be subject to modification. However, patient's age, gender and genotype may be non-modifiable, yet influence node sample. Quantitative issues may reflect the balance between absolute numbers and models investigating the relationships of positive to negative nodes (lymph node ratio; log odds of positive lymph nodes). This review provides an updated overview of the current controversies and a state-of-the-art perspective on the qualitative and quantitative aspects of using lymph nodes as a prognostic marker in colon cancer.

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“…3,4,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] A MEDLINE search was conducted to provide an overview of the literature concerning the prognostic impact of the LNR using the keywords "colorectal cancer" and "lymph node ratio." Of these 21 articles, 7 reports, including the present study, addressed the relationship between the prognostic impact of the LNR and the number of LNs examined.…”

Section: Discussionmentioning

confidence: 99%

“…9 To date, several other studies have reported the prognostic signifi cance of the LNR in colorectal cancer. 3,4,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] It has also been suggested that the LNR can predict survival more accurately than the number of positive LNs. 3,4,11,13,16,19 Furthermore, the application of the LNR, together with the TNM system, may be more predictive of cancer recurrence and survival.…”

Section: Introductionmentioning

confidence: 99%