Prognosis of Patients With Colorectal Cancer Is Associated With Lymph Node Ratio

Rosenberg, Robert D.; Friederichs, Jan; Schuster, Tibor; Gertler, Ralf; Maak, Matthias; Becker, Karen; Grebner, Anne; Ulm, Kurt; Höfler, Heinz; Nekarda, H.; Siewert, J. R.

doi:10.1097/sla.0b013e318190eddc

Cited by 228 publications

(98 citation statements)

References 30 publications

(33 reference statements)

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“…Although the data were collected prospectively, the study was designed retrospectively, which may have introduced a selection bias. In addition, the prognostic significance of the LNR has been previously evaluated using different methodologies yielding varying results, particularly due to differences in the cut-off values used for grouping patients and heterogeneity of collected data [8][9][10][21][22][23] for colorectal cancer. For the practical use of the LNR as a prognostic variable, the most effective LNR cutoff values need to be determined.…”

Section: Discussionmentioning

confidence: 99%

“…The LNR, defined as the ratio of metastatic to examined LNs, has been shown to be useful in identifying prognostic subgroups within gastric and esophageal cancer patients [6,7] . The prognostic value of the LNR has also been demonstrated in colon and rectal cancer [8][9][10] . These previous studies have shown that the LNR can be used not only as a prognostic indicator, but also as a parameter for a more accurate stratification system than the metastatic LN absolute number-based staging system in colon and rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Park¹,

Yu²,

Lim³

et al. 2015

WJG

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AIM:To evaluate the predictive value of the lymph node (LN) ratio (LNR, number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy (PCRT). The cut-off LNR was determined based on the pN1 vs pN2 when the recommended number of LNs was harvested. The 5-year recurrence-free survival (RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each group. METHODS: RESULTS:Among patients with the same p/ypN stage, the 5-year RFS rate differed according to the LNR. In addition, the 5-year RFS rate was significantly different between pN and LNR groups in patients with No PCRT. In PCRT group, however, only LNR was associated with prognosis. On multivariate analysis, both pN and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT group. In the PCRT group, only LNR category was found to be associated with RFS (HR = 2.36, 95%CI: 1.31-3.84, and P = 0.001). CONCLUSION:The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with PCRT. Current pN categories could not discriminate between prognostic groups of RFS after PCRT. Core tip: The number of metastatic lymph node might show different prognosis according to the number of examined lymph node. Retrieved number of lymph node after preoperative chemoradiotherapy (PCRT) has been known fewer than those without PCRT. However, number of metastatic lymph nodes used in pathologic staging was same between patients treated with PCRT and those without PCRT. The present study suggests the metastatic lymph node ratio would be useful prognostic indicator and it is more prominent in patients treated with PCRT.Park IJ, Yu CS, Lim SB, Yoon YS, Kim CW, Kim TW, Kim JH, Kim JC. Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Park¹,

Yu²,

Lim³

et al. 2015

WJG

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“…In addition, a substantial body of literature suggests that the absolute number of lymph nodes removed, whether positive or negative, is independently correlated with survival [14,15]. Furthermore, a number of studies have examined the ratio of positive lymph nodes to total number of lymph nodes as a predictor of survival [16][17][18][19][20][21]. These studies show that the ratio of positive nodes to the total number of nodes removed and examined is more predictive of patient outcome than the number of nodes involved with tumor alone.…”

Section: Introductionmentioning

confidence: 99%

Meeting the 12 lymph node (LN) benchmark in colon cancer

Rajput

Romanus

Weiser

et al. 2010

Journal of Surgical Oncology

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Background: Examining 12 LN in colon cancer has been suggested as a quality metric. The purpose of this study was to determine whether the 12 LN benchmark is achieved at NCCN centers compared to a US population-based sample. Methods: Patients with stage I-III disease resected at NCCN centers were identified from a prospective database (n ¼ 718) and were compared to 12,845 stage I-III patients diagnosed in a SEER region. Age, gender, location, stage, number of positive nodes were compared for NCCN and SEER data in regards to number of nodes evaluated. Multivariate logistic regression models were developed to identify factors associated with evaluating 12 LNs. Results: 92% of NCCN and 58% of SEER patients had 12 LN evaluated. For patients treated at NCCN centers, factors associated with not meeting the 12 LN target were left-sided tumors, stage I disease and BMI >30. Conclusions: 12 LN are almost always evaluated in NCCN patients. In contrast, this target is achieved in 58% of SEER patients. With longer follow-up of the NCCN cohort we will be able to link this quality metric to patterns of recurrence and survival and thereby better understand whether increasing the number of nodes evaluated is a priority for cancer control.

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“…Hastalığın evresi sağkalımı belirleyen en önemli faktörlerden biridir (14,26,27). Çalışmamızda da hastalığın evresi ve sağkalım arasında korelasyon (p=0,003) tespit edilmiştir.…”

Section: Discussionunclassified

“…Lenf nodu oranı (LNR), metastatik lenf nodlarının çıkarılan total lenf nodlarına oranıdır (14,32). İlk defa gastrik kanserde araştırıl-mış ve lenf nodu tutulumu olan mide kanserli hastaların bazı subgruplarında önemli bir prognostik faktör olduğu gösterilmiştir (11).…”

Section: Discussionunclassified

Relationship of Lymph Node Ratio, Standard Prognostic Factors and Survival in Patients with Colorectal Cancer

İlgün¹,

Yıldırım²,

Şit³

et al. 2013

JAREM

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ÖZETAmaç: Kolorektal kanserli hastalarda, standart faktörlerin yanı sıra, tutulu lenf nodlarının çıkarılan lenf nodlarına oranının (LNR), sağkalımla olan ilişki-sinin belirlenmesi hedeflenmiştir.Yöntemler: Ocak 2003-Mart 2010 yılları arasında kolorektal kanser nedeniyle ameliyat edilen ve istenen kriterleri sağlayan 72 hastanın dosyaları, T, N ve M durumu ve evreleri, lenfovasküler ve perinöral invazyon varlığı, çıkarılan lenf nodu sayısı, tutulu lenf nodu sayısı, lenf nodu kapsül invazyonu varlığı ve LNR açısından incelenmiş ve bu parametrelerin sağkalımla ilişkileri retrospektif olarak araştırılmıştır.Bulgular: Kolorektal kanserli hastaların sağkalımlarıyla, LNR, lenf nodu evresi, tutulu lenf nodu sayısı, TNM evresi, PNI ve lenf nodu kapsül invazyonu varlığının korelasyon gösterdiği belirlenmiştir.Sonuç: LNR ve lenf nodu evresi, incelenen parametreler arasında sağkalımla en yüksek ilişkili parametreler olarak bulunmuştur. (JAREM 2013; 3: 14-8) Anahtar Sözcükler: Kolorektal kanser, lenf nodu oranı, sağkalım, prognoz ABSTRACT Objective: The aim of our study is to investigate the relationship between overall survival and lymph node ratio (the number of positive lymph nodes divided by total number of lymph nodes) (LNR) as well as other standard prognostic factors in patients who underwent surgery for colorectal cancer.Methods: A retrospective study was performed to analyse the data collected for 72 patients who underwent surgery with the diagnosis of colorectal cancer from January 2003 to March 2010. The variables such as T, N and M stage, lymphovascular and perineural invasion, number of retrived lymph nodes, number of metastatic lymph nodes, lymph node capsule invasion, LNR and their effects on overall survival were analysed.Results: LNR, lymph node stage, number of metastatic lymph nodes, TNM stage, perineural invasion and lymph node capsule invasion had significant effects on overall survival.Conclusion: LNR and lymph node stage were the most significant variables associated with overall survival. (JAREM 2013; 3: 14-8)

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Prognosis of Patients With Colorectal Cancer Is Associated With Lymph Node Ratio

Abstract: The defined cut-off values of LNRs were strong independent prognostic factors for colorectal cancer patients and should be calculated for risk group stratification.

Cited by 228 publications

References 30 publications

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Meeting the 12 lymph node (LN) benchmark in colon cancer

Relationship of Lymph Node Ratio, Standard Prognostic Factors and Survival in Patients with Colorectal Cancer

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