Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer

Abstract

PurposeLymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer.MethodsA retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival.ResultsAccording to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (P = 0.02). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was independently associated with worse DFS.ConclusionThis study showed the prognostic significance of ratio-based staging for rectal cancer and may help in developing better staging systems. LNR 0.15 (15%) was shown to be a cutoff point for determining survival and prognosis in rectal cancer cases.

Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Gastric Cancer

“…In this study we confirmed the well known fact that the most important prognostic factors of GC are depth of invasion and lymph node metastasis (nodal status) [4]. However, in contrast to our previous study on rectal cancer [15], this study could not determine a single cut-off value of LNR as an independent prognostic factor for GC.…”

“…Also, we found a cutoff value of the LNR for predicting a prognosis for patients with rectal cancer [15].…”

Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research

“…As limited lymph node dissection may result in pathological understaging, lymph node density (LND) has emerged as an independent prognostic factor for carcinoma of the bladder as well as for OSCC (Stein et al , 2003; Gil et al , 2009). Lymph node density (Gil et al , 2009; Kim et al , 2011; Lee et al , 2012; Passoni et al , 2013), or lymph node ratio (LNR) (Attaallah et al , 2013; Sayed et al , 2013; Wu et al , 2013), equals the ratio of positive lymph nodes to the total number of excised lymph nodes. This ratio attempts to compensate for the potential bias of the sampling method by utilising two information components: the disease regional spread (number of positive nodes) and the surgical treatment (total number of nodes removed during surgery).…”

A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma

“…Lymph node ratio has been reported to be associated with prognosis in a variety of cancers, including oesophageal, gastric, colonic and breast. [6][7][8][9] In 2004, Berger et al examined the association of lymph node ratio and total nodes examined on survival in patients with PDAC and reported that only lymph node ratio had an impact on overall and disease-free survival. 10 Further studies were subsequently conducted on the prognostic role of lymph node ratio, lymph node ratio to delineate the most predictive marker of survival, but there was no consensus.…”