Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis

Zhang, Ming-Ran; Xie, Tianhang; Chi, Jun-Lin; Li, Yuan; Yang, Lie; Yu, Yanyan; Sun, Xiao‐Feng; Zhou, Zong‐Guang

doi:10.18632/oncotarget.12131

Cited by 39 publications

(36 citation statements)

References 44 publications

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“…In this study, high LNR was significantly associated with low DFS (HR, 2.75; 95% CI, 2.14-3.53; P < 0.001) and OS (HR, 1.91; 95% CI, 1.71-2.14; P < 0.001). In addition, LNR remained a significant prognostic factor regardless of the number of harvested LNs; ≥12 and <12 of harvested LNs (HR, 1.97; 95% CI, 1.71-2.26; P < 0.001 and HR, 1.74; 95% CI, 1.40-2.17; P < 0.001, respectively) [33]. A standard reference value of LNR is required for universal use of LNR for predicting prognosis; however, there is no consensus on what this value should be.…”

Section: Lymph Node Ratiomentioning

confidence: 94%

“…Some studies reported that LNR only had a significant influence on survival in patients with adequate number of examined lymph nodes (≥10-12) [30,31]; however, a few studies have reported that N staging was superior to LNR in predicting patient survival with a high number of examined lymph nodes [32]. Antithetically, some studies have reported that LNR was an independent prognostic factor for survival, regardless of the total number of examined lymph nodes [33][34][35][36][37][38]. Recent meta-analysis of 33 studies that included a total of 75,839 patients with node-positive colorectal cancer supported these findings.…”

Section: Lymph Node Ratiomentioning

confidence: 99%

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Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives

Kim

Choi

2019

Ann Coloproctol

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Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.

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Section: Lymph Node Ratiomentioning

confidence: 94%

Section: Lymph Node Ratiomentioning

confidence: 99%

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives

Kim

Choi

2019

Ann Coloproctol

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“…In contrast to the number of positive lymph nodes alone, especially in stage III colon cancer, the LNR has been shown to reflect outcome. 10 The aim of this study was to compare the location of the colorectal cancer, stage and lymphnode ratio in young (≤40 years) and older patients.…”

mentioning

confidence: 99%

“…It was similar to other studies where the retrieved nodes ranges from 10 to 26.8 nodes, which signifies the adequacy of nodal dissection in our study. 10,18 The cut off LNR has been reported to be 0.12 to 0.35. 10 In our series, the mean LNR was 0.31 in the younger patients where as in those above 40 years, it was 0.13 and the difference was statistically significant.…”

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confidence: 99%

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Comparison of Stage and Lymph Node Ratio in Young and Older Patients with Colorectal Cancer Operated in a Tertiary Hospital in Nepal

Ghimire

Singh

Kurlberg

et al. 2018

J Nepal Health Res Council

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Background: Colorectal cancer is being diagnosed more frequently in the young and it presents in an advanced stage. In TNM staging, stage depends on tumor size and number of positive nodes, which depend on location of tumor as well as the extent of dissection.The lymph node ratio is regarded as a more reliable marker for prognosis. In this study, we compare epidemiology of colorectal cancer in the young (<40 years) and older patients as well as the LNR. Methods:Patients with colorectal cancer operated at the Tribhuvan University Teaching Hospital, Kathmandu, Nepal for a period of 4 years (2012 -2016) were included in the study. Patients were grouped into young (≤ 40 years) and older (> 40 years) and clinic-pathological data such as site of lesion, clinical stage, and lymph node ratio were compared. Results:Of the 95 patients of colorectal cancer, 25 patients were of age ≤ 40 years (26%) and they had a higher median stage at diagnosis. In patients above 40 years, it was diagnosed at a relatively earlier stage. The mean number of positive nodes was 11.64 in younger patients whereas it was 18.34in those more than 40 years of age,but younger patients had higher lymph node ratio than elderly (0.31 vs 0.13) (P-value ≤ 0.005). Conclusions:Young patients with colorectal cancer tend to have more advanced disease. The lymph node metastasis and lymph node ratio tend to be higher in young patients.

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Early PET‐CT in patients with pathological stage III colon cancer may improve their outcome: Results from a large retrospective study

et al. 2018

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BackgroundCurrent staging of pathological stage III colon cancer (CC) is suboptimal; many patients recur despite unremarkable preoperative staging. We previously reported that early postoperative PET‐CT can alter the stage and management of up to 15% of patients with high‐risk stage III CC. This study aimed to determine the role of the test in the general stage III CC population.MethodsA retrospective study of all consecutive patients with stage III CC who underwent early postoperative PET‐CT between 2005 and 2017.ResultsA total of 342 patients, 166 (48.5%) males, median age 66 years (range, 29‐90), were included. Pathological stage was IIIA, IIIB, and IIIC in 18 (5.3%), 257 (75.1%), and 67 (19.6%) patients, respectively. Median number of positive lymph nodes was 2 (range, 0‐32). PET‐CT results modified the management of 46 patients (13.4%): 37 (10.8%) with overt metastatic disease and 9 (2.6%) with a second primary. The 5‐year disease‐free survival for true stage III patients was 81%. The median overall survival for the entire cohort and for true stage III patients was not reached and was 57.2 months for true stage IV. Of the 37 patients found to be metastatic, 14 (37.8%) underwent curative treatments and 9/14 (64.3%) remain disease‐free, with a median follow‐up of 83.8 months. Predictive factors for upstaging following PET‐CT were identified.ConclusionEarly postoperative PET‐CT changed the staging and treatment of 13.4% of stage III CC patients and has the potential for early detection of curable metastatic disease. Outcome results are encouraging. Prospective validation is ongoing.

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Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis

Cited by 39 publications

References 44 publications

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives

Comparison of Stage and Lymph Node Ratio in Young and Older Patients with Colorectal Cancer Operated in a Tertiary Hospital in Nepal

Early PET‐CT in patients with pathological stage III colon cancer may improve their outcome: Results from a large retrospective study

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