Prognostic Significance of Metastatic Lymph Node Ratio in Node-Positive Colon Carcinoma

Lee, Ho‐Young; Choi, Hong-Jo; Park, Ki-Jae; Shin, Jang-Soo; Kwon, Hyuk‐Chan; Roh, Mee‐Sook; Kim, Choongrak

doi:10.1245/s10434-006-9322-3

Cited by 167 publications

(155 citation statements)

References 17 publications

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“…In gastric cancer, ratio-based nodal staging was shown to be better than number-based classification in defining stage migration [12][13][14]20]. In addition ratiobased staging has been reported to significantly predict oncologic prognosis in patients with colon cancer [16,21]. In the present study, we found also that LNR has important prognostic significance in patients with colorectal cancer.…”

Section: Discussionsupporting

confidence: 59%

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

Park

Choi

Jun

2009

Journal of Surgical Oncology

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Purpose:We assessed which classification of lymph node metastasis better predicted outcomes in patients with colorectal carcinoma. Methods: We identified 318 patients (176 men) with stage III colon cancer who underwent curative resection. The number of LNs dissected, LNR, and disease-free survival time, were analyzed. Lymph node disease was stratified by the American Joint Committee on Cancer staging and LNR, with the latter categorized into groups with LNR <0.059 (n ¼ 67), 0.059-0.23 (n ¼ 171), and >0.23 (n ¼ 80). Median follow-up time was 37 (range, 1-122) months. Results: LNR significantly increased with the number of metastatic LNs (P < 0.0001). Three-year disease-free survival (DFS) rates differed significantly in the three LNR groups. Within each TNM stage, 3-year DFS rates differed according to LNR, but, within each LNR subgroup, 3-year DFS did not differ according to TNM stage. When both TNM stage and LNR subgroup were considered, 3-year DFS was stratified into four groups, which differed significantly (P < 0.0001). Considering number of retrieved lymph nodes, this stratification was not found when <12 lymph nodes retrieved. Conclusions: Re-stratified lymph node staging, reflecting both LNR and TNM stage, can predict survival in patients with LN-positive colon cancer, especially when more than 12 lymph nodes harvested.

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Section: Discussionsupporting

confidence: 59%

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

Park

Choi

Jun

2009

Journal of Surgical Oncology

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“…the ratio of metastatic to retrieved lymph nodes) was found to be an important independent prognostic factor in various malignancies (19)(20)(21)(22). Also in colon cancer some studies show a strong association of metastatic lymph node ratio (LNR) with disease recurrence and survival (23)(24)(25)(26). In rectal cancer the evidence is still limited.…”

Section: Introductionmentioning

confidence: 99%

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

Dekker¹,

Peeters²,

Putter³

et al. 2010

European Journal of Surgical Oncology (EJSO)

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Aims: Optimal staging in rectal cancer is indispensable for the decision on further treatment and estimation of prognosis. This study assesses the prognostic capacity of the metastatic lymph node ratio (LNR) in addition to the new TNM classification.Methods: LNR was determined, in stage III patients from the Dutch TME trial. Six year median follow up data from the trial database were used to analyse the relation of LNR to overall survival (OS) and local recurrence (LR). The relation of LNR to lymph node yield was assessed and appropriate cut off values of LNR for clinical use were determined.Results: 605 patients were analyzed. 278 underwent preoperative radiotherapy.82 patients developed a local recurrence and 289 distant metastases. LNR was an independent risk factor for OS, hazard ratio (HR) 2.10 (95%CI 1.35-3.27) (in addition to age >= 65 years, involved circumferential resection margin (CRM) and new TNM stage) and LR, HR 2.25 (95%CI 1.02-4.56) (in addition to pre operative radiotherapy and involved CRM). LNR is predictive of OS and LR from a lymph node yield of more than one and more than five respectively. A LNR value of 0.60 offers the best cut off to identify high risk patients (5 years OS was 61 vs. 32%, HR 2.45 (95% CI 1.96-3.08) and 5-years LR rate 12.6 versus 16.3%, HR 1.65 (95% CI 1.03-2.64)). 3Conclusions: LNR is an independent risk factor for OS and LR in addition to the 7th edition of the TNM classification. It can aid in predicting prognosis and identifying patients that should be considered for adjuvant treatment.

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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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Prognostic Significance of Metastatic Lymph Node Ratio in Node-Positive Colon Carcinoma

Abstract: Ratio-based LN staging, which reflects the number of LNs examined and the quality of LN dissection, is a potent modality for prognostic stratification in patients with LN-positive colon cancer.

Cited by 167 publications

References 17 publications

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

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

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

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

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