Prognostic Value of Lymph Node Ratio in Cutaneous Melanoma: A Systematic Review

Khan, Jaffar; Ullah, Asad; Matolo, Nathaniel M.; Waheed, Abdul; Nama, Noor; Sharma, Nitasha; Kalyani, Ballur; Gilstrap, Lauren; Singh, Sohni G; Ghleilib, Intisar; White, Joseph; Cason, Frederick D

doi:10.7759/cureus.19117

Cited by 3 publications

(2 citation statements)

References 29 publications

(53 reference statements)

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“…Although it had the effect of lowering the survival rate of high-stage patients [ 14 ], it is difficult to predict the prognosis in detail by observing patients with N1b PTC after treatment. To better predict prognosis in patients with N1b PTC, we introduced the concept of LNR, which is known to be a prognostic factor in various types of solid tumors [ 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma

Kang

Kim

Park

et al. 2022

Cancers

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The lymph node ratio (LNR) indicates the number of metastatic lymph nodes (LNs) to the total number of LNs. The prognostic value of LNR in papillary thyroid carcinoma (PTC) and other solid tumors is known. This study aimed to investigate the relationship between LNR and disease-free survival (DFS) in patients with PTC with lateral LN metastases (N1b PTC). A total of 307 patients with N1b PTC who underwent total thyroidectomy and therapeutic central and lateral LN dissection were retrospectively analyzed. The DFS and recurrence risk in the patients with LNR, central-compartment LNR (CLNR), and lateral-compartment LNR (LLNR) were compared. The mean follow-up duration was 93.6 ± 19.9 months. Eleven (3.6%) patients experienced recurrence. Neither LNR nor LLNR affected the recurrence rate in our analysis (p = 0.058, p = 0.106, respectively). However, there was a significant difference in the recurrence rates between the patients with low and high CLNR (2.1% vs. 8.8%, p = 0.017). In the multivariate analysis, CLNR ≥ 0.7 and perineural invasion were independent predictors of tumor recurrence. High CLNR was associated with an increased risk of recurrence, and was shown to be a significant predictor of prognosis in patients with N1b PTC.

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Section: Discussionmentioning

confidence: 99%

Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma

Kang

Kim

Park

et al. 2022

Cancers

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“…Lymph node ratio (LNR) is defined as the number of positive lymph nodes divided by the number of lymph nodes resected, which is widely accepted as a potential prognostic factor in tumors (6)(7)(8). Renaud et al also indicated that LNR had superior performance over number of lymph node involved for the prognostic prediction in colorectal carcinoma (9).…”

Section: Introductionmentioning

confidence: 99%

A prediction model for the 5-year, 10-year and 20-year mortality of medullary thyroid carcinoma patients based on lymph node ratio and other predictors

Lu²,

Hu³

et al. 2023

Front. Surg.

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AimTo explore the predictive value of lymph node ratio (LNR) for the prognosis of medullary thyroid carcinoma (MTC) patients, and constructed prediction models for the 5-year, 10-year and 20-year mortality of MTC patients based on LNR and other predictors.MethodsThis cohort study extracted the data of 2,093 MTC patients aged ≥18 years undergoing total thyroidectomy and neck lymph nodes dissection. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between LNR < 15% group and LNR ≥ 15% group. All data was divided into the training set (n = 1,465) and the testing set (n = 628). The random survival forest model was constructed in the training set and validated in the testing set. The area under the curve (AUC) was employed for evaluating the predictive ability of the model.ResultsThe 5-year, 10-year and 20-year overall survival (OS) and cause-specific survival (CSS) of MTC patients with LNR <15% were higher than those with LNR ≥15%. The OS was 46% and the CSS was 75% after 20 years' follow-up. The AUC of the model for the 5-year, 10-year, and 20-year OS in MTC patients was 0.878 (95%CI: 0.856–0.900), 0.859 (95%CI: 0.838–0.879) and 0.843 (95%CI: 0.823–0.862) in the training set and 0.845 (95%CI: 0.807–0.883), 0.841 (95%CI: 0.807–0.875) and 0.841 (95%CI: 0.811–0.872) in the testing set. In the training set, the AUCs were 0.869 (95%CI: 0.845–0.892), 0.843 (95%CI: 0.821–0.865), 0.819 (95%CI: 0.798–0.840) for the 5-year, 10-year and 20-year CCS in MTC patients, respectively. In the testing set, the AUCs were 0.857 (95%CI: 0.822–0.892), 0.839 (95%CI: 0.805–0.873) and 0.826 (95%CI: 0.794–0.857) for the 5-year CCS, 10-year CCS and 20-year CCS in MTC patients, respectively.ConclusionThe models displayed good predictive performance, which might help identify MTC patients might have poor outcomes and appropriate interventions should be applied in these patients.

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Survival Mechanisms of Metastatic Melanoma Cells: The Link between Glucocorticoids and the Nrf2-Dependent Antioxidant Defense System

Obrador

Palmer

López-Blanch

et al. 2023

Cells

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Circulating glucocorticoids increase during stress. Chronic stress, characterized by a sustained increase in serum levels of cortisol, has been associated in different cases with an increased risk of cancer and a worse prognosis. Glucocorticoids can promote gluconeogenesis, mobilization of amino acids, fat breakdown, and impair the body’s immune response. Therefore, conditions that may favor cancer growth and the acquisition of radio- and chemo-resistance. We found that glucocorticoid receptor knockdown diminishes the antioxidant protection of murine B16-F10 (highly metastatic) melanoma cells, thus leading to a drastic decrease in their survival during interaction with the vascular endothelium. The BRAFV600E mutation is the most commonly observed in melanoma patients. Recent studies revealed that VMF/PLX40-32 (vemurafenib, a selective inhibitor of mutant BRAFV600E) increases mitochondrial respiration and reactive oxygen species (ROS) production in BRAFV600E human melanoma cell lines. Early-stage cancer cells lacking Nrf2 generate high ROS levels and exhibit a senescence-like growth arrest. Thus, it is likely that a glucocorticoid receptor antagonist (RU486) could increase the efficacy of BRAF-related therapy in BRAFV600E-mutated melanoma. In fact, during early progression of skin melanoma metastases, RU486 and VMF induced metastases regression. However, treatment at an advanced stage of growth found resistance to RU486 and VMF. This resistance was mechanistically linked to overexpression of proteins of the Bcl-2 family (Bcl-xL and Mcl-1 in different human models). Moreover, melanoma resistance was decreased if AKT and NF-κB signaling pathways were blocked. These findings highlight mechanisms by which metastatic melanoma cells adapt to survive and could help in the development of most effective therapeutic strategies.

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Prognostic Value of Lymph Node Ratio in Cutaneous Melanoma: A Systematic Review

Cited by 3 publications

References 29 publications

Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma

Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma

A prediction model for the 5-year, 10-year and 20-year mortality of medullary thyroid carcinoma patients based on lymph node ratio and other predictors

Survival Mechanisms of Metastatic Melanoma Cells: The Link between Glucocorticoids and the Nrf2-Dependent Antioxidant Defense System

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