The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage <scp>III</scp> colon cancer

Mohan, Helen; Walsh, Cathal; Kennelly, Rory; Ng, Chin Teck; O'Connell, P. R.; Hyland, John; Hanly, Ann; Martin, Seán T.; Gourichon, David; Sheahan, Kieran; Winter, D. C.

doi:10.1111/codi.13410

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…A recent meta-analysis supporting LNR being superior compared to pN-category in outcome prediction mostly included retrospective studies with a low median number of LN resected [ 19 ]. Conversely, our findings are supported by Mohan et al and Schiffmann et al, who did not find a difference in outcome predicting comparing LNR and pN-category, even with a marked lower resected number of lymph nodes compared to our data [ 20 , 21 ].…”

Section: Discussionsupporting

confidence: 83%

Lymph node ratio is inferior to pN-stage in predicting outcome in colon cancer patients with high numbers of analyzed lymph nodes

et al. 2018

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BackgroundThe lymph node ratio (LNR), i.e. the number of positive lymph nodes (LN) divided by the total number of analyzed LN, has been described as a strong outcome predictor in node-positive colon cancer patients. However, most published analyses are constrained by relatively low numbers of analyzed LN. Therefore, the objective of the present study was to evaluate the prognostic impact of LNR in colon cancer patients with high numbers of analyzed LN.MethodsOne hundred sixty-six colon cancer patients underwent open colon resection. All node-positive patients were analyzed for this study. The number of analyzed LN, of positive LN, the disease-free (DFS) and overall survival (OS) time were prospectively recorded. Patients were dichotomously allocated to a high or a low LNR-group, respectively, with the median LNR (0.125) as a cut-off value. Median follow-up was 34.3 months.ResultsFifty-eight patients (34.9%) were node-positive. The median number of analyzed LN was 23 (range 8–54). DFS and OS were significantly shorter in pN2 vs pN1 patients (p < 0.001, and p = 0.001, respectively), and in LNR high vs low patients (p = 0.032, and p = 0.034, respectively). pN2 (vs pN1) disease showed hazard ratios (HR) of 6.2 (p < 0.001), and 6.8 (p < 0.005; for DFS and OS, respectively), while LNR high (vs low) showed HR of 3.0 (p =0.041), and 4.5 (p = 0.054).ConclusionsLNR is a reasonable outcome predictor in node-positive colon cancer patients. However, LNR is inferior to pN-stage in predicting survival in patients with high number of harvested lymph nodes.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0417-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 83%

Lymph node ratio is inferior to pN-stage in predicting outcome in colon cancer patients with high numbers of analyzed lymph nodes

et al. 2018

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“…However, this study included patients with rectal cancer, which had quite different operation standards compared with colon cancer. Mohan10 reported that N1/N2 and LNR do not provide additional prognostic value to current staging for OS, with an analysis of only 402 colon cancer patients in one center. Thus, all current research about LNR explored the value in stage III colon cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery remains the curative treatment of choice for colon cancer 11. However, prognosis in colon cancer is still based on pathological criteria including TNM staging, and LNR has been proposed to improve the prediction of outcomes 10. LNR is dependent on optimal retrieval of lymph nodes—ELN and is defined as the number of PLN divided by the total ELN 12.…”

Section: Discussionmentioning

confidence: 99%

“…LNR has been reported5–8 many times to be a robust predictor of survival, better than traditional N stage; therefore, the specific clinical advantage of LNR with respect to non-TNM factors such as age, differentiation grade, has still not been explored in colon cancer patients with a population-based scale 9. Many reports have studied the clinical value of LNR by only focusing on stage III colon cancer (with lymph node metastasis) and demonstrated that LNR has no clinically prognostic power to differentiate Stage I and Stage II (colon cancer patients with no lymph node metastasis) 10. However, according to the current AJCC classification on colon cancer, the same T categories with or without lymph node metastasis were considered as different prognosis groups, even in selective patients with a low value of LNR (such as 1 PLN of 99 examined lymph nodes).…”

Section: Introductionmentioning

confidence: 99%

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<p>Exploration of exact significance of lymph node ratio and construction of a novel stage in colon cancer with no distant metastasis</p>

Feng

Lin

et al. 2019

CMAR

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Aim Lymph node ratio (LNR) seems to be more precise than classic N stage in classifying cancer stage. Thus, we aim to construct a modified classification system based on LNR for colon cancer without distant metastasis. Methods This study enrolled two independent cohorts of patients. The primary cohort enrolled 2,152 patients from 2008 to 2013 in Zhongshan Hospital, Fudan University. The validation cohort consisted of 77,406 patients from the Surveillance, Epidemiology, and End Results (SEER) registry from 2004 to 2014. The inclusion criteria were: pathologically confirmed colon cancer, and American Joint Committee on Cancer (AJCC) stage I/II/III. The exclusion criteria included: incomplete follow-up information, rectal cancer, and multiple primary sites. The prognostic value of LNR for overall survival was evaluated. The cutoff value of LNR was determined by the X-tile. Predictive performance of modified classification was determined by the concordance index. Results After analysis, 0.05 and 0.50 were determined as the best threshold values of LNR. A value of <0.05, 0.05–0.50 and >0.50 was reclassified as the mN0, mN1 and mN2 stage. A modified classification based on mN0, mN1, and mN2 was further constructed for stage I/II/III colon cancer. C-index of the modified classification was statistically more precise than AJCC classification (0.687 versus 0.605, P <0.001). The same results can also be determined in the validation cohort (0.715 versus 0.640, P <0.001). Furthermore, a prognostic nomogram including independent factors was constructed. The constructed nomogram showed good performance according to the calibration curve. Conclusion The clinical value of LNR level was preferable to classic N stage in colon cancer patients. Our proposed classification based on LNR and AJCC T category can effectively differentiate patients with varied survival outcomes.

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“…Mohan et al . [ 27 ] compared the LNR1/LNR2 ratio with N1/N2 to determine whether, for a given specificity, the LNR had a better sensitivity. Use of the LNR resulted in a small improvement in sensitivity, but this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Is there a relationship between length of resection and lymph-node ratio in colorectal cancer?

Zanghì

Cavallaro

Menzo

et al. 2020

Gastroenterology Report

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BackgroundThe prognosis of colorectal cancer depends on the number of positive lymph nodes (LN+) and the total number of lymph nodes resected (rLN). This represents the lymph-node ratio (LNR). The aim of our study is to assess how the length of the resected specimen (RL) influences the prognostic values of the LNR.MethodsWe conducted a retrospective study of all the patients operated on for colorectal cancer from 2000 to 2015 at our institution. Pathology details were analysed. The total number of rLN, the number of LN+, and the LNR were calculated and measured against the RL. The receiver-operating characteristic (ROC) curve of patients with LN+ was calculated.ResultsOf the 670 patients included in our study, 337 were men (50.3%) and the mean age was 69.2 years. The correlation with prognosis of the LNR is greater than that of the LNR adjusted to RL (LNR/RL), both in subjects with positive nodes (n = 312) and in all cases (n = 670). The LNR presents a higher prognostic value than LNR/RL and RL in patients with LN+ except for metastatic recurrence, for which the predictive value appears slightly higher for LNR/RL. The statistical significance of the maximal divergence in Kaplan–Meier survival plots was demonstrated for the LNR (P = 0.043), not for LNR/RL (P = 0.373) and RL alone (P = 0.314).ConclusionAn increase in RL causes an increase in the number of harvested lymph nodes without affecting the number of LN+, thus representing a confounding factor that could alter the prognostic value of the LNR. Prospective larger-scale studies are needed to confirm these findings.

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The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer

Abstract: Both the N1/N2 system and the LNR predict survival in colon cancer, but both have low specificity and sensitivity. The LNR does not provide additional prognostic value to current staging for overall or disease-specific survival for a given cut-off point.

Cited by 7 publications

References 24 publications

Lymph node ratio is inferior to pN-stage in predicting outcome in colon cancer patients with high numbers of analyzed lymph nodes

Lymph node ratio is inferior to pN-stage in predicting outcome in colon cancer patients with high numbers of analyzed lymph nodes

<p>Exploration of exact significance of lymph node ratio and construction of a novel stage in colon cancer with no distant metastasis</p>

Is there a relationship between length of resection and lymph-node ratio in colorectal cancer?

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