The superiority of ratio-based lymph node staging in gastric carcinoma

Inoue, Kentaro; Nakane, Yasushi; Iiyama, Hitoshi; Sato, Mutsuya; Kanbara, Tatsuya; Nakai, Kenta; Okumura, Syunichiro; Yamamichi, Keigo; Hioki, Koshiro

doi:10.1245/aso.2002.9.1.27

Cited by 218 publications

(206 citation statements)

References 27 publications

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“…To overcome these shortcomings of the TNM staging system, some authors suggested use of LNR, defined as the ratio of metastatic to total number of lymph nodes. 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].…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Atualmente, além da importância do total de linfonodos dissecados, vem ganhando destaque o quociente linfonodos acometidos/ linfonodos dissecados 16 . Inicialmente, este parâmetro foi utilizado em trabalhos de câncer gástrico, em que se verificou que o quociente linfonodal era fator independente de sobrevida 19,20 .…”

Section: Discussionunclassified

Razão entre linfonodos positivos e dissecados como fator prognóstico em câncer de cólon

Trufelli¹,

Miranda²,

Palos³

et al. 2007

Rev. Assoc. Med. Bras.

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“…The incorporation of both the number of PLNs and the number of negative lymph nodes (and, thus, the TLNs assessed) to calculate the LNR provided further prognostic power, a finding that is similar to reports from studies in breast cancer, gastric cancer, and colon cancer. [27][28][29] However, as with studies in those other sites, the best use of the LNR in clinical decision-making remains unclear.…”

Section: Lymph Nodes In Small Bowel Carcinoma/overman Et Almentioning

confidence: 99%

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Overman

Wolff

et al. 2010

Cancer

100

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BACKGROUND:The presence of distant metastases and the completeness of resection are important prognostic factors in patients with small bowel adenocarcinoma (SBA); however, the influence of lymph node metastasis on patient outcome has not been well characterized. The objective of the current study was to evaluate the impact of the number of positive and negative lymph nodes on survival after curative resection. METHODS: Patients who had SBA diagnosed between 1988 and 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox proportional hazards regression analyses were performed after adjusting for age, sex, race, tumor stage, tumor grade, and primary site. Five-year disease-specific survival (DSS) was determined, all patients were categorized according to the total lymph nodes (TLNs) assessed, and patients with stage III disease also were categorized according to the number of positive lymph nodes (PLNs) and the PLN-to-TLN ratio (the lymph node ratio [LNR]). RESULTS: In total, 1991 patients (n ¼ 1216 with stage I/II SBA and n ¼ 775 with stage III SBA) were analyzed. Survival depended on the TLNs assessed. The 5-year DSS rate for patients with stage II disease was associated with the TLNs assessed (44%, 69%, and 83% for 0 TLNs, 1-7 TLNs, and >7 TLNs, respectively). The 5-year DSS for patients with stage III disease was associated with the number of PLNs (58% and 37% for <3 PLNs and 3 PLNs, respectively). Among patients with stage III disease, the LNR was even more predictive of survival than stratification by the number of PLNs. CONCLUSIONS: Survival after surgical resection for stage I, II, and III SBA was associated with the TLNs assessed. Stratifying patients with stage III disease into those with <3 PLNs and 3 PLNs significantly improved prognostication. Cancer 2010;116:5374-82.

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The superiority of ratio-based lymph node staging in gastric carcinoma

Abstract: Ratio-based lymph node staging is simple and gives more precise information for prognosis with fewer problems related to stage migration than the 1997 UICC/AJCC staging system.

Cited by 218 publications

References 27 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

Razão entre linfonodos positivos e dissecados como fator prognóstico em câncer de cólon

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

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