Lymph Node Ratio as a Prognostic Factor in Patients With Stage III Rectal Cancer Treated With Total Mesorectal Excision Followed by Chemoradiotherapy

Kim, Young Seok; Kim, Jong Hoon; Yoon, Sang Min; Choi, Eun Kyung; Ahn, Seung Do; Lee, Sangwook; Kim, Jin Cheon; Yu, Chang Sik; Kim, Hee Chul; Kim, Tae Won; Chang, Heung Moon

doi:10.1016/j.ijrobp.2008.08.065

Cited by 73 publications

(77 citation statements)

References 34 publications

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“…Park et al (2011) in a study on 186 stage III colorectal cancer patients had selected cutoff point of LNR as 0.07 Several studies (Peschaud et al, 2008;Kim et al, 2009;Priolli et al, 2009;Dekker et al, 2010;Rosenberg et al, 2010;Thomas et al, 2012) had chosen different cutoff points by different parameters such as quartiles, median value and arbitrary values. The cutoff points for LNR were proposed in many studies but the optimal level need to be determined.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

Nadoshan¹,

Omranipour²,

Beiki³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

Nadoshan¹,

Omranipour²,

Beiki³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…For rectal cancer the prognostic significance of the metastatic LNR was earlier addressed in four studies (34)(35)(36)(37). All these studies determined the predictive capacity of LNR in addition to the previous (6 th edition) TNM classification.…”

Section: Discussionmentioning

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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“…The LNR, defined as the ratio of metastatic to examined LNs, has been shown to be useful in identifying prognostic subgroups within gastric and esophageal cancer patients [6,7] . The prognostic value of the LNR has also been demonstrated in colon and rectal cancer [8][9][10] . These previous studies have shown that the LNR can be used not only as a prognostic indicator, but also as a parameter for a more accurate stratification system than the metastatic LN absolute number-based staging system in colon and rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Park¹,

Yu²,

Lim³

et al. 2015

WJG

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AIM:To evaluate the predictive value of the lymph node (LN) ratio (LNR, number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy (PCRT). The cut-off LNR was determined based on the pN1 vs pN2 when the recommended number of LNs was harvested. The 5-year recurrence-free survival (RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each group. METHODS: RESULTS:Among patients with the same p/ypN stage, the 5-year RFS rate differed according to the LNR. In addition, the 5-year RFS rate was significantly different between pN and LNR groups in patients with No PCRT. In PCRT group, however, only LNR was associated with prognosis. On multivariate analysis, both pN and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT group. In the PCRT group, only LNR category was found to be associated with RFS (HR = 2.36, 95%CI: 1.31-3.84, and P = 0.001). CONCLUSION:The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with PCRT. Current pN categories could not discriminate between prognostic groups of RFS after PCRT. Core tip: The number of metastatic lymph node might show different prognosis according to the number of examined lymph node. Retrieved number of lymph node after preoperative chemoradiotherapy (PCRT) has been known fewer than those without PCRT. However, number of metastatic lymph nodes used in pathologic staging was same between patients treated with PCRT and those without PCRT. The present study suggests the metastatic lymph node ratio would be useful prognostic indicator and it is more prominent in patients treated with PCRT.Park IJ, Yu CS, Lim SB, Yoon YS, Kim CW, Kim TW, Kim JH, Kim JC. Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy.

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Lymph Node Ratio as a Prognostic Factor in Patients With Stage III Rectal Cancer Treated With Total Mesorectal Excision Followed by Chemoradiotherapy

Cited by 73 publications

References 34 publications

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

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

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

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