Lymph Node Ratio Improves TNM and Astler-Coller’s Assessment of Colorectal Cancer Prognosis: an Analysis of 761 Node Positive Cases

Costi, Roberta; Beggi, Filippo; Reggiani, Valeria; Riccò, Matteo; Crafa, Pellegrino; Bersanelli, Melissa; Tartamella, Francesco; Violi, Vincenzo; Roncoroni, L; Sarli, Leopoldo

doi:10.1007/s11605-014-2591-4

Cited by 17 publications

(20 citation statements)

References 55 publications

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“…Costi et al . also reported that the LNR was superior to the TNM classification in colorectal cancer, but their patient cohort differed from the present study in that they included both colon and rectal cancer patients. They divided their group into LNR1 and LNR2 based on a cut‐off point of 0.15 and used an arbitrary method to determine the cut‐off point based on the 75th percentile, having originally divided the group into quartiles.…”

Section: Discussioncontrasting

confidence: 57%

“…In a systematic review Ceelen et al [26] reported that the LNR was superior to the number of positive nodes, but comparison of N1/N2 with the LNR was limited owing to heterogeneity in the included studies. Costi et al [27] also reported that the LNR was superior to the TNM classification in colorectal cancer, but their patient cohort differed from the present study in that they included both colon and rectal cancer patients. They divided their group into LNR1 and LNR2 based on a cut-off point of 0.15 and used an arbitrary method to determine the cut-off point based on the 75th percentile, having originally divided the group into quartiles.…”

Section: Discussioncontrasting

confidence: 57%

“…The method used to compare the cohorts consisted of using LNR1 and LNR2 to substratify TNM IIIb and IIIc and identify patients at increased risk of an adverse outcome. Hence, rather than demonstrating superiority of the LNR over TNM, Costi et al [27] showed that the LNR may be used as an adjunct to TNM staging. The specificity and sensitivity are not given, but it would be reasonable to deduce that this may improve sensitivity at the cost of decreased specificity [28].…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2017

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Section: Discussioncontrasting

confidence: 57%

Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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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

et al. 2017

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“…The cumulative 5-year survival rate was 63 % for patients with 1–3 positive node whereas 0 % for those with ≥4 positive nodes. LNR, another node-associated factor, has drawn much attention for predicting the survival outcome in patients with various gastrointestinal malignancies [ 16 , 17 , 19 – 21 ]. LNR may to some degree compensate or standardize variations in inadequate surgical lymph node dissection [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection

et al. 2015

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BackgroundLymph node involvement is one of the well-demonstrated prognostic factors in ampullary carcinoma. The aim of this study is to clarify the role of lymph nodes in predicting the survival outcome of ampullary carcinoma.MethodsA cohort of consecutive curative pancreaticoduodenectomies for ampullary carcinoma from 1999 to 2014 was retrospectively analyzed. The effect of node-associated variables, including lymph node status, positive lymph node number, total harvested lymph node (THLN) number, and lymph node ratio (LNR) was examined using univariate and multivariate analyses for survival outcome prediction.ResultsIn 194 evaluable patients, univariate analysis demonstrated that stage, cell differentiation, perineural invasion, and nodal status were significant conventional prognostic factors. Concerning the node-associated variables, positive nodal status, positive lymph node number ≥2, THLN number <14, and LNR ≥0.15 were significantly associated with poorer survival outcomes, with a 5-year survival rate of 20.3, 38.9, 25.4, and 18 %, respectively. By multivariate analysis, nodal status and THLN number were two independent predictors of survival. The most favorable 5-year survival rate was 84.4 % in patients with negative nodal involvement and THLN number ≥14, compared with the poorest 5-year survival rate of 16.1 % in those with positive nodal status and THLN number <14.ConclusionsTumor biology reflected by lymph node status is the most important independent prognostic factor; nevertheless, surgical radicality based on THLN number also plays a significant role in the survival outcome for patients with ampullary carcinoma after curative pancreaticoduodenectomy.

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“…The positive lymph node ratio (PLNR), the ratio of the number of positive lymph nodes to the total number of dissected lymph nodes, has been proposed as an independent prognostic factor in several solid cancers [6,7,8]. In a series of 353 ESCC patients, He et al [9] described the PLNR as an important predictor of OS after radical esophagectomy.…”

Section: Introductionmentioning

confidence: 99%

Value of Positive Lymph Node Ratio for Predicting Postoperative Distant Metastasis and Prognosis in Esophageal Squamous Cell Carcinoma

Huang¹,

Hu²,

Pang

et al. 2015

Oncol Res Treat

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Background: The aim of this study was to investigate the relationship between positive lymph node ratio (PLNR) and postoperative distant metastasis and prognosis in esophageal squamous cell carcinoma (ESCC). Patients and Methods: 167 ESCC patients with regional lymph node metastasis, who underwent radical esophagectomy and lymphadenectomy at the Ningbo Yinzhou People's Hospital between October 2005 and December 2010, were enrolled in this study. The prognostic value of PLNR was calculated by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. Results: After a median follow-up time of 34 months, 88 (52.7%) of the 167 patients had distant metastasis and 76 (45.5%) had died. Patients with a PLNR of less than 0.15 had a 5-year distant metastasis-free survival (DMFS) rate of 33.3% while those with a PLNR greater than 0.15 had a 5-year DMFS rate of 25.5% (log-rank test, p = 0.002). Multivariate analysis indicated that a PLNR > 0.15 was an independent poor prognostic factor for DMFS (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.21-3.05) and overall survival (OS) (HR 2.08, 95% CI 1.26-3.43). This analysis was adjusted for patient age, sex, smoking behavior, and pT stage. Conclusion: The PLNR is an independent prognostic factor for predicting postoperative distant metastasis and prognosis in ESCC, and patients with a PLNR ≤ 0.15 have better OS.

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Lymph Node Ratio Improves TNM and Astler-Coller’s Assessment of Colorectal Cancer Prognosis: an Analysis of 761 Node Positive Cases

Abstract: LNR is a powerful prognosis predictor, easily integrated with TNM and AC classifications to improve prognosis assessment and facilitate clinical use. Possible confusing factors should be considered in future studies.

Cited by 17 publications

References 55 publications

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

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

The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection

Value of Positive Lymph Node Ratio for Predicting Postoperative Distant Metastasis and Prognosis in Esophageal Squamous Cell Carcinoma

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