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

Jakob, Manuel O.; Güller, Ulrich; Ochsner, A; Oertli, Daniel; Viehl, Carsten T.

doi:10.1186/s12893-018-0417-0

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…Some studies state that LNR is a significant risk factor that should be incorporated into the TNM staging system of the American Joint Committee on Cancer due to its high predictive value for survival [ 39 , 40 ]. However, some studies disagree with this because the lymph node assessment in CRC specimens can be influenced by both surgical and pathological factors, including the extent of the lymph node dissection, the length of the surgical specimen, the surgeon’s technique, and the thoroughness of the pathologists [ 41 , 42 , 43 ]. In our study, the mean number of total harvested lymph nodes was over 20, which is a proxy for high-quality surgical resection [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

A Prediction Model for Tumor Recurrence in Stage II–III Colorectal Cancer Patients: From a Machine Learning Model to Genomic Profiling

et al. 2022

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Background: Colorectal cancer (CRC) is one of the most prevalent malignant diseases worldwide. Risk prediction for tumor recurrence is important for making effective treatment decisions and for the survival outcomes of patients with CRC after surgery. Herein, we aimed to explore a prediction algorithm and the risk factors for postoperative tumor recurrence using a machine learning (ML) approach with standardized pathology reports for patients with stage II and III CRC. Methods: Pertinent clinicopathological features were compiled from medical records and standardized pathology reports of patients with stage II and III CRC. Four ML models based on logistic regression (LR), random forest (RF), classification and regression decision trees (CARTs), and support vector machine (SVM) were applied for the development of the prediction algorithm. The area under the curve (AUC) of the ML models was determined in order to compare the prediction accuracy. Genomic studies were performed using a panel-targeted next-generation sequencing approach. Results: A total of 1073 patients who received curative intent surgery at the National Cheng Kung University Hospital between January 2004 and January 2019 were included. Based on conventional statistical methods, chemotherapy (p = 0.003), endophytic tumor configuration (p = 0.008), TNM stage III disease (p < 0.001), pT4 (p < 0.001), pN2 (p < 0.001), increased numbers of lymph node metastases (p < 0.001), higher lymph node ratios (LNR) (p < 0.001), lymphovascular invasion (p < 0.001), perineural invasion (p < 0.001), tumor budding (p = 0.004), and neoadjuvant chemoradiotherapy (p = 0.025) were found to be correlated with the tumor recurrence of patients with stage II–III CRC. While comparing the performance of different ML models for predicting cancer recurrence, the AUCs for LR, RF, CART, and SVM were found to be 0.678, 0.639, 0.593, and 0.581, respectively. The LR model had a better accuracy value of 0.87 and a specificity value of 1 in the testing set. Two prognostic factors, age and LNR, were selected by multivariable analysis and the four ML models. In terms of age, older patients received fewer cycles of chemotherapy and radiotherapy (p < 0.001). Right-sided colon tumors (p = 0.002), larger tumor sizes (p = 0.008) and tumor volumes (p = 0.049), TNM stage II disease (p < 0.001), and advanced pT3–4 stage diseases (p = 0.04) were found to be correlated with the older age of patients. However, pN2 diseases (p = 0.005), lymph node metastasis number (p = 0.001), LNR (p = 0.004), perineural invasion (p = 0.018), and overall survival rate (p < 0.001) were found to be decreased in older patients. Furthermore, PIK3CA and DNMT3A mutations (p = 0.032 and 0.039, respectively) were more frequently found in older patients with stage II–III CRC compared to their younger counterparts. Conclusions: This study demonstrated that ML models have a comparable predictive power for determining cancer recurrence in patients with stage II–III CRC after surgery. Advanced age and high LNR were significant risk factors for cancer recurrence, as determined by ML algorithms and multivariable analyses. Distinctive genomic profiles may contribute to discrete clinical behaviors and survival outcomes between patients of different age groups. Studies incorporating complete molecular and genomic profiles in cancer prediction models are beneficial for patients with stage II–III CRC.

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Section: Discussionmentioning

confidence: 99%

A Prediction Model for Tumor Recurrence in Stage II–III Colorectal Cancer Patients: From a Machine Learning Model to Genomic Profiling

et al. 2022

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“…Colorectal cancers are some of the most common forms of cancer, and surgery is the main treatment in most colon cancers. 4 The number of lymph nodes removed during surgery and the number of metastatic lymph nodes affects prognosis and treatment indication. 9 Patients’ lymph node numbers were evaluated in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Current guidelines state that 12 lymph nodes are sufficient for the assessment of lymph node involvement. 3 , 4 However, insufficient lymph node removal can lead to pN-related problems and to difficulties in determining prognosis and treatment planning. 5 …”

Section: Introductionmentioning

confidence: 99%

The association between the lymph node ratio, surgical margin, and survival in patients with colon cancer receiving adjuvant chemotherapy

Fidan

Merev²,

Usta³

et al. 2022

Pak J Med Sci

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Objectives: To investigate the prognostic significant of lymph node ratio and surgical margins in patients with colon cancer undergoing surgery. Methods: This observational and retrospective study was conducted at Karadeniz Technical University Medical Faculty, between 1 January, 2010 and 31 November, 2020. A series of 137 patients who had undergone surgical resection of colon carcinoma were included in this study. mLNR, deﬁned as the ratio of the number of mLNs to the number of examined lymph nodes, was calculated in colorectal cancer cases with lymph node metastasis. Patients were divided into three groups; LNR1 (< 0.25), LNR2 (0.25-0.6) and LNR3 (> 0.6). Results: Mean disease-free survival was 79.2 months (95% CI 71.0-87.4). The mean expected survival time was 73.5 months (95% CI: 65.9-81.0). As the metastatic LN ratio increased, the rate of local recurrence or distant metastasis increased statistically significantly (p=0.007). As the metastatic LN ratio increased, the death rate increased statistically significantly (p=0.036). Metastatic lymph node ratio did not have a statistically significant effect on overall survival in patients with stage-3 and more than 12 LNs removed (p=0.069). There was no statistically significant association between the closeness of the surgical margin and disease-free survival in stage 1 (p=0.505) and stage-2 (p=0.161). There was no statistically significant association between the closeness of the surgical margin and overall survival among patients with stage 1 (p=0.494) and stage 2 (p=0.265). Conclusion: A high metastatic LNR is associated with poorer overall and disease-free survival. doi: https://doi.org/10.12669/pjms.38.3.5085 How to cite this:Fidan E, Merev E, Usta A, Alandag C, Disli S, Ozdover A. The association between the lymph node ratio, surgical margin, and survival in patients with colon cancer receiving adjuvant chemotherapy. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5085 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Lymph nodes ratio is considered as an effective parameter for stratification, especially because it seems to be independent of the resection length[ 24 ], and as a strong predictor for tumor recurrence[ 25 , 26 ]. However, the more recent paper of Jakob et al [ 27 ] reported the bigger impact of pN than lymph node ratio on recurrence suggesting that the latter parameter could be more helpful in presence of a relatively low number of harvested lymph nodes[ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of prognostic factors and clinicopathological patterns of recurrence after curative surgery for colorectal cancer

Melli¹,

Bartolini²,

Risaliti³

et al. 2021

WJGS

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BACKGROUND Colorectal cancer is a common tumor with a quite high-related mortality. Despite the used curative treatments, patients will develop cancer recurrence in up to 50% of the cases and/or other primary neoplasms. Although most of the recurrences are discovered within 3 years from the first treatment, a small percentage is found after 5 years. The early detection of recurrence is crucial to allow further therapies improving patients’ survival. Several follow-up programs have been developed but the optimal one is far from being established. AIM To evaluation of potential prognostic factors for timing and patterns of recurrence in order to plan tailored follow-up programs. METHODS Perioperative and long-term data of all consecutive patients surgically treated with curative intent, from January 2006 to June 2009, for colorectal adenocar-cinoma, were retrospectively reviewed to find potential prognostic factors associated with: (1) Recurrence incidence; (2) Incidence of an early (within 3 years from surgery) or late recurrence; and (3) Different sites of recurrence. In addition, the incidence of other primary neoplasms has been evaluated in a cohort of patients with a minimum potential follow-up of 10 years. RESULTS Our study included 234 patients. The median follow-up period has been 119 ± 46.2 mo. The recurrence rate has been 25.6%. Patients with a higher chance to develop recurrence had also the following characteristics: Higher levels of preoperative glycemia and carcinoembryonic antigen, highest anaesthesiologists Score score, occlusion, received a complex operation performed with an open technique, after a longer hospital stay, and showed advanced tumors. The independent prognostic factors for recurrence were the hospital stay, N stage 2, and M stage 1 (multivariate analysis). Younger ages were significantly associated with an early recurrence onset. Patients that received intermediate colectomies or segmental resections, having an N stage 2 or American Joint Committee on Cancer stage 3 tumors were also associated with a higher risk of liver recurrence, while metastatic diseases at diagnosis were linked with local recurrence. Neoadjuvant treatments showed lung recurrence. Finally, bigger tumors and higher lymph node ratio were associated with peritoneal recurrence (marginally significant). Thirty patients developed a second malignancy during the follow-up time. CONCLUSION Several prognostic factors should be considered for tailored follow-up programs, eventually, beyond 5 years from the first treatment.

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

Cited by 12 publications

References 23 publications

A Prediction Model for Tumor Recurrence in Stage II–III Colorectal Cancer Patients: From a Machine Learning Model to Genomic Profiling

A Prediction Model for Tumor Recurrence in Stage II–III Colorectal Cancer Patients: From a Machine Learning Model to Genomic Profiling

The association between the lymph node ratio, surgical margin, and survival in patients with colon cancer receiving adjuvant chemotherapy

Evaluation of prognostic factors and clinicopathological patterns of recurrence after curative surgery for colorectal cancer

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