Lymph Node Ratio Versus Number of Affected Lymph Nodes as Predictors of Survival for Resected Pancreatic Adenocarcinoma

Bhatti, Imran; Peacock, Oliver; Awan, Altaf; Semeraro, D; Larvin, Michael; Hall, Richard

doi:10.1007/s00268-009-0336-4

Cited by 64 publications

(76 citation statements)

References 31 publications

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“…In contrast, this report strongly declines such approach in rectal cancer patients who have received neoadjuvant treatment. In addition to the total number of lymph nodes examined, the absolute number of metastatic lymph nodes and LNR of metastatic to total number of lymph nodes examined have been recognized as new prognostic factors for the survival in rectal cancer similar to other malignancies including breast, pancreas and gastric carcinoma (4,11,12,(44)(45)(46). Moreover, LNR has been identified superior than pN stage in rectal cancer in view of reflecting the response of preoperative therapy as well as regulating the administration of post-operative adjuvant treatment (47)(48)(49).…”

Section: Discussionmentioning

confidence: 99%

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Gurawalia¹,

Dev²,

Nayak³

et al. 2016

J. Gastrointest. Oncol.

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Background: The number of lymph node retrieved in the surgical specimen is important for tumor staging and has paramount impact on prognosis in colorectal cancer and imitates the adequacy of lymph node surgical clearance. The paucity of lymph node yields in patients undergoing resection after preoperative chemo radiotherapy (CRT) in rectal cancer has seen. Lower total number of lymph nodes in the total mesoractal excision (TME) specimen after CRT, could a marker of better tumor response. Methods: We retrospectively reviewed the prospectively managed data of patients underwent excision for rectal cancer, who treated by neoadjuvant radiotherapy with or without chemotherapy in locally advanced rectal cancer. From 2010 to 2014, 364 patients underwent rectal cancer surgery, of which ninety-one treated with neoadjuvant treatment. Standard surgical and pathological protocols were followed. Patients were categorized into two groups based on the number of total harvested lymph nodes with group 1, having 12 or more nodes harvested, and group 2 including patients who had <12 lymph nodes harvested. The total number of lymph nodes retrieved from the surgical specimen was correlated with grade of tumor regression with neoadjuvant treatment. Results: Out of 91 patients, 38 patients (42%) had less than 12 lymph nodes examined in specimen. The difference in median number of lymph nodes was observed significantly as 9 (range, 2-11) versus 16 (range, 12-32), in group 2 and 1, respectively (P<0.01). Patients with fewer lymph node group were comparable with respect to age, BMI, pre-operative staging, neoadjuvant treatment. Pathological complete response in tumor pCR was seen with significantly higher rate (40% vs. 26%, P<0.05) in group 2. As per Mandard criteria, there was significant difference in tumor regression grade (TRG) between both the groups (P<0.05). Among patients with metastatic lymph nodes, median LNR was lower in <12 lymph nodes group at 0.167 (range, 0.09-0.45) versus 0.187 (range, 0.05-0.54), difference was not statistically significant (P=0.81).Conclusions: Retrieval of fewer than 12 lymph nodes in surgical specimen of rectal cancer who had received neo-adjuvant radiotherapy with or without chemotherapy should be considered as a good indicator of tumor response with better local disease control, and a good prognostic factor, rather than as a pointer of poor diligence of the surgical and pathological assessment.

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Section: Discussionmentioning

confidence: 99%

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Gurawalia¹,

Dev²,

Nayak³

et al. 2016

J. Gastrointest. Oncol.

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“…Only four studies did not report the nodal and R status. 28,[30][31][32] Adjuvant therapy (chemoradiotherapy) data were available in 10 studies that included 1,739 patients (36%), 13,14,19,[21][22][23]26,[28][29][30] and data on neoadjuvant therapy were available in only two studies.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] There were 5 prospective studies, 1 randomised controlled trial and 13 retrospective studies (Table 1). All included studies analysed survival using the Kaplan-Meier method, defining an event as the death of a patient and overall survival from the time elapsed from surgery to death.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma

Elshaer

Gravante

Kosmin

et al. 2017

annals

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BACKGROUND Pancreatic ductal adenocarcinoma is the most common pancreatic cancer. Five-year overall survival is currently 3.3-6.0%. The aim of this review was to evaluate the prognostic value of lymph node ratio, number of positive nodes and total nodes examined on overall survival rate following pancreatic resection. MATERIALS AND METHODS A literature search was conducted of MEDLINE, EMBASE, the Cochrane Library and Central Register of Controlled Trials and the Cochrane Database of Systematic Review databases, from January 1996 to January 2016. RESULTS Overall, 19 studies including 4,883 patients examined the relationship between lymph node ratio and overall survival. A high lymph node ratio was associated with decreased overall survival in 17 studies. A total of 12 studies examined the relationship between the number of positive nodes and overall survival, and 11 studies revealed that an increase in the number of positive nodes was associated with decreased overall survival. In 15 studies examining the relationship between the total nodes examined and overall survival, there was no association with overall survival in 12 studies. CONCLUSIONS Lymph node ratio and number of positive nodes are factors associated with overall survival in pancreatic ductal adenocarcinoma, but not total nodes examined.

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“…The metastatic LNR is the ratio of pathologically involved LNs to total resected LNs. The LNR has been shown to be an important prognostic factor in gastric, breast, pancreatic and CRC, 12,13 but the value of LNR in different studies varies. The purpose of our study was to assess the impact of metastatic LNR on survival in patients with locally advanced rectal cancer, especially on OS, DFS, local failure and distant metastasis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of lymph node ratio in survival of patients with locally advanced rectal cancer

Zhou

Bai

et al. 2015

cjs

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Background:The lymph node ratio (LNR) has been shown to be an important prognostic factor in patients with gastric, breast, pancreatic and colorectal cancer. We investigated the prognostic impact of the LNR in addition to TNM classification in patients with locally advanced rectal cancer. Methods:We retrospectively analyzed patients who underwent curative resection for locally advanced rectal cancer between July 2005 and December 2010. We determined the LNR cutoff value using a receiver operating characteristic curve. The Kaplan-Meier method was used to estimate survival curves, while Cox regression analyses were used to evaluate the relationship between LNR and survival. Results:We included 180 patients aged 28-83 years with median follow-up of 41.8 months. The median number of lymph nodes examined and lymph nodes involved were 11.5 and 4, respectively, and the median LNR was 0.366. An LNR of 0.19 (19%) was the cutoff point to separate patients with regard to median overall survival. Median overall survival was 64.2 months for patients with an LNR of 0, 59.1 for an LNR of 0.19 or less and 37.6 for an LNR greater than 0.19 (p = 0.004). The median disease-free survival was 32.9 months for patients with an LNR of 0, 30.4 for an LNR of 0.19 or less and 17.8 for an LNR greater than 0.19 (p = 0.002). Conclusion:Our results suggest that LNR should be considered an additional prognostic factor in patients with locally advanced rectal cancer.Contexte : Il a été démontré que le ratio de ganglions lymphatiques positifs est un important facteur pronostique chez les patients atteints de cancer de l'estomac, de cancer du sein, de cancer du pancréas et de cancer colorectal. Nous avons étudié l'incidence pronostique de l'utilisation de ce ratio en plus de la classification TNM chez les patients présentant un cancer du rectum localement avancé.Méthodes : Nous avons analysé rétrospectivement des patients ayant subi une résec-tion curative visant à traiter un cancer du rectum localement avancé entre juillet 2005 et décembre 2010. Nous avons déterminé la valeur seuil du ratio de ganglions lymphatiques positifs à l'aide d'une courbe caractéristique de la performance. La méthode de Kaplan-Meyer a été utilisée pour estimer les courbes de survie, tandis que le modèle de régression des hasards proportionnels de Cox a servi à évaluer la corréla-tion entre le ratio à l'étude et la survie.Résultats : Notre étude a porté sur 180 patients de 28 à 83 ans dont la durée mé diane du suivi était de 41,8 mois. Les nombres médians de ganglions lymphatiques examinés et de ganglions lymphatiques positifs étaient de 11,5 et 4, respectivement, et le ratio médian de ganglions lymphatiques positifs était de 0,366. Nous avons utilisé une valeur seuil de 0,19 (19 %) pour séparer les patients en ce qui a trait à la survie globale médiane. Cette mesure était de 64,2 mois pour les patients présentant un ratio de 0, de 59,1 mois pour ceux présentant un ratio de 0,19 ou moins, et de 37,6 mois pour ceux dont le ratio était supérieur à 0,19 (p = 0,004). La survi...

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Lymph Node Ratio Versus Number of Affected Lymph Nodes as Predictors of Survival for Resected Pancreatic Adenocarcinoma

Abstract: The LNR represents a stronger independent prognostic indicator than the absolute number of affected lymph nodes in patients with resected pancreatic ductal adenocarcinoma.

Cited by 64 publications

References 31 publications

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma

Prognostic value of lymph node ratio in survival of patients with locally advanced rectal cancer

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