Metastatic lymph node ratio as an independent prognostic variable in colorectal cancer: study of 113 patients

Priolli, Denise Gonçalves; Cardinalli, Izilda Aparecida; Pereira, José Aires; Alfredo, Camila Helaehil; Margarido, Nelson Fontana

doi:10.1007/s10151-009-0467-5

Cited by 31 publications

(33 citation statements)

References 45 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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“…In the literature, only 3 studies have studied the LNR in 2 groups. These groups were based on the quartiles 18,19 or the mean LNR 20 and not on the correlation between LNR and survival.…”

Section: Discussionmentioning

confidence: 99%

A Lymph Node Ratio of 10% Is Predictive of Survival in Stage III Colon Cancer: A French Regional Study

Sabbagh

Mauvais

Cossé

et al. 2014

International Surgery

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Lymph node ratio (LNR) (positive lymph nodes/sampled lymph nodes) is predictive of survival in colon cancer. The aim of the present study was to validate the LNR as a prognostic factor and to determine the optimum LNR cutoff for distinguishing between “good prognosis” and “poor prognosis” colon cancer patients. From January 2003 to December 2007, patients with TNM stage III colon cancer operated on with at least of 3 years of follow-up and not lost to follow-up were included in this retrospective study. The two primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS) as a function of the LNR groups and the cutoff. One hundred seventy-eight patients were included. There was no correlation between the LNR group and 3-year OS (P = 0.06) and a significant correlation between the LNR group and 3-year DFS (P = 0.03). The optimal LNR cutoff of 10% was significantly correlated with 3-year OS (P = 0.02) and DFS (P = 0.02). The LNR was not an accurate prognostic factor when fewer than 12 lymph nodes were sampled. Clarification and simplification of the LNR classification are prerequisites for use of this system in randomized control trials. An LNR of 10% appears to be the optimal cutoff.

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“…Ceelen et al [42], in a systematic review of the prognostic value of the LNR in stage III colorectal cancer, stated that it is a stronger prognostic factor than the number of LN for both colon and rectal cancer patients. All identified studies about rectal cancer [43][44][45][46][47][48][49][50] showed that the LNR is an independent predictor of overall survival and disease-free survival. In particular, Rosenberg et al [46] in 1,263 rectal cancer patients over a 25-year time period and Peschaud et al [47] in 307 patients with high, mid, or low rectal cancer reported LNR as an independent prognostic factor, even when fewer than 12 LN were examined.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, Rosenberg et al [46] in 1,263 rectal cancer patients over a 25-year time period and Peschaud et al [47] in 307 patients with high, mid, or low rectal cancer reported LNR as an independent prognostic factor, even when fewer than 12 LN were examined. Nevertheless, several limitations apply to the interpretation of the results of these studies: most did not separately analyze intra-and extraperitoneal rectal cancer patients [43,46,47], and some included only upper rectal cancer patients [50], had a median follow-up period of less than 5 years [45,[47][48][49][50], did not report data regarding the surgical technique used [43,49], or included patients operated on before the introduction of TME [43,46]. Moreover, different cutoff values for LNR were proposed based mainly on quartiles classification rather than a single value.…”

Section: Discussionmentioning

confidence: 99%

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

et al. 2012

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BackgroundThe lymph node ratio (LNR; number of positive nodes divided by total nodes harvested) has been demonstrated to be a prognostic factor in colon cancer, but its role in extraperitoneal rectal cancer is still debated; furthermore, no data are available on laparoscopic rectal resection. The aim of this study was to evaluate the prognostic impact of LNR on long-term outcomes after laparoscopic total mesorectal excision (LTME) for extraperitoneal cancer in consecutive patients with a 5-year minimum follow-up. Methods This study is a prospective analysis of consecutive patients who underwent LTME for adenocarcinoma of the extraperitoneal rectum. Results LTME was performed in 158 patients. The median number of LN harvested was 12 (range = 3-25). The proportion of specimens with fewer than 12 examined LN was significantly higher in patients who had neoadjuvant chemoradiotherapy (p < 0.001). During a median follow-up period of 122 months, the local recurrence rate was 8 %. At univariate analysis, disease-free survival and overall survival significantly decreased with increasing LNR (p < 0.001). Multivariate analysis showed that the distal margin ≤1 cm was the only independent predictor of local recurrence (p = 0.028). LNR (cutoff value = 0.25) and lymphovascular invasion were significant prognostic factors for both disease-free (p = 0.015 and p = 0.046, respectively) and overall survival (p = 0.031 and p = 0.040, respectively). Even in the subgroup of patients in whom fewer than 12 LN were examined, LNR confirmed its prognostic role, with a statistical trend toward worse disease-free survival and overall survival. Conclusion Metastatic LNR is an independent prognostic factor for disease-free survival and overall survival after LTME for extraperitoneal rectal cancer. Keywords Lymph node ratio Survival Laparoscopy Total mesorectal excision Rectal cancer Excellence of surgical technique is of particular relevance in the treatment of extraperitoneal rectal cancer. Routine excision of the intact mesorectum during resection of cancer of the middle and lower rectum has resulted in a significant decrease in local recurrence rates [1]. Developed and popularized by Heald and co worker [1], total mesorectal excision (TME) is presently the surgical gold standard, with a 4 % local recurrence rate and a 78 % tumor-free survival rate in curative cases at 5 years [2]. A recent meta-analysis by Huang et al. [3] of randomized controlled trials that included small numbers of patients with upper or mid-to-low rectal cancer did not show differences between laparoscopic and open surgery in terms of the number of lymph nodes (LN) harvested, local recurrence, 3-year disease-free survival, and overall survival. Although a minimum of 12 LN in the

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Metastatic lymph node ratio as an independent prognostic variable in colorectal cancer: study of 113 patients

Abstract: The results showed that the LNR can be considered an independent prognostic variable in overall survival of patients with colorectal cancer.

Cited by 31 publications

References 45 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

A Lymph Node Ratio of 10% Is Predictive of Survival in Stage III Colon Cancer: A French Regional Study

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

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