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

Zhou, Di; Ye, Ming; Bai, Yongrui; Rong, Ling; Hou, Yanli

doi:10.1503/cjs.001515

Cited by 16 publications

(10 citation statements)

References 22 publications

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“…Till now, the prognostic value of LNR has been proven in previous studies of patients with rectal cancer treated with postoperative CRT. 29 , 30 The status of LNs, however, is absolutely different in rectal cancer patients with or without preoperative CRT. Preoperative CRT followed by TME and postoperative chemotherapy is the current standard treatment for the patients with T3 or T4 tumors and/or positive LNs according to the guidelines issued by the National Health and Family Planning Commission of the People's Republic of China.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision

et al. 2016

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Although the absolute number of positive lymph nodes (LNs) has been established as 1 of the most important prognostic factors in rectal cancers, many researchers have proposed that the lymph node ratio (LNR) may have better predicted outcomes. We conducted a retrospective study to compare the predictive ability of LNR and ypN category in rectal cancer.A total of 264 locally advanced rectal cancer (LARC) patients who underwent preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) between 2005 and 2012 were reviewed. All patients were categorized into 3 groups or patients with metastatic LNs were categorized into 2 groups according to the LNR. The prognostic effect on overall survival (OS) and disease-free survival (DFS) was evaluated.With a median follow-up of 45 months, the OS and DFS were 68.4% and 59.3% for the entire cohort, respectively. The respective 5-year OS and DFS rates for the 3 groups (LNR = 0, 0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were as follows: 83.2%, 72.6%, and 49.4% (P < 0.001) and 79.5%, 57.3%, and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that LNR and differentiation, but not the number of positive LNs, had independent prognostic value for OS (hazard ratio [HR] = 2.328, 95% confidence interval [CI]: 1.850–4.526, P < 0.001) and DFS (HR = 3.004, 95% CI: 1.616–5.980, P < 0.001). As for patients with positive LNs, the respective 5-year OS and DFS rates for the 2 groups (0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were 72.6% and 49.4% (P < 0.001) and 57.3% and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that only LNR was an independent factor for OS (HR = 3.214, 95% CI: 1.726–5.986, P < 0.001) and DFS (HR = 4.230, 95% CI: 1.825–6.458, P < 0.001). Subgroups analysis demonstrated that the ypN category had no impact on survival whereas increased LNR was a significantly prognostic indicator for worse survival in the LNs < 12 subgroup.LNR is an independent prognostic factor in LARC patients treated with preoperative CRT followed by TME. It may be a better independent staging method than the number of metastatic LNs when <12 LNs are harvested after preoperative CRT.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision

et al. 2016

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“…For accurate staging of colorectal cancer, removal of at least twelve lymph nodes was recommended by AJCC. LNR involves both TLN and PLN and has been claimed to be more accurate than AJCC N stage for rectal cancer (22,23). However, other scholars have noticed that when TLN are either all non-metastatic or all metastatic, patients with the same LNR values might be extremely varied.…”

Section: Discussionmentioning

confidence: 99%

A Prognostic Nomogram for Patients with Stage II/III Rectal Cancer Undergoing Surgical Resection after Neoadjuvant Chemoradiotherapy

Lin

2022

Preprint

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Background: The purpose of this study was to create a nomogram incorporated on log odds of positive nodes (LODDS) for predicting the overall survival (OS) of patients with stage II/III rectal cancer who underwent surgical resection after neoadjuvant chemoradiotherapy (NCRT).Methods: The Surveillance, Epidemiology, and End Results database was used to collect information on patients diagnosed with stage II/III rectal cancer who underwent surgical resection after neoadjuvant chemoradiotherapy between 2010 and 2015. The Cox regression analyses were performed to determine the independent prognostic factors. In this study, LODDS was employed instead of American Joint Committee on Cancer (AJCC) 7th N stage to determine lymph node status. Then a nomogram integrating independent prognostic factors was created to predict the 24-, 36-, and 60-month overall survival of patients. The receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the nomogram. Furthermore，patients were stratified into three risk groups(high-, middle-, and low-risk) based on the total points obtained from the nomogram using X-tile software. And Kaplan-Meier curves were plotted to compare OS of the three groups.Results: A total of 3,829 patients were included in the study. Race, sex, age, marital status, T stage, tumor grade, tumor size, LODDS, CEA level, and postoperative chemotherapy were identified as independent prognostic factors. Then the prognostic nomogram was created and evaluated. The ROC curves and calibration curves showed good performance of the prognostic nomogram. The Kaplan-Meier curves showed that the three risk groups had significant differences in overall survival.Conclusion: The LODDS-incorporated prognostic nomogram was created and showed satisfactorily discriminative and stable ability to predict the OS of patients with stage II/III rectal cancer undergoing surgical resection after NCRT. It is convenient to access the risk factors included in this nomogram in clinical practice. The nomogram is expected to be a useful tool in developing individualized treatment strategies and follow-up protocols.

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“…However, even though univariate analysis has not identified an association between a correct lymph node sampling and survival, a percent of 55.9% of correct lymphadenectomies could be improved [ 4 ]. Because only on the basis of a correct lymph node sampling can we calculate the N stage and the lymph node ratio (LNR), which are well known prognostic factors for rectal cancer [ 20 – 23 ]. In order to improve the percentage of lymph nodes identified, a tight collaboration between the surgeon and the pathologist must exist.…”

Section: Discussionmentioning

confidence: 99%

The importance of a multidisciplinary team in rectal cancer management

Bochis

Fekete

Vlad

et al. 2017

Medicine and Pharmacy Reports

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IntroductionThe aim of this study was to evaluate the impact of the interval between surgery and adjuvant treatments regarding the overall survival and recurrence-free survival in patients from a developing country. For stages II and III rectal cancer, international guidelines recommend neoadjuvant chemoradiotherapy (CRT) regardless of the tumor location. In the developing countries there is a shortage of radiotherapy centers, specialists, which lead to long waiting lists for radiotherapy. These problems might lead to protocol deviations.MethodsWe conducted a retrospective study on 161 patients with rectal cancer treated with surgery, postoperative CRT and with or without chemotherapy for a total of 6 months, at The Oncology Institute Cluj-Napoca between 2006–2010. All patients had 5 years of follow-up.ResultsA total of 161 patients were enrolled in this study. The majority of patients were locally advanced stages (89.44%). The well known prognostic factors, such as TNM stage, performance status, CEA serum level, perineural, vascular and lymphatic invasion, and node capsular effraction had a statistically significant influence on overall survival. In 21.12% of patients the first adjuvant treatment was started in the first 4 weeks after surgery. Only 13.04% of patients started the concomitant CRT within the limit of 6 weeks after surgery. Concerning the time between surgery and CRT, we did not observe a statistically significantly difference in OS if the radiotherapy started after the first 6 weeks (p=0.701). The OS rate for locally advanced rectal cancer patients was 69.44%.ConclusionsIn rectal cancer, the importance of the first therapeutic act is crucial. Following international guidelines provides a survival advantage and a better quality of life. In case of adjuvant treatment, it is recommended to start this treatment as soon as the local infrastructure allows it.

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

Cited by 16 publications

References 22 publications

Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision

Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision

A Prognostic Nomogram for Patients with Stage II/III Rectal Cancer Undergoing Surgical Resection after Neoadjuvant Chemoradiotherapy

The importance of a multidisciplinary team in rectal cancer management

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