The Number of Metastatic Lymph Nodes and the Ratio Between Metastatic and Examined Lymph Nodes Are Independent Prognostic Factors in Esophageal Cancer Regardless of Neoadjuvant Chemoradiation or Lymphadenectomy Extent

Mariette, C.; Piessen, Guillaume; Briez, Nicolas; Triboulet, Jean

doi:10.1097/sla.0b013e31815aaadf

Cited by 363 publications

(262 citation statements)

References 30 publications

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“…Patients with a lymph node ratio of less than 0.2 have a significantly better prognosis [54,94,96,97] with a reported ratio range from 0.1 [87,98] to 0.3 [97]. When comparing a lymph node ratio of less than 0.2 with greater than 0.2, it has been shown that the 5-year survival falls from 54% to 22% and the risk of recurrence rises from 44% to 69% [89]. This discrepancy in the value of the cut-off ratio is likely due to the fact that a more extensive lymphadenectomy leads to a greater number of uninvolved nodes being resected and thus reducing the cut-off ratio [94].…”

Section: Lymph Node Ratiomentioning

confidence: 99%

“…These modifications reflect findings which show improved prognostic stratification with consideration of the number ofdiseased lymph nodes [13,[84][85][86]. Several studies have shown the number of positive lymph nodes to be an independent prognostic indicator [13,14,[87][88][89][90]. …”

Section: Number Of Positive Lymph Nodesmentioning

confidence: 99%

“…was suggested, that lymph node number is a better prognostic measure for patients who have adequate lymph node (LN) resection (≥15 LN), whereas lymph node ratio is more accurate in inadequate lymph node resections (<15 LN) [89]. However, multivariate Cox regression modelling has identified lymph node ratio as the strongest independent prognostic factor for overall survival in patients with nodal disease [60], and thus advocated for it to be included in the UICC classification.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

“…The second school advocates an optimum cut off point, above which prognosis significantly falls [11,15,17,22,71], of 4 lymph nodes (reported range: 3-7 involved lymph nodes) [13, 14, 41, 54, 57, 71, 79, 87, 94 95]. When comparing patients with greater than four involved lymph nodes to those with four or less involved lymph nodes, the risk of developing recurrent disease rises from 45% to 82% and the 5-year survival is significantly reduced [13,22,71,87,89]. Median survival with 1-4 involved lymph nodes is 33 months (95% CI: 28-37 months) but this falls to 17 months (95% CI: 16-19 months) for patients with greater than 4 involved lymph nodes (87).…”

Section: Prognostic Implications: Number Of Positive Lymph Nodesmentioning

confidence: 99%

See 3 more Smart Citations

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Kayani

Zacharakis

Ahmed

et al. 2011

European Journal of Surgical Oncology (EJSO)

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Oesophageal cancer is the seventh most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The seventh edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system.

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Section: Lymph Node Ratiomentioning

confidence: 99%

Section: Number Of Positive Lymph Nodesmentioning

confidence: 99%

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Section: Prognostic Implications: Number Of Positive Lymph Nodesmentioning

confidence: 99%

See 2 more Smart Citations

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Kayani

Zacharakis

Ahmed

et al. 2011

European Journal of Surgical Oncology (EJSO)

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“…Furthermore, among the stage III patients, there was a higher percentage of pN2 in the group of patients with more than 12 LN in the surgical specimen (p = 0.100). The metastatic LNR, which was initially proposed for patients with esophageal and gastric cancer [40,41], is expected to yield a more reliable prognosis. Several recent studies have investigated the role of the LNR in colorectal cancer; however, few reported on rectal cancer and none on laparoscopic resection.…”

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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Variation in Lymph Node Examination After Esophagectomy for Cancer in the United States

Merkow

Bilimoria²,

Chow

et al. 2012

Arch Surg

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The Number of Metastatic Lymph Nodes and the Ratio Between Metastatic and Examined Lymph Nodes Are Independent Prognostic Factors in Esophageal Cancer Regardless of Neoadjuvant Chemoradiation or Lymphadenectomy Extent

Cited by 363 publications

References 30 publications

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

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

Variation in Lymph Node Examination After Esophagectomy for Cancer in the United States

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