The Prognostic Significance of Lymph Node Ratio in Carcinoid Tumors

Flatow, Virginia; Warner, Richard R.P.; Overbey, Jessica; Divino, Celia M.

doi:10.1097/mpa.0000000000000476

Cited by 7 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rN was identified to be an independent prognostic marker in these types of tumor, with the exception of carcinoid tumors (36). Consistent with these results, the present study demonstrated that the rN score was a significant prognostic factor based on univariate and multivariate analyses, as an increased rN score was associated with a reduced OS time.…”

Section: Discussionsupporting

confidence: 79%

“…A number of studies have focused on the prognostic significance of rN in other types of malignant tumor, including esophageal carcinoma (31), breast cancer (32), non-small cell lung cancer (33), colon cancer (34), pancreatic adenocarcinoma (35) and carcinoid tumors (36). The rN was identified to be an independent prognostic marker in these types of tumor, with the exception of carcinoid tumors (36).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metastatic lymph node ratio and Lauren classification are independent prognostic markers for survival rates of patients with gastric cancer

Wang

Xing

et al. 2018

Oncol Lett

View full text Add to dashboard Cite

Abstract. The long-term prognosis for patients with gastric cancer (GC) following radical resection remains poor. It is important to identify prognostic markers to predict survival. In the present retrospective study, the association between the metastatic lymph node ratio (rN) and the Lauren classification on predicting overall survival (OS) was investigated. Furthermore, a subgroup analysis was performed on the Lauren classification, using rN score as an independent prognostic marker. In total, 261 pathologically confirmed patients with GC were retrospectively reviewed. Kaplan-Meier curves and Cox's proportional hazards modeling were applied to analyze the OS of patients, and were utilized in the subgroup analysis. Receiver operating characteristic (ROC) curves were used to compare the accuracy of prognosis between the rN score and lymph node staging (N stage). The χ 2 test was used to analyze the association between the rN score and Lauren classification. Univariate survival and multivariate analysis demonstrated that the rN score and Lauren classification were significant prognostic markers for patients with GC. The ROC analysis confirmed that the rN score was more effective than N staging for OS prediction. Subgroup analysis indicated that rN was more accurate at predicting OS time in patients with diffuse type GC. The rN score and the Lauren classification were independent prognostic factors for the OS of patients with GC following radical resection, and the rN score was more accurate than the N stage for predicting the prognosis. Overall, the rN may be suitable as an independent predictor for OS in patients with diffuse type GC. IntroductionGastric cancer (GC) is the fourth most common type of cancer, and the second leading cause of cancer-associated mortality worldwide (1). GC mortality rates continue to increase yearly, particularly in low-and middle-income countries (2). The long-term prognosis remains poor due to postoperative recurrence and metastasis; and therefore, it is important to identify new prognostic markers for the identification of higher risk patients, and to direct the application of adjuvant chemotherapy regimens.Several factors have been previously associated with the prognosis of patients with GC including tumor diameter, histological differentiation, lymph node status and surgical margin status. However, it has been demonstrated that the number of metastatic lymph nodes may be one of the most reliable prognostic markers available (3). At present, the 7th edition of the Tumor-Node-Metastasis (TNM) staging system by the American Joint Committee on Cancer (AJCC) (4) is commonly used to determine the stage of GC and its prognosis. N stage is determined by the number of metastatic lymph nodes. According to this classification, it is necessary to examine sufficient lymph nodes, with ≥15 required for the accurate diagnosis of the N stage in GC (4). However, an insufficient number of lymph nodes commonly hampers the clinical application of lymph node staging in GC specimens (5,6). Previously...

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Metastatic lymph node ratio and Lauren classification are independent prognostic markers for survival rates of patients with gastric cancer

Wang

Xing

et al. 2018

Oncol Lett

View full text Add to dashboard Cite

show abstract

“…This binary staging differs from lymph node staging for almost all other solid tumors such as rectal adenocarcinomas, which have multiple categories based on the number of lymph nodes involved . Previous studies have shown that the number of positive lymph nodes is linked with NET prognosis . However, no studies to date have evaluated the independent prognostication for lymph node positivity in rectal NETs.…”

Section: Introductionmentioning

confidence: 98%

New lymph node staging for rectal neuroendocrine tumors

Fields

McCarty

Ma‐Pak

et al. 2018

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objectives: Current guidelines of the American Joint Commission on Cancer (AJCC) for rectal neuroendocrine tumors (NETs) classify tumor nodal status as N0/N1. This staging does not take into consideration the number of positive lymph nodes. The goal of this study is to determine how the number of positive lymph nodes affects the prognosis for patients with rectal NETs. Methods: The National Cancer Database was used to identify patients with rectal NETs who underwent rectal resection. Nearest-neighborhood grouping was used to classify patients by survival to create a new nodal staging system. Results: There were 687 patients with rectal NETs. There were distinct 5-year survival estimates for patients with N0 [81.8% (95%CI:77.1%-85.6%)], N1 (1-4 positive lymph nodes) [57.8% (95% confidence interval (CI: 51.2%-63.9%)] and N2 (≥5 positive lymph nodes) [32.6% (95%CI:25.1%-40.3%)] patients, P < 0.0001. Distinct 5-year survival estimates using the new nodal staging system was apparent for patients in the external validation set. After adjusting for predictors of survival in multivariable analysis, the new nodal stage remained an independent predictor of overall survival. Conclusions: The number of positive locoregional lymph nodes is an independent prognostic factor in rectal NETs. The next AJCC edition should consider classifying patients with rectal NETs as N0, N1, and N2 to provide better estimates of survival for patients. K E Y W O R D S AJCC staging, carcinoid tumor, lymph nodes, rectal cancer, rectal neuroendocrine tumor 1 | INTRODUCTION Gastroenteropancreatic neuroendocrine tumors (NETs) have varied behaviors and prognoses depending on their location in the gastrointestinal tract. The rectum is one of the most common sites of gastrointestinal NETs with an age-adjusted incidence of approximately 1 per 100,000. 1,2 Furthermore, the incidence of rectal NETs has increased tenfold over the past 30 years. 3 Tumor size, depth of invasion, and lymph node status are important prognostic factors. 4-6 The five-year survival after diagnosis with rectal NETs is typically higher than other NET sites and exceeds 88%. 4 This is likely due to tumors being localized at the time of diagnosis. 2 Once rectal NETs metastasize, however, five-year survivaldrops to 36%-73% in the presence of regional lymph node metastasis and to 15%-30% for distant metastasis. 2,7,8 In 2010, the American Joint Commission on Cancer (AJCC) published its first TNM staging classification for rectal NETs; locoregional lymph node metastases were characterized as present or absent (N1/N0) and continue to be characterized in this system in the 2017 AJCC 8th edition. 9 This staging system matches the classification developed by the European Neuroendocrine Tumor Society (ENETS) and North American Neuroendocrine J Surg Oncol. 2019;119:156-162. wileyonlinelibrary.com/journal/jso 156 |

show abstract

“…However, the prognostic accuracy of LNM‐based nodal staging system (N descriptor) is affected by the number of retrieved lymph nodes, especially in tumors treated with neoadjuvant therapy 7,8 . The positive lymph node ratio (LNR), defined as the ratio of metastatic lymph nodes to the number of retrieved lymph nodes, has been revealed to be more accurate in survival prediction relative to the N descriptor in many cancers including esophageal carcinoma 7‐14 . However, it has been reported that in some tumors such as rectal and gastric cancers, LNR lost its prognostic efficacy in survival prediction for patients without metastatic lymph nodes retrieved 8,15 .…”

Section: Introductionmentioning

confidence: 99%

Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Chen

Wang

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objectives: We aimed to evaluate the efficacy of the log odds of positive lymph nodes (LODDS) in survival prediction of patients with esophageal carcinoma receiving neoadjuvant therapy, compared with N descriptor and positive lymph node ratio (LNR). Methods: Patients with esophageal carcinoma receiving neoadjuvant therapy from 2004 to 2015 were reviewed in Surveillance, Epidemiology, and End Results database. The receiver operating characteristics curve and area under the curve (AUC) were used to compare discriminatory power among N descriptor, LNR, and LODDS. The goodness of fit was measured using the −2 log-likelihood ratio (-2LLR). Results: About 2239 patients with a 22 months median follow-up and a 37.8% 5-year overall survival rate were included. LODDS had the best discriminatory power and goodness of fit (LODDS vs N descriptor, AUC 0.666 vs 0.626, −2LLR 15 680.402 vs 15 746.162; LODDS vs LNR, AUC 0.666 vs 0.635, −2LLR 15 680.402 vs 15 712.379; all P < .001). LODDS was the best for fewer than 15 lymph nodes retrieved (LODDS vs N descriptor, AUC 0.652 vs 0.618, P < .001; LODDS vs LNR, AUC 0.652 vs 0.625, P = .005). The prognosis of patients without metastatic nodes could be discriminated by LODDS. Conclusions: LODDS could better predict survival of patients with esophageal carcinoma receiving neoadjuvant therapy. K E Y W O R D S esophageal carcinoma, log odds of positive lymph nodes, neoadjuvant therapy

show abstract

The Prognostic Significance of Lymph Node Ratio in Carcinoid Tumors

Abstract: Our study indicated that LNR is an independent predictor of survival for patients with carcinoid tumors but was no better than N1/N0 for 10-year survival.

Cited by 7 publications

References 10 publications

Metastatic lymph node ratio and Lauren classification are independent prognostic markers for survival rates of patients with gastric cancer

Metastatic lymph node ratio and Lauren classification are independent prognostic markers for survival rates of patients with gastric cancer

New lymph node staging for rectal neuroendocrine tumors

Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Contact Info

Product

Resources

About