Prognostic Value of Lymph Node Ratio in Patients with Resected Synchronous Colorectal Liver Metastases and Less Than 12 Examined Lymph Nodes

Abstract Objective The authors seek to assess whether the LNR could predict the risk of metachronous liver metastases. Background data Using the goal of sampling 12 lymph nodes for a proper staging of colorectal cancer is often "uncommon" and the lymph node ratio (LNR) is what allows for a better prognosis selection of patients. Methods A homogeneous group of 280 patients, followed-up for at least 5 years, was evaluated. In order to highlight the groups with the highest risk of metachronous liver metastases, patients were divided into four quartiles groups in relation to the LNR. Results The number of lymph nodes sampled in group "stage I" was significantly lower. Even if statistical significance between the global LNR and the development of liver metastases has not been reached, the subdivision into quartiles has made it possible to highlight that in the more advanced ratio groups, a higher incidence of metachronous liver metastases (p <0.028) was registered and was a different distribution of patients with or without liver metastasis in function of quartiles (P =0.01). Conclusions The LNR has enabled us to prognosticate patients who are at greater risk of developing metachronous liver metastases. The lower lymph node sampling in the patients with less advanced staging (I) and in patients with node-negative cancer (I+II) who developed liver metastases, leads us to believe that some patients have been understaged. We believe that the LNR, especially in cases of adequate lymph node sampling, is a useful gauge to better sub-stratify "node-positive" patients.

Download Full-text

Lymph Node Ratio as an Alternative to pN Staging in Node-Positive Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2008.18.6965 ◽

2009 ◽

Vol 27 (7) ◽

pp. 1062-1068 ◽

Cited By ~ 147

Author(s):

Vincent Vinh-Hung ◽

Helena M. Verkooijen ◽

Gerald Fioretta ◽

Isabelle Neyroud-Caspar ◽

Elisabetta Rapiti ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Prognostic Value ◽

Lymph Node Ratio ◽

Optimal Cutoff ◽

Mortality Risks ◽

Cutoff Points ◽

Node Ratio ◽

Positive Breast Cancer

PurposeIn the current pTNM classification system, nodal status of breast cancer is based on the number of involved lymph nodes and does not account for the total number of lymph nodes removed. In this study, we assessed the prognostic value of the lymph node ratio (LNR; ie, ratio of positive over excised lymph nodes) as compared with pN staging and determined its optimal cutoff points.Patients and MethodsFrom the Geneva Cancer Registry, we identified all women diagnosed with node-positive breast cancer between 1980 and 2004 (n = 1,829). The prognostic value of LNRs was calculated for values ranging from 0.05 to 0.95 by Cox regression analysis and validated by bootstrapping. Based on maximum likelihood, we identified cutoff points classifying women into low-, intermediate-, and high-risk LNR groups.ResultsOptimal cutoff points classified patients into low- (≤ 0.20), intermediate- (> 0.20 and ≤ 0.65), and high-risk (> 0.65) LNR groups, corresponding to 10-year disease-specific survival rates of 75%, 63%, and 40%, and adjusted mortality risks of 1 (reference), 1.78 (95% CI, 1.46 to 2.18), and 3.21 (95% CI, 2.54 to 4.06), respectively. In contrast to LNR risk categories, survival curves of pN2 and pN3 crossed after 15 years, and their adjusted mortality risks showed overlapping CIs: 2.07 (95% CI, 1.69 to 2.53) and 2.84 (95% CI, 2.23 to 3.61), respectively.ConclusionLNR predicts survival after breast cancer more accurately than pN classification and should be considered as an alternative to pN staging.

Download Full-text

Is there a relationship between length of resection and lymph-node ratio in colorectal cancer?

Gastroenterology Report ◽

10.1093/gastro/goz066 ◽

2020 ◽

Author(s):

Antonio Zanghì ◽

Andrea Cavallaro ◽

Emanuele Lo Menzo ◽

Serena Curella Botta ◽

Salvatore Lo Bianco ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Prognostic Value ◽

Lymph Node Ratio ◽

Statistical Significance ◽

Resected Specimen ◽

Metastatic Recurrence ◽

Kaplan Meier ◽

Node Ratio

Abstract Background The prognosis of colorectal cancer depends on the number of positive lymph nodes (LN+) and the total number of lymph nodes resected (rLN). This represents the lymph-node ratio (LNR). The aim of our study is to assess how the length of the resected specimen (RL) influences the prognostic values of the LNR. Methods We conducted a retrospective study of all the patients operated on for colorectal cancer from 2000 to 2015 at our institution. Pathology details were analysed. The total number of rLN, the number of LN+, and the LNR were calculated and measured against the RL. The receiver-operating characteristic (ROC) curve of patients with LN+ was calculated. Results Of the 670 patients included in our study, 337 were men (50.3%) and the mean age was 69.2 years. The correlation with prognosis of the LNR is greater than that of the LNR adjusted to RL (LNR/RL), both in subjects with positive nodes (n = 312) and in all cases (n = 670). The LNR presents a higher prognostic value than LNR/RL and RL in patients with LN+ except for metastatic recurrence, for which the predictive value appears slightly higher for LNR/RL. The statistical significance of the maximal divergence in Kaplan–Meier survival plots was demonstrated for the LNR (P = 0.043), not for LNR/RL (P = 0.373) and RL alone (P = 0.314). Conclusion An increase in RL causes an increase in the number of harvested lymph nodes without affecting the number of LN+, thus representing a confounding factor that could alter the prognostic value of the LNR. Prospective larger-scale studies are needed to confirm these findings.

Download Full-text