Prognostic value of the extent of lymphadenectomy for esophageal cancer-specific survival among T1 patients

Abstract Background Clinically, there are no clear guidelines on the extent of lymphadenectomy in patients with T1 esophageal cancer. Studying the minimum number of lymph nodes for resection may increase cancer-specific survival. Methods Patients who underwent esophagectomy and lymphadenectomy at T1 stage were selected from the Surveillance, Epidemiology and End Results Program (United States, 1998–2014). Maximally selected rank and Cox proportional hazard models were used to examine three variables: the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio. Results Approximately 18% had lymph node metastases, where the median values were 10, 10 and 0 for the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio, respectively. All three examined variables were statistically associated with cancer-specific survival probability. Dividing patients into two groups shows a clear difference in cancer-specific survival compared to four or five groups for all three variables: there was a 29% decrease in the risk of death with the number of lymph nodes examined ≥14 vs < 14 (hazard ratio 0.71, 95% confidence interval: 0.57–0.89), a 35% decrease in the risk of death with the number of negative lymph nodes ≥13 vs < 13 (hazard ratio 0.65, 95% confidence interval: 0.52–0.81), and an increase of 1.21 times in the risk of death (hazard ratio 2.21, 95% confidence interval: 1.76–2.77) for the lymph node ratio > 0.05 vs ≤ 0.05. Conclusions The extent of lymph node dissection is associated with cancer-specific survival, and the minimum number of lymph nodes that need to be removed is 14. The number of negative lymph nodes and the lymph node ratio also have prognostic value after lymphadenectomy among T1 stage patients.

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The impact of negative lymph nodes in the survival outcomes of pN+ patients following radical gastrectomy: the inverse lymph node ratio as a better score to study negative lymph nodes

Updates in Surgery ◽

10.1007/s13304-020-00757-y ◽

2020 ◽

Vol 72 (4) ◽

pp. 1031-1040

Author(s):

Paulo Matos da Costa ◽

Patrícia Lages ◽

Susana Onofre ◽

Ruy M. Ribeiro

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Survival Outcomes ◽

Radical Gastrectomy ◽

Node Ratio ◽

The Impact ◽

Negative Lymph Nodes

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Metastatic lymph node ratio as a better prognostic tool than the TNM system in colorectal cancer

Future Oncology ◽

10.2217/fon-2020-0993 ◽

2021 ◽

Author(s):

Filipa Macedo ◽

Hugo Sequeira ◽

Katia Ladeira ◽

Nuno Bonito ◽

Charlene Viana ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Metastatic Lymph Node ◽

Prognostic Indicator ◽

Lymph Node Status ◽

Regional Lymph Nodes ◽

Tnm System ◽

Node Ratio ◽

Minimum Number

Background: The minimum number of lymph nodes that should be evaluated in colon cancer to adequately categorize lymph node status is still controversial. The lymph node ratio (LNR) may be a better prognostic indicator. Materials & methods: We studied 1065 patients treated from 1 January 2000 to 31 August 2012. Results: Significant differences in survival were detected according to regional lymph nodes (pN) (p < 0.001) and LNR (p < 0.001). LRN and pN are independent prognostic factors. Spearman correlation analysis showed a significant correlation between the total number of dissected lymph nodes and pN (rs = 0.167; p < 0.001), but the total number of dissected lymph nodes is not significantly correlated with LNR (rs = -0.019; p = 0.550). Interpretation: In this study, LNR seems to demonstrate a superior prognostic value compared with the pN categories, in part due to its greater independence regarding the extent of lymphadenectomy.

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Comparison of 3 Ways of Dissecting the Pancreatoduodenectomy Specimen and Their Impact in the Lymph Node Count and the Lymph Node Metastatic Ratio

International Journal of Surgical Pathology ◽

10.1177/1066896918780343 ◽

2018 ◽

Vol 26 (8) ◽

pp. 707-713 ◽

Cited By ~ 3

Author(s):

Leonardo S. Lino-Silva ◽

Rosa A. Salcedo-Hernández ◽

Patricia Segales-Rojas ◽

César Zepeda-Najar

Keyword(s):

Lymph Node ◽

Confidence Interval ◽

Lymph Node Ratio ◽

Hazard Ratio ◽

Lymph Node Count ◽

Node Ratio ◽

The Mean ◽

Dissection Techniques ◽

Work Up ◽

Method Group

Background. Lymph node metastasis (LNM) is a strong prognostic factor in the cancer of the pancreatobiliary tree, but it is influenced by the number of lymph nodes (LNs). The lymph node ratio (LNR) is considered a more reliable factor than the number of LNM. The aim was to examine the LN retrieval and the LNR of 3 pathologic work-up strategies. Methods. Pancreaticoduodenectomies (n = 165) were analyzed comparing 3 pathological dissection techniques, classified as “control,” “Verbeke method,” and “Adsay method” groups. Results. The mean of the dissected LNs and the number of cases with >20 LNs were superior in the Adsay method group, compared with the other groups ( P < .001). The LNR was different between the Adsay and Verbeke groups (0.144 vs 0.069, P = .032). The median of the 3 positive LNs was associated with decreased survival compared with an absence of LNM (3-year specific survival of 48% vs 22%, P = .011). In the multivariate analysis, LNM (hazard ratio = 6.148, 95% confidence interval = 2.02-8.1, P = .042) and the evaluation of >15 LNs (hazard ratio = 12.52, 95% confidence interval = 5.51-21.01, P = .001) were independent predictors of survival. Conclusion. The Adsay technique for LN retrieval was associated with a better LN count, more cases with LNM, and an LNR >0.1.

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Lymph Nodes Ratio Is Associated with the Survival of Colorectal Cancer Patients with Peritoneal Carcinomatosis

The American Surgeon ◽

10.1177/000313481107700521 ◽

2011 ◽

Vol 77 (5) ◽

pp. 602-607 ◽

Cited By ~ 3

Author(s):

Kenji Matsuda ◽

Tsukasa Hotta ◽

Katsunari Takifuji ◽

Yasuhito Kobayashi ◽

Takeshi Tsuji ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Confidence Interval ◽

Peritoneal Carcinomatosis ◽

Lymph Node Ratio ◽

Hazard Ratio ◽

Lymph Node Status ◽

Node Ratio ◽

Colorectal Cancer Patients

The purpose of this study was to clarify the prognostic factors in patients with peritoneal carcinomatosis from colorectal origin, especially focusing on lymph node status. Between 1998 and 2007, 126 patients who underwent surgical treatment for primary colorectal cancer with peritoneal carcinomatosis were retrospectively assessed concerning prognostic factors. To estimate survival, we formulated a scoring system by numbers of independent poor prognostic factors. According to a multivariate analysis, extent of peritoneal carcinomatosis (hazard ratio, 1.93; 95% confidence interval, 1.19-3.13; P = 0.008) and lymph node ratio (hazard ratio, 1.87; 95% confidence interval, 1.05-3.33; P = 0.034) were found to be independent poor prognostic factors for survival. Furthermore, we demonstrated that score formulated by the number of these criteria was highly predictive of survival ( P < 0.001). The 5-year survival rate for patients with score 0 (having no criteria), score 1 (having one criterion), and score 2 (having two criteria) were 25.1 per cent, 6.2 per cent, and 0 per cent, respectively. Lymph node ratio is an important prognostic factor in addition to the extent of peritoneal carcinomatosis after resection of primary colorectal carcinoma. Patients without these criteria have a favorable outcome, and therefore should be considered for further aggressive surgery and intraperitoneal chemotherapy.

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Assessment on the Prognostic Validity of Dissected and Positive Lymph Node Counts and Lymph Node Ratio in Patients with Gastric Cancer: A Multi-central Cohort Study

International Journal of Cancer Management ◽

10.5812/ijcm.114118 ◽

2021 ◽

Vol 14 (9) ◽

Author(s):

Alireza Negahi ◽

Mohammad Esmaeil Akbari ◽

Paniz Motaghi ◽

Atieh Akbari ◽

Hooman Riazi ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Prognostic Significance ◽

Lymph Node Status ◽

P Value ◽

Adequate Treatment ◽

Risk Of Death ◽

Comprehensive Therapy ◽

Node Ratio

Background: Adequate treatment for all resectable early gastric cancers (EGCs) is gastrectomy with regional lymphadenectomy. The number of positive resected lymph nodes during lymphadenectomy can be a reliable predictor of survival of GC. Objectives: We aimed at assessing the prognostic significance of Dissected Lymph Node Count (DLNC), positive LNC (PLNC), and Lymph Node Ratio (LNR) in patients with EGC. Methods: In the current retrospective cohort, 201 patients with resectable EGC were included. Demographic variables, clinicopathological characteristics of tumors (including numbers of total dissected nodes and positive, negative nodes), history of receiving adjuvant cancer therapies, and 1- and 5-year survivals were noted. Results: DLNC, PLNC, and LNR were associated with differentiation and depth of tumor, lymph node status, and risk of death (P-value for all < 0.05). There was no correlation between either of these measures with preoperative symptoms, lymphovascular invasion, and recurrence. DLNC, PLNC, and LNR showed prognostic significance only in patients, who did not receive comprehensive therapy (P-value < 0.001 for all). A significantly higher LNR was seen in patients with more than 1-year survival compared to others (P-value = 0.011). A significantly lower DLNC and higher PLNC were seen in patients, who survived over 5 years (P-value of 0.002 and 0.047, respectively). Conclusions: LNR, DLNC, and PLNC are significant prognostic factors for EGC. According to our findings, choosing the optimal approach, through which fewer negative lymph nodes are dissected, is crucial in increasing overall survival and extended lymphadenectomy cannot necessarily benefit patients.

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Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

Scientific Reports ◽

10.1038/s41598-021-81663-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Honghu Wang ◽

Hao Qi ◽

Xiaofang Liu ◽

Ziming Gao ◽

Iko Hidasa ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Prognostic Index ◽

Staging System ◽

R0 Resection ◽

Remnant Gastric Cancer ◽

Curative Intent ◽

Node Ratio

AbstractThe staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.

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