scholarly journals The Lymph Node Ratio Optimizes Staging System while Adjuvant Chemotherapy Plays an Invalid Role for Patients with Nonmetastatic Colorectal Neuroendocrine Carcinomas: A Propensity Score Matching Analysis of Patients from the Surveillance, Epidemiology, and End-Results Database

2021 ◽  
Author(s):  
Xiaoxiao Chen ◽  
Hongjuan Zheng ◽  
Xia Zhang ◽  
Wanfen Tang ◽  
Shishi Zhou ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Propensity Score ◽  
Survival Benefit ◽  
Lymph Node Ratio ◽  
Cutoff Value ◽  
Survival Difference ◽  
N Classification ◽  
Node Ratio ◽  
End Results

Abstract Objective: Colorectal neuroendocrine carcinoma (CRNEC) is rare and little is known about survival benefit between lymph node ratio (LNR) and improved overall survival (OS), and so is the adjuvant chemotherapy (AC). We aim to evaluate the survival benefit of LNR and AC in patients with nonmetastatic CRNEC following resection. Methods: Patients with resected nonmetastatic CRNECs were identified in Surveillance, Epidemiology, and End Results (SEER) during year 1992 to 2016. A Log-rank test was conducted to determine the survival difference. The survival benefit was evaluated using a competing-risks regression model and propensity score-matched (PSM) techniques were used to reduce the selection bias.Results: A total of 251 patients met the inclusion criteria, of which, 152 patients (60.56%) received AC. The age of 60 (P=0.848) and number of 12 of resected regional lymph nodes (P=0.082) acted as an optimal cutoff value in terms of survival, failing to reach a significance. Chemotherapy failed to bring survival benefit (hazard ratio [HR], 0.959; 95% confidence interval [CI], 0.649-1.416; P=0.832). Current N classification was not a significant predictor of patient survival (N1: P = 0.174; N2: P=0.028, compared to N0, respectively). Multivariate analyses explored the revised Nr classification, based on LNR of 0.30 and 0.75 as cutoff value (Nr0: LNR£0.30; Nr1: 0.3<LNR£0.75; Nr2: LNR >0.75), as an independent prognostic factor (Nr1: P = 0. 003; Nr2: P<0.001, compared to Nr0, respectively). With the foundation of revised Nr classification, a revised TNrM was proposed for nonmetastatic CRNEC: stage I (T1–2Nr0), stage II (T1-2Nr1 or T3Nr0–1 or T4Nr0), and stage III (TxNr2 or T4Nr1). TNrM stage had better stratification according to Kaplan-Meier survival curves (P <0.001). Conclusions: AC seems invalid for improving the survival of patients with nonmetastatic CRNECs following resection. The LNR more accurately predict survival of CRNEC patients than current N classification.

The Relationship Between Lymph Node Ratio and Survival Benefit With Adjuvant Chemotherapy in Node-positive Esophageal Adenocarcinoma

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Vignesh Raman ◽  
Oliver K. Jawitz ◽  
Norma E. Farrow ◽  
Soraya L. Voigt ◽  
Kristen E. Rhodin ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Esophageal Adenocarcinoma ◽  
Survival Benefit ◽  
Lymph Node Ratio ◽  
Node Positive ◽  
Node Ratio ◽  
The Relationship

The Lymph Node Ratio Optimizes Staging in Patients with Small Intestinal Neuroendocrine Tumors

2018 ◽  
Vol 107 (3) ◽  
pp. 209-217 ◽  
Author(s):  
Lunpo Wu ◽  
Fei Chen ◽  
Shujie Chen ◽  
Liangjing Wang
Keyword(s):  
Lymph Node ◽  
Lymph Node Ratio ◽  
Staging System ◽  
Survival Outcome ◽  
Stage I ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
N Classification ◽  
Node Ratio ◽  
Small Intestinal

Background: The effectiveness of the current Tumor, Lymph node, Metastases (TNM) staging system in small intestinal neuroendocrine tumors (SiNETs) is unsatisfactory. Current N classification only distinguishes between node-negative and node-positive status. We aim to refine the N classification for updated TNM stage. Methods: During the period from 1988 to 2012, patients with non-metastatic ­SiNETs were enrolled in the Surveillance, Epidemiology, and End Results database. Using the X-tile program, we calculated an optimal cutoff value for lymph node ratio (LNR) and proposed a novel Nr category. Survival outcomes were estimated using the Kaplan-Meier method and Cox regression model. Adjusted hazard ratio (HR) and cluster analysis were performed to differentiate TNrM stages. Results: Patients with existing TNM stage I and II had equivalent survival prognosis (p = 0.214). Current N classification was not a significant predictor of patient survival (p = 0.372). Multivariate analyses identified the revised Nr classification, based on LNR of 0.6 optimal cutoff value, as an independent prognostic factor (p = 0.020). By incorporating the Nr classification, a revised TNrM, which categorized patients into 3 new stages was proposed: stage I (T1–2Nr0–1), stage II (T3Nr0–1), and stage III (TxNr2 or T4Nrx). TNrM stage had better stratification according to the survival outcome (primary cohort: stage I: reference, II: HR 3.852, 95% CI 1.731–8.575; III: HR 7.169, 95% CI 3.220–15.963, p < 0.001; validation cohort: stage I: reference, II: HR 2.034; III: HR 3.815; p < 0.001). Conclusions: The Nr classification more accurately stratifies SiNET patients than current N classification. The new TNrM staging system could improve the ability to predict survival outcome of SiNET patients.

scholarly journals Survival Based On The Pathologic Lymph Node Ratio For Local Advanced Gastric Cancer; Elderly Patients Versus Non Elderly Patients

2021 ◽  
Author(s):  
Omer Yalkin ◽  
Nidal Iflazoglu ◽  
Olgun Deniz ◽  
Mustafa Yener Uzunoglu ◽  
Ezgi Isil Turhan
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Elderly Patients ◽  
Advanced Gastric Cancer ◽  
Lymph Node Ratio ◽  
Locally Advanced ◽  
Survival Rates ◽  
The Elderly ◽  
Survival Difference ◽  
Node Ratio

Abstract Objective: The aim of this study was to clarify the prognostic value of the pathological lymph node ratio for elderly and non-elderly gastric cancer patients and to evaluate whether there is a difference in the survival of patients with the same LNR (Lymph Node Ratio).Materials and Methods: A total of 222 patients diagnosed with locally advanced gastric cancer and who underwent gastrectomy were included. The patients were divided into two groups according to age. Clinicopathological properties of the two groups were compared. Potential prognostic factors affecting survival were analyzed. Subsequently, the effect of lymphadenectomy and LNR on survival in both groups was evaluated. Results: Significant differences were detected in terms of the location of primary lesions, hemoglobin and albumin levels between elderly patients and non-elderly patients (p < .05). Overall survival (OS) was significantly worse in elderly patients (22 months vs. 67 months, p<0.001). The survival rates in elderly patients were significantly lower from those of non-elderly in the subgroup LNR Stage 2 (12.1% vs. 47.9 %, P = 0.004) and LNR Stage 3 classification (9.1% vs. 34.1%, P = 0.039). LNR was found to be significant for OS with a cut-off point of 0.18. Conclusion: A survival difference was found between the elderly and non-elderly patients with the same LNR. LNR was found to be an independent factor for survival especially in elderly patients. Survival was found to be further decreased in elderly patients compared to non-elderly patients with increasing LNR.

Use of lymph node ratio improves staging and selection criteria for adjuvant therapy of gastric cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4051-4051 ◽  
Author(s):  
N. G. Coburn ◽  
C. J. Swallow ◽  
A. Kiss ◽  
C. Law
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Adjuvant Therapy ◽  
Lymph Node Ratio ◽  
North American Population ◽  
Cox Models ◽  
Node Negative ◽  
Survival Difference ◽  
Node Ratio ◽  
Resected Gastric Cancer

4051 Background: Despite 1997 American Joint Commission on Cancer (AJCC) guidelines stipulating assessment of ≥15 lymph nodes (LN) for staging of gastric cancer, only one third of patients in the Surveillance, Epidemiology and End Results (SEER) database from 1998–2002 had ≥15 LN assessed (ASCO 2005 #4004), with resultant understaging and probable under-treatment. In series from Asia and Europe, Lymph Node Ratio (LNR), the ratio of positive to total LN assessed, has been shown to be more accurate for staging than number of positive LN. However, most of these excluded cases with <15 LN assessed. We examined the utility of LNR in a North American population. Methods: Using SEER data, we identified 9503 M0 resected gastric cancer cases from 1988–2002. LNR was categorized as 0%, 1–10%, 11–30%, 31–50% and >50%. For node negative cases (LNR = 0%, n = 3652), we stratified by number of LN assessed (A=1–4; B = 5–9; C = 10–14; D≥15). For each AJCC stage or LNR strata, the degree of understaging in patients with inadequate LN assessment was measured by survival difference on Kaplan-Meier curves. Cox proportional hazard ratio (HR) models determined the effect of stratifying node negative patients and the accuracy of LNR for prognostication. Results: 27% of patients had a LNR > 50%, a high proportion compared to Asian series. Fewer nodes assessed resulted in a higher likelihood of being node negative. In node negative cases, the HR of death increased for those with fewer LN assessed (vs. Group D, with 95% CI): A: HR=1.6 (1.5–1.8); B: HR = 1.3 (1.1–1.5); C: HR = 1.3 (1.1–1.5). Understaging was observed for patients with inadequate LN assessment when AJCC criteria were used (p < 0.0001); this effect significantly decreased by using LNR. LNR had superior prognostic accuracy in Cox models. Conclusions: This study examines LNR in the largest series of resected gastric cancer in the literature, and the only one in which the majority of cases were inadequately staged. LNR significantly decreases understaging and improves prognostic ability. Node negative patients, nearly one third of cases, should be risk stratified by number of LN assessed, and considered for adjuvant therapy on this basis. LNR should be used to stratify node positive patients in clinical trials, and to provide more accurate staging and prognostication. No significant financial relationships to disclose.

scholarly journals Efficacy of capecitabine and oxaliplatin versus S-1 as adjuvant chemotherapy in gastric cancer after D2 lymph node dissection according to lymph node ratio and N stage

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kabsoo Shin ◽  
Se Jun Park ◽  
Jinsoo Lee ◽  
Cho Hyun Park ◽  
Kyo Young Song ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Prognostic Value ◽  
Lymph Node Ratio ◽  
Node Dissection ◽  
Stage Iiic ◽  
Node Ratio ◽  
N Stage ◽  
N Staging

Abstract Background We sought to assess the prognostic significance of lymph node ratio (LNR) and N stage in patients undergoing D2 gastrectomy and adjuvant chemotherapy, S-1, and XELOX and to compare the efficacy of them according to LNRs and N stages to evaluate the clinical impact of using LNRs compared with using N staging. Methods Patients undergoing D2 gastrectomy with adequate lymph node dissection and adjuvant chemotherapy for stage II/III gastric cancer between Mar 2011 and Dec 2016 were analysed. Of the 477 patients enrolled, 331 received S-1 and 146 received XELOX. LNR groups were segregated as 0, 0–0.1, 0.1–0.25, and > 0.25 (LNR0, 1, 2, and 3, respectively). Propensity score matching (PSM) was used to minimise potential selection bias and compare DFS and OS stratified by LNRs and N stages in the two treatment groups. Results After PSM, the sample size of each group was 110 patients, and variables were well balanced. All patients had more than 15 examined lymph nodes (median 51, range 16~124). In multivariate analysis, LNR (> 0.25) and N stage (N3) showed independent prognostic value in OS and DFS, but LNR (> 0.25) showed better prognostic value. In subgroup analysis, the LNR3 group showed better 5-year DFS (20% vs 54%; HR 0.29; p = 0.004) and 5-year OS (26% vs 67%; HR 0.28; p = 0.020) in the XELOX group. The N3 group showed better 5-year DFS (38% vs 66%; HR 0.40; p = 0.004) and 5-year OS (47% vs 71%; HR 0.45; p = 0.019) in the XELOX group. Stage IIIC showed better 5-year DFS (22% vs 57%; HR 0.32; p = 0.004) and 5-year OS (27% vs 68%; HR 0.32; p = 0.009) in the XELOX group. The LNR3 group within N3 patients showed better 5-year DFS (21% vs 55%; HR 0.31; p = 0.004) and 5-year OS (27% vs 68%; HR 0.34; p = 0.018) in the XELOX group. Conclusions LNR showed better prognostic value than N staging. LNR3, N3 and stage IIIC groups showed the superior efficacy of XELOX to that of S-1. And the LNR3 group within N3 patients showed more survival benefit from XELOX. LNR > 0.25, N3 stage and stage IIIC were the discriminant factors for selecting XELOX over S-1. Trial registration Not applicable (retrospective study).

Survival outcome of small bowel adenocarcinoma (SBA) in the last 12 years: Meta-analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14667-e14667
Author(s):  
Tannaz Armaghany ◽  
Runhua Shi ◽  
Joseph Ryan Shows ◽  
Glenn Morris Mills
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Lymph Node Ratio ◽  
Meta Analysis ◽  
Positive Lymph Node ◽  
Low Grade ◽  
Small Bowel Adenocarcinoma ◽  
Node Ratio

e14667 Background: Due to rarity, management of SBA is currently controversial. Despite results from several single institutional studies showing no survival benefit with adjuvant chemotherapy, data extrapolated from established colorectal cancer studies are commonly used to manage this cancer. Here we report results of a meta-analysis on data from 14 retrospective studies published in English between years 2000 and 2011. Methods: PubMed database was searched using relevant keywords. Patients with SBA were included. Studies involving ampulary, periampulary and ileocecal valve tumors were excluded. The combined location and stage distribution were adjusted by sample size of each study. Primary outcome for the magnitude of benefit analysis were OS. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted. A random-effect model according to the method of DerSimonian and Laird was used; a heterogeneity test was used. The effect of adjuvant chemotherapy and/or radiation treatment after curative surgery was evaluated. Effect of stage, grade, and positive lymph node ratio was also evaluated. Results: With available information within 14 studies, mean age of patients was 59.3(95% CI: 56.4 and 62.1). Duodenum was the most common site of primary tumor followed by the jejunum, ileum and not specified sites (59.27%, 23.49%, 11.42%, and 3.03%), respectively. Overall median survival was 17.2 months (95% CI: 13.9 and 20.5). Adjuvant treatment vs. non adjuvant treatment showed a HR of 1.17 (95% CI: 0.71-1.93) that was not statistically significant. HR for low grade vs. high grade tumors was 3.90 (95% CI: 2.15- 7.06). HR for stage was 3.09 (95% CI: 0.89-10.67, p=0.07) comparing high stage with low stage which suggested a marginally statistically significant effect. HR for positive lymph node ratio (LNR) was 4.63 (95% CI: 2.67-8.03). Conclusions: Our meta-analysis suggests adjuvant treatment after cancer directed curative intent surgery does not improve overall survival compared to observation in SBA. Grade of tumor and positive LNR are significant predicators of overall survival whereas stage has marginally significant effect on survival. Future trials investigating new or innovative adjuvant therapy in SBA are needed.

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