Lymph node ratio and liver metachronous metastases in colorectal cancer

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.

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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.

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Lymph node ratio as an independent prognostic indicator in stage III colorectal cancer: especially for fewer than 12 lymph nodes examined

Tumor Biology ◽

10.1007/s13277-014-2484-x ◽

2014 ◽

Vol 35 (11) ◽

pp. 11685-11690 ◽

Cited By ~ 6

Author(s):

Kewei Jiang ◽

Yi Zhu ◽

Yan Liu ◽

Yingjiang Ye ◽

Qiwei Xie ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Prognostic Indicator ◽

Stage Iii ◽

Node Ratio

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Lymph node ratio and survival for gastric cancer: A retrospective analysis of the SEER database

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4561 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4561-4561

Author(s):

R. Shridhar ◽

G. W. Dombi

Keyword(s):

Gastric Cancer ◽

Multivariate Analysis ◽

Lymph Node ◽

Prognostic Factor ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Seer Database ◽

Node Negative ◽

Node Ratio ◽

Gastric Cancer Patients

4561 Purpose: To determine the prognostic significance of the lymph node ratio (ratio of number of positive lymph nodes to number of dissected lymph nodes) in gastric cancer patients. Methods: We retrospectively analyzed 10,176 gastric patients from 1990–2003 who underwent curative gastrectomy from the SEER database. Survival curves were calculated according to the Kaplan-Meier method and analyzed with log-rank test. Multivariate analysis of prognostic factors related to survival was performed by the Cox proportional hazard model. Results: The lymph node ratio (LNR) was a strong predictor of survival. LNR was equally predictive of survival whether the analysis was restricted to patients with <15 lymph nodes dissected or >15 lymph nodes dissected. Survival of patients with a LNR of 0.1–5% was not significantly different than node negative patients; however, survival of patients with a LNR of 5–10% was significantly different than node negative patients. Multivariate analysis showed that LNR, T-stage, tumor size, and number of lymph nodes positive were independent prognostic predictors of death and that LNR was the strongest predictor for death. Multivariate analysis showed that the number of lymph nodes dissected was an independent prognostic factor for survival. Moreover, LNR was an independent prognostic factor for N1 and N2 patients by AJCC staging. LNR trended toward significance in AJCC N3 patients. Conclusions: LNR was the strongest predictor of death in gastric cancer patients when compared to T-stage, number of lymph nodes positive, and tumor size. LNR is equally predictive regardless of the adequacy of the lymph node dissection. No significant financial relationships to disclose.

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Prognostic Value of Number of Removed Lymph Nodes, Number of Involved Lymph Nodes, and Lymph Node Ratio in 7502 Breast Cancer Patients Enrolled onto Trials of the Austrian Breast and Colorectal Cancer Study Group (ABCSG)

Annals of Surgical Oncology ◽

10.1245/s10434-011-2189-y ◽

2011 ◽

Vol 19 (6) ◽

pp. 1808-1817 ◽

Cited By ~ 33

Author(s):

Christoph Tausch ◽

Susanne Taucher ◽

Peter Dubsky ◽

Michael Seifert ◽

Roland Reitsamer ◽

...

Keyword(s):

Breast Cancer ◽

Colorectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Prognostic Value ◽

Lymph Node Ratio ◽

Study Group ◽

Breast Cancer Patients ◽

Cancer Study Group ◽

Node Ratio

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

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-021-05079-x ◽

2021 ◽

Author(s):

Sorin Tiberiu Alexandrescu ◽

Florin M. Selaru ◽

Andrei S. Diaconescu ◽

Cristian A. Zlate ◽

Diana Blanita ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Liver Metastases ◽

Prognostic Value ◽

Colorectal Liver Metastases ◽

Lymph Node Ratio ◽

Node Ratio ◽

Synchronous Colorectal Liver Metastases

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An Evaluation of Lymph Node Yield and Lymph Node Ratio in Well-Differentiated Thyroid Carcinoma

The American Surgeon ◽

10.1177/000313481007600107 ◽

2010 ◽

Vol 76 (1) ◽

pp. 28-32 ◽

Cited By ~ 20

Author(s):

Shannon H. Beal ◽

Steven L. Chen ◽

Philip D. Schneider ◽

Steve R. Martinez

Keyword(s):

Lymph Node ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Differentiated Thyroid Carcinoma ◽

Lymph Node Yield ◽

Node Negative ◽

Node Ratio ◽

Well Differentiated ◽

Node Yield

It is unknown whether the number of lymph nodes harvested (lymph node yield, LNY) or the proportion of metastatic lymph nodes resected (metastatic lymph node ratio, MLNR) influence survival in well-differentiated thyroid carcinoma (WDTC). We hypothesized that overall survival in WDTC is influenced by the LNY and MLNR. We used the Surveillance, Epidemiology, and End Results database to identify all patients with primary, nonmetastatic WDTC who underwent thyroidectomy with at least one lymph node removed between 1988 and 2004. Kaplan-Meier survival curves for LNY and MLNR were compared using the log rank test. Multivariate Cox proportional hazards models included tumor and patient-specific factors. WDTC patients that met entry criteria totaled 9926. In the univariate model, LNY and MLNR had a significant impact on survival ( P < 0.001). In multivariate analysis, increasing LNY was associated with poorer survival in all patients ( P = 0.001) and node-negative patients ( P = 0.03), but not for node-positive patients ( P = 0.27). MLNR did not influence survival in node-positive patients ( P = 0.84). Among patients with WDTC treated with thyroidectomy and lymphadenectomy, increasing LNY and MLNR were associated with decreased survival. The decrease in survival associated with increasing LNY, even in node-negative patients, indicates that nodal understaging is inconsequential to WDTC survival.

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16128 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16128-e16128

Author(s):

Filipa Macedo ◽

Hugo Sequeira ◽

Katia Ladeira ◽

Nuno Bonito ◽

Charlene Viana ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Venous Invasion ◽

Lymph Node Status ◽

Tnm System ◽

Metastatic Lymph ◽

Node Ratio ◽

The Impact

e16128 Background: Colorectal cancer (CRC) is the third leading cause of cancer death in the world. Lymph node metastasis is an important prognostic factor; however, the minimum number of lymph nodes that should be evaluated for adequately categorizing lymph node status is still a controversial theme. The TNM staging system has limitations in defining the pN category. The lymph node ratio (LNR) may be a better prognostic indicator. Objectives: Evaluate the impact on the prognosis of patients operated for CRC, comparing the LNR with the pN category of TNM system. Methods: We studied 1065 patients treated at a General Surgery Department from 01/01/2000 to 08/31/2012. The LNR was separated into 5 categories based on three previously calculated cut-off values: LNR0 (0), LNR1 (0.01-0.17), LNR2 (0.18- 0.41), LNR3 (0.42-0.69) and LNR4 (≥0.70). Results: The results of the univariate analysis indicated significant differences in survival according to age (p < 0.001), tumor size (p < 0.001), serosal invasion (p < 0.001), histological type (p = 0.002), differentiation (p < 0.001), pT (p < 0.001), pN (p < 0.001), LNR (p < 0.001), M (p = 0.001), TNM stage (p < 0.001), venous invasion (p < 0.001). Multivariate analysis confirmed the LRN, pN, age, venous invasion and pT as independent prognostic factors. The survival analysis showed significant differences between the categories of pN (p < .001) and LNR (p < .001). Spearman correlation analysis showed a significant correlation between the total number of dissected lymph nodes and the number of metastatic lymph nodes (rs = 0.167, p < 0.001). The total number of dissected lymph nodes is not significantly correlated with LNR (rs = -0.019, p = 0.550). Conclusions: In this study LNR seems to demonstrate a superior prognostic value when compared to the pN categories, in part due to its greater independence regarding the extent of lymphadenectomy.

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