Lymph node ratio: Role in the staging of node-positive colon cancer
ABSTRACT Recent literature has shown that lymph node ratio (LNR) is superior to the number of positive lymph nodes (pLNs) in predicting the prognosis in several malignances other than colon cancer. We hypothesize that LNR may play a similar role in stage III colon cancer.
We included 24,477 stage III colon cancer cases from the Surveillance, Epidemiology, and End Results cancer registry. Patients were categorized into four groups, LNR1 to 4, according to cutoff points 1/14, 0.25, and 0.50. Kaplan-Meier and Cox proportional hazard model were used to evaluate the prognostic effect and estimate the relative risk (RR) and 95% confidence interval (CI) of LNR.
The 5-year survival for patients with stage IIIA, IIIB, and IIIC was 71.3%, 51.7%, and 34.0%, respectively (P < .0001). There was no survival difference among LNR1 to LNR4 for stage IIIA patients. In stage IIIB patients, the 5-year survival for those with LNR1 to LNR4 was 63.5%, 54.7%, 44.4%, and 34.2%, respectively (P < .0001). In stage IIIC patients, the 5-year survival for those with LNR2 to LNR4 was 49.6%, 41.7%, and 25.2%, respectively (P < .0001). LNR is an independent predictor of survival after adjusting patient's age, tumor size, tumor grade, race, number of pLNs, and total number of LNs harvested. (RR 2.30, 95% CI 2.08-2.55).
Patients with stage IIIB and IIIC colon cancer represent a heterogeneous group of patients with the majority either overstaged or understaged. LNR is a more accurate prognostic method for stage III colon cancer patients. We propose an algorithm to incorporate LNR into current AJCC staging system.
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ABSTRACT: The tumor status of the regional lymph nodes is the most important prognostic indicator in colorectal cancer (CRC), as it is in other solid tumors. Sentinel lymph node biopsy (SLNB), which has profoundly impacted the treatment of melanoma and breast cancer, has been applied in CRC in an attempt to improve nodal staging accuracy. The challenge lies in identifying patients who have tumor-negative nodes but are at high risk of regional or distant failure and therefore may benefit from adjuvant chemotherapy. Because standard pathological analysis of lymph nodes may incorrectly stage colon cancer, multiple studies have investigated nodal ultrastaging based on identification and immunohistochemical and/or molecular assessment of the sentinel node. This review focuses on the technique of SNLB, its feasibility and validity, and the controversies that remain regarding the clinical significance of nodal ultrastaging in CRC.
Dataset: LNR Picardie, Int Surg 2013
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ABSTRACT: Metastatic disease to the regional lymph node (LN) is a strong predictor of worse long-term outcome after curative-intent resection of intrahepatic cholangiocarcinoma (ICC). The objectives of this study were to assess the prognostic performance of American Joint Committee on Cancer (AJCC)/International Union Against Cancer, 7th edition, N stage, LN ratio (LNR), and log odds of metastatic LN (LODDS) staging criteria in patients with ICC. The surveillance, epidemiology, and end results cancer registry was queried to identify 749 patients who underwent surgical resection of ICC during 1988-2011. The Kaplan-Meier method and Cox proportional hazards regression models were used to analyze survival. The relative discriminative abilities of the different LN staging systems were assessed by the Harrell concordance index (c statistic). Of the 749 patients, 477 (63.7 %) had no LN metastasis, while 272 (36.3 %) had LN metastasis. Patients with LN metastasis had an increased risk of death (hazard ratio 2.42, 95 % confidence interval 1.98-2.95; P < 0.001). When assessed using categorical values, LNR (C index 0.620) and LODDS (C index = 0.630) showed a better prognostic performance than the AJCC 7th edition staging system (C index = 0.607). When assessed using continuous values, the LODDS staging system (C index = 0.626) slightly outperformed LNR (C index = 0.621). There was heterogeneity of outcomes among patients with no LN involved (LNR = 0) or all LN involved (LNR = 1), indicating that LODDS may better characterize and stratify outcomes among these groups. LODDS and LNR showed better prognostic performance than the AJCC 7th edition staging system. When assessed as categorical and continuous variables, LODDS outperformed LNR, especially among those patients with either very low or high LNR.Annals of Surgical Oncology 02/2015; DOI:10.1245/s10434-015-4419-1 · 3.94 Impact Factor