Free Peritoneal Cancer Cells in Patients with Adenocarcinoma of the Stomach or Esophagogastric Junction: Risk Factors and Outcomes

To analyze the effects of number of positive lymph nodes and metastatic lymph node ratio (LNR) in evaluation of recurrence risk and overall survival in patients with adenocarcinoma of the esophagogastric junction (AEG) after curative resection. Clinical data of 337 AEG patients who underwent curative resection in our hospital were retrospectively reviewed. The pN stage was categorized based on the number of metastatic lymph nodes and LNR stage, and was determined by the best cutoff approach at log-rank test. Univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model were used to analyze the effects of pN and LNR on recurrence-free survival and overall survival of these patients. Receiver operating characteristic (ROC) curves were plotted to compare the accuracy of prognosis prediction with pN and LNR. The 5-year recurrence-free survival rate and overall survival rate for all patients were 25.5% and 29.9%, respectively. The 5-year recurrence-free survival rates were 47.6%, 23.2%, 17.1% and 5.7% for pN0, pN1, pN2, and pN3, respectively, (P < 0.001) and the 5-year overall survival rates were 53.3%, 28.9%, 18.9% and 7.3%, respectively (P < 0.001). The 5-year recurrence-free survival rates were 47.6%, 24.3%, 11.4% and 2.0% for LNR0, LNR1, LNR2, and LNR3, respectively (P < 0.001), and the 5-year overall survival rates were 53.3%, 28.5%, 15.0%, 2.6%, respectively (P < 0.001). Univariate analysis showed that tumor size, macroscopic type, degree of differentiation, pT, pN, LNR and TNM stage were significantly associated with RFS and OS (P < 0.05). Cox multivariate analysis showed that either pN or LNR was independent risk factor for RFS and OS (P < 0.001). When pN and LNR were entered into the Cox hazard ratio model as covariates at the same time, LNR remained as an independent prognosis factor for RFS and OS (P < 0.001), but pN was not (P > 0.05). ROC curves showed that the area under the curve of LNR stage was larger than that of pN stage in prediction of both RFS and OS, however the differences were not statistically significant (P > 0.05). LNR is an independent risk factor associated with the prognosis of AEG patients. The value of LNR in prediction of recurrence hazard and overall survival was better than that of pN stage. It offers some helpful suggestions for AEG patients risk classification, allowing clinicians to develop a reasonable treatment.

To evaluate the value of the metastatic lymph node ratio (MLR) in predicting the postoperatively survival time of patients with T(3) gastric carcinoma. Eighty-nine patients with T(3) gastric carcinoma who underwent curative gastrectomy were analyzed retrospectively. The correlations between MLR, positive nodes and the total lymph nodes (15 or more) in histologic examination were analyzed using Spearman's correlation analysis. The influence of MLR and positive nodes on survival time of patients was identified with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. The predicting accuracy of MLR to death of patients within 2 years postoperatively was determined by receiver working characteristic curve and was compared with that of positive nodes. (1) The MLR did not correlate with the total lymph nodes in histologic examination (Spearman's correlation coefficient was -0.0022, P > 0.05), whereas positive lymph nodes did (correlation coefficient was 0.2504, P < 0.05). (2) Kaplan-Meier survival analysis identified that the MLR influenced significantly the survival time postoperatively (Log-rank chi(2) = 35.7470, P < 0.01). Cox proportional hazard model showed the high MLR was an independent poor prognostic factor (chi(2) = 7.9708, P < 0.01). (3) There was not difference between the area under the receiver working curve of MLR and positive nodes to predict the death of patients within 2 years postoperatively (P > 0.05). The MLR in T(3) gastric carcinoma is not correlated with the number of total lymph nodes examined on the condition that 15 or more lymph nodes were assessed in pathology. The predicting accuracy of MLR to death of patients with T(3) gastric carcinoma within 2 years postoperatively is same as, but not better than that of positive nodes if the extent of lymphadenectomy is optimal.

To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients. The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (c2 = 4.26, P = 0.0389), tumor size (c2 = 18.48, P < 0.001), Borrmann type (c2 = 7.41, P = 0.0065), histological grade (c2 = 5.07, P = 0.0243), pT category (c2 = 49.42, P < 0.001), pN category (c2 = 87.7, P < 0.001), total number of retrieved lymph nodes (c2 = 8.22, P = 0.0042) and MLR (c2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (c2 = 7.985, P = 0.018), pT category (c2 = 30.82, P < 0.001) and MLR (c2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple linear regression (beta = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%. The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.

Presence of free gastric cancer cells in the peritoneal cavity of patients who underwent surgical treatment for gastric cancer is a negative prognostic factor and caused rapid disease recurrence, manifested as peritoneal metastases. Positive peritoneal cytology despite lack of visible peritoneal metastases was regarded as M1 class in the TNM classification (7th edition) in 2010. The aim of the study was to analyze factors associated with positive peritoneal cytology and identify groups of patients in whom diagnostic laparoscopy plus peritoneal lavage in the diagnostic process could affect therapeutic decisions. The study enrolled patients with gastric cancer who underwent surgical treatment at the Department of Surgery, Wielkopolskie Oncology Center in Poznań. During the laparotomy, after opening of the peritoneal cavity, 200 ml of physiological saline at 37 °C was administered in the tumor region. After this fluid was mixed, 100 ml of lavage fluid was collected. This fluid was subsequently spun many times to obtain sediment for cytology and immunohistochemistry investigation using anti-BerEp-4, CK 7/20, and B72.3. Results of peritoneal cytology were analyzed jointly with clinical factors--patient's age, sex and pathology factors--tumor invasion, involvement of lymph nodes, histological grade, histological type according to Lauren and localization of the cancer in the stomach. Analysis of the peritoneal fluid for presence of free cancer cells was done in 51 patients. Positive peritoneal cytology was found in 12 (23.5%) patients. In the group of patients with positive cytology, all patients had T3/T4 tumors and all were found to have lymph node metastases, while G3 cancer was found in 83.3% of patients. In patients with positive cytology, diffuse gastric cancer according to Lauren predominated (9 of 12 patients, 75%), while in patients with negative cytology--intestinal type (20 of 39 patients, 51.2%). In the group of patients with positive histology, the whole stomach was involved by the cancer process in 7 of 12 patients (58.3%), while in the group with negative histology, in 29 of 39 patients the tumor was located in the gastric body and prepyloric part (74.4%). Based on this study we can conclude that determinants of positive peritoneal cytology include: tumor stage T3/T4, N+, G3, cancer located in the whole stomach, diffuse histological type according to Lauren.

IntroductionThe metastatic lymph node ratio (MLNR) has been proposed as a meaningful prognostic indicator in colon cancer (CC). This study aimed to assess the prognostic relevance of MLNR by investigating its association with disease-free survival (DFS), overall survival (OS), and recurrence, and to compare its predictive value with traditional parameters, including the TNM classification and total lymph node count (TNLC).Materials and methodsThis retrospective, single-center study included patients who underwent surgical resection for colon cancer. Survival outcomes were analyzed using Kaplan-Meier survival curves and multivariate logistic regression. MLNR was evaluated in relation to demographic and clinical factors, including age, tumor location, surgical type, and the administration of adjuvant chemotherapy. The optimal MLNR cut-off value for predicting recurrence was determined via receiver operating characteristic (ROC) curve analysis.ResultsA total of 122 patients were analyzed. MLNR >0.125 was significantly associated with increased recurrence risk (adjusted HR: 7.0, p<0.001) and reduced DFS. Patients with an MLNR ≤0.125 demonstrated significantly longer DFS (p<0.001). MLNR emerged as an independent prognostic factor, offering potential prognostic benefit compared to TNLC in predicting both DFS and OS. Additionally, adjuvant chemotherapy was independently associated with a lower recurrence risk (Exp(B):0.234, p=0.038). Emergency surgery was found to be significantly correlated with poorer survival outcomes (p=0.023).ConclusionMLNR contributes additional prognostic information to the TNM staging system and may support more individualized risk stratification and decision-making regarding adjuvant therapy in colon cancer. Further large-scale prospective studies are warranted to validate these findings and to establish a clinically applicable MLNR threshold.

To compare the prognostic value of AJCC/UICC pN stage with metastatic lymph node ratio (MLR) and the prognostic difference between the tumor-node-metastasis (TNM) stage and tumor-ratio-metastasis (TRM) stage in patients with adenocarcinoma of the gastroesophageal junction. Clinical data of 414 patients with adenocarcinoma of the gastroesophageal junction undergoing curative resection at the Tianjin Medical University Cancer Institute and Hospital from January 2000 to June 2007 were retrospectively reviewed. Spearman correlation analysis was performed to examine the correlations between pN, MLR and retrieved nodes. Univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis were performed to analyze the effects of pN, MLR, TNM and TRM stage on the prognosis of these patients. The area under the ROC curve (AUC) was plotted to compare the value of these stages and to predict the 5-year survival rate. The median number of retrieved nodes was 17 (4-71) per patient, and the median number of positive nodes was 4 (0-67) per patient. The number of metastatic lymph node was positively correlated with that of retrieved nodes (P<0.01), but MLR was not correlated with the number of retrieved nodes (P>0.05). Univariate and multivariate survival analysis showed that either pN or MLR could be used as an independent risk factor for survival (P<0.01) and the hazard ratio of MLR stage was larger than that of pN stage (1.573 vs 1.382). While pN and MLR were entered into the Cox hazard ratio model as covariates at the same time, MLR remained as the independent prognostic factor (P<0.01), but pN lost significance (P>0.05). The AUC of MLR and pN staging was 0.726 and 0.714, and of TRM and TNM staging was 0.747 and 0.736, respectively, however the differences were not statistically significant (all P>0.05). MLR is an independent prognostic factor for patients with adenocarcinoma of the gastroesophageal junction. The value of MLR and TRM staging systems may be superior to pN and TNM staging systems in evaluating the prognosis of these patients.

The value of positive peritoneal cytology in colorectal cancer has been controversial. In this study, we aimed to clarify the prognostic significance of peritoneal cytology and the impact of the combination of peritoneal dissemination and peritoneal cytology on the prognostic evaluation of colorectal cancer. From January 1997 to December 2005, intraoperative peritoneal cytology was performed on 410 patients who had at least serosal invasion. Thirty-one patients (7.6%) had positive peritoneal cytology. Patients with negative cytology showed a significantly better survival rate at five years than those with positive cytology (negative cytology, 68.0%; positive cytology, 20.6%; P < 0.0001). Multivariate analysis revealed that peritoneal cytology is one of the significant prognostic factors. Sixty percent of patients with positive cytology and 30.4% of patients with negative cytology recurred (P = 0.08). Regarding the recurrence site, patients with positive cytology showed a significantly higher recurrence rate of peritoneal dissemination than those with negative cytology (P = 0.0038). Some patients with positive cytology but without evident peritoneal dissemination achieved long-term survival. Additionally, some patients with macroscopic peritoneal dissemination and negative peritoneal cytology also achieved long-term survival. But for those patients with both positive cytology and evident macroscopic peritoneal dissemination, the five-year survival rate was zero. Patients with negative peritoneal cytology had a significantly better five-year survival rate than those with positive peritoneal cytology. In some cases in which either peritoneal cytology or peritoneal dissemination was negative, long-term survival could be achieved.

PurposeThe metastatic lymph node ratio (MLNR) is one of the most important factors in prognostic analysis of breast cancer. The objective of this study was to determine if MLNR combined with protein-tyrosine phosphatase H1 (PTPH1) pathological expression can be used to predict the prognosis of patients with breast invasive ductal carcinoma (IDC) better than one factor only.Patients and MethodsA total of 136 patients with invasive ductal carcinoma (IDC) of breast who underwent modified radical mastectomy and were treated with chemotherapy after operation at Qilu Hospital of Shandong University from December 2008 to October 2011 were included. PTPH1 expression was evaluated by immunohistochemistry in surgical specimens retrospectively collected from patients with histologically proven invasive ductal breast cancer. Kaplan–Meier survival analysis and Cox regression analysis were performed to assess the prognostic significance of PTPH1 expression. A prognostic factor for disease-free survival (DFS) was identified by univariate and multivariate analyses. ROC analysis was used to evaluate the performance of single factors and combined feature.ResultsOne hundred and thirty-six patients were included in the analysis. By cut-point survival analysis, MLNR cut-off was designed as 0.2. On multivariate analysis, a MLNR>0.2 was associated with a worse DFS (HR=2.581, 95% CI=1.303–5.113, P=0.007). PTPH1 overexpression is correlated with a better DFS (HR=0.391, 95% CI=0.162–0.945, P=0.037). In addition, MLNR and PTPH1 combined feature had better performance in predicting clinical outcomes after surgery long before recurrence had occurred (Area under the curve=0.795 [95% CI=0.694–0.896], P<0.001).ConclusionThese findings indicate that both PTPH1 and MLNR are accurate independent prognostic parameters in patients with IDC of the breast. Better information on IDC prognosis could be obtained from the combined feature.

Peritoneal meatastasis is the most important pattern in postoperative recurrence of gastric cancer. The purpose of this study was to investigate the predictive factors of peritoneal recurrence in gastric cancer patients who underwent surgical resection. We retrospectively analyzed clinical data of 137 consecutive patients diagnosed with peritoneal recurrence after curative gastrectomy at Department of Osaka City University Hospital. We evaluated association of clinicopathological features with relapse free survival rate. Parameters analyzed in this study included age, sex, tumor diameter, histological type, tumor infiltration, number of lymph node metastasis, TNM stage, lymphatic invasion, venous invasion, and metastatic lymph node ratio (MLR). Median survival time of entire patients was 12 months and mean MLR was 34%. For statistical analysis, we divided patients into two groups based on relapse free survival time. 78 patients who had peritoneal recurrence within one year after gastrectomy were defined as early recurrence group. The remaining 59 patients were stratified to late recurrence group. In comparison of both groups, univariate analysis showed statistically significant predictive factors associated with recurrence, for example, peritoneal lavage cytology, lymphatic invasion, tumor diameter, number of lymph node metastasis, and MLR. In multivariate analysis, MLR was identified as an independent predictive factor. Also the patients with 20% or higher MLR had poorer prognosis in overall survival. We demonstrated that lymph node metastasis was associated with peritoneal recurrence. Our findings suggested that MLR should be considered for postoperative adjuvant therapy to impede progression of peritoneal metastasis for gastric cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3396. doi:1538-7445.AM2012-3396

To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate Kaplan-Meier survival analysis and multivariate Cox's proportional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC = 0.795, 95%CI: 0.751-0.839, P = 0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size < 4.8 cm). Tumor size was significantly correlated with histological type (P = 0.039), Borrmann type (P = 0.000), depth of tumor invasion (P = 0.000), lymph node metastasis (P = 0.000), tumor-nodes metastasis stage (P = 0.000), mean number of metastatic lymph nodes (P = 0.000) and metastatic lymph node ratio (P = 0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P = 0.000). Univariate analysis showed that depth of tumor invasion (χ² = 69.581, P = 0.000), lymph node metastasis (χ² = 138.815, P = 0.000), tumor size (χ² = 78.184, P = 0.000) and metastatic lymph node ratio (χ² = 139.034, P = 0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P = 0.000), lymph node metastasis (P = 0.019) and tumor size (P = 0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P < 0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT2-3N0-2 stage tumors (P > 0.05). Using a tumor size cutoff value of 4.8 cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.

ObjectiveThis study aimed to investigate the demographic and clinicopathological characteristics, and survival outcomes of subglottic Squamous Cell Carcinoma (SCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. MethodsDemographic and clinicopathological information, including age, sex, race, tumor size, histologic grade, clinical/TNM stage, tumor invasion extent, Lymph Node Metastasis (LNM) extent, size of metastatic lymph nodes, LNM ratio and treatment data, of 842 subglottic SCC patients diagnosed between 1996 and 2016 were acquired. Kaplan-Meier survival analyses were performed to assess the effects of clinicopathological characteristics, treatment modalities, surgical procedures, and adjuvant therapies on overall survival and cancer-specific survival. ResultsSubglottic SCC was more frequent among males aged 60–70 years, with low-grade but locally advanced lesions without local or distant metastases. Age and several primary tumor/LNM related variables were independent risk factors for overall survival and cancer specific survival. Advanced-stage and high-grade disease led to unfavorable prognosis. The most common treatment modality and surgical procedure were surgery plus radiotherapy and total laryngectomy, respectively. Surgery plus radiotherapy provided favorable 5-year survival outcomes, while total laryngectomy had the worst. Surgery plus adjuvant therapy showed better survival outcomes than surgery alone. ConclusionThis study confirmed the rarity of subglottic SCC. Patients with subglottic SCCs suffered poor prognosis especially for those with advanced-stage or high-grade lesions. The prognosis of subglottic SCC remained poor over the years, despite recent progress in cancer therapies. Surgery plus adjuvant therapy improved the survival outcome. Although larynx preservation surgery was beneficial for early-stage disease, total laryngectomy was favored for patients with advanced tumors. Level of evidenceLevel 4.

ObjectiveThe value of adjuvant therapy in resected laryngeal cancer remains controversial. This large SEER‐based cohort study aimed to investigate the existing parameters of lymph node status that could predict survival outcomes and the prognostic value of adjuvant treatment in resected laryngeal carcinoma.MethodsPopulation‐based data from the US Surveillance, Epidemiology, and End Results (SEER‐18) Program on patients after laryngectomy and lymphadenectomy (2004‐2015) were analyzed. The optimal cut‐off values for examined lymph nodes number (ELNs) and metastatic lymph nodes ratio (MLNR) were determined using the X‐tile program. Associations of ELNs and MLNR with overall survival were investigated through Cox regression analysis. A survival‐predicting model was then constructed to stratified patients. The prognostic value of adjuvant therapy was evaluated in different subgroups.ResultsA total of 2122 patients with resected laryngeal cancer were analyzed. A novel survival‐predicting model was proposed based on ELNs, MLNR, and other clinicopathological characteristics. Patients were stratified into three subgroups with the increasing risk of death. Only patients in the high‐risk group who receiving adjuvant treatment had a significantly better survival outcome than those receiving surgery alone.ConclusionA new survival‐predicting model was established in this study, which was superior in assessing the survival outcomes of patients with resected laryngeal cancer. Notably, this model was also able to assist in the decision making of adjuvant therapy for patients and physicians.

Previous studies revealed serosal invasion as one of the most important predictors of peritoneal micrometastasis. However, even for cancers with serosal invasion, the macroscopic serosal appearance is highly heterogeneous. The aim of the present study was to propose a macroscopic serosal classification (MSC) and to investigate the validity of this classification as a predictor of peritoneal recurrence. Clinicopathologic features including MSC of 1528 patients with pT3/pT4a stage gastric cancers who underwent potentially radical surgery were retrospectively reviewed. MSC was classified as reactive type, nodular type, tendonoid type, and color-diffused type according to the macroscopic serosal appearance. There were significant differences in tumor size, location, Bormann type, Lauren grade, lymphatic and/or blood vessels invasion (LBVI), width of serosa changes, depth of invasion, number of nodes metastasis, lymph node metastasis ratio, pN stage, and peritoneal cytology between patients with different types of serosa. Multivariate analysis revealed MSC, as well as depth of invasion, Lauren grade, and pN stage, significantly predicted the presence of peritoneal-free cancer cells. Both MSC and peritoneal cytology significantly correlated with patient survival. However, only MSC significantly predicted peritoneal recurrence on multivariate analysis, but peritoneal cytology did not, indicating MSC was more sensitive than cytologic examination. Further investigation suggested MSC and pN stage were also independent predictors of peritoneal recurrence for patients with negative peritoneal cytology. The MSC sensitively predicts the presence of peritoneal micrometastasis for pT3/pT4a-stage gastric cancer patients who underwent potentially radical surgery. Consequently, it might be considered a good indicator to guide perioperative adjuvant therapy for patients with high risk of peritoneal recurrence.

The aim of this study was to investigate the effect of metastatic lymph node ratio (mLNR) on overall survival after curative resection in patients with right-sided colon cancer. Patients diagnosed with right-sided colon cancer and treated at Istanbul Teaching and Research Hospital between 2012 and 2017 were retrospectively analyzed. Variables including age, sex, total number of lymph nodes removed, metastatic lymph node ratio, disease stage, tumor location, and patient morbidity were compared with overall survival. Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate the impact of these variables on overall survival. A total of 129 patients were included in this study. By the end of the follow-up period, 51 patients (39.5%) had died. Receiver operating characteristic (ROC) analysis identified a cut-off value for mLNR at 0.0801 (p < 0.001), with 39 patients (30.2%) having an mLNR greater than this threshold. Patients with a high mLNR exhibited significantly shorter overall survival (20.3 months, 95% confidence interval (CI): 12.0-28.6) compared to those with a lower mLNR (106.6 months, 95% CI: 98.4-114.8) (p < 0.001). Furthermore, overall survival was significantly lower in patients with advanced-stage tumors, highlighting the prognostic importance of tumor, node, and metastasis (TNM) staging system. In multivariate Cox regression analysis, TNM stage (hazard ratio (HR) = 50.229, 95% CI: 6.678-372.242, p < 0.001) and mLNR (HR = 3.136, 95% CI: 1.843-5.337, p < 0.001) were identified as independent prognostic factors for overall survival. This study underscores that in right-sided colon cancer, the mLNR and TNM stage provide critical prognostic insights, independent of the total number of lymph nodes removed. These findings support the use of mLNR as a practical and reliable tool for refining prognostic assessments and guiding personalized treatment strategies, emphasizing its potential role in clinical decision-making.

In women with negative cervical cytology and positive high-risk human papillomavirus (HR-HPV) test results, we compared the risk of cervical intraepithelial neoplasia 3 (CIN 3) or cancer (CIN 3+) in women with previous abnormal cervical cytology, CIN, or HR-HPV with that in women without this history, and we determined their cumulative risk of CIN 3+. We reviewed colposcopies for negative cytology and positive HR-HPV test results from 2007 to 2009 (colposcopy was done for previous abnormal cytology, HR-HPV, or CIN or if negative cytology and positive HR-HPV test results for 20-35 months). Women with negative cytology and positive HR-HPV test results in 2007 were reviewed to determine their cumulative risk of CIN 3+. Of the 513 women with colposcopy for negative cytology and positive HR-HPV test results, 367 had previous abnormal cytology, CIN, or HR-HPV greater than 35 months ago and 146 had negative cytology and positive HR-HPV test results for 20 to 35 months. Risk of CIN 3+ for women with negative cytology and positive HR-HPV test results with previous abnormal cytology, HR-HPV, or CIN who did not have previous colposcopy was 11.9% (8/67); for similar women with previous colposcopy, it was 2.7% (8/300); and for women with positive HR-HPV test result for 20 to 35 months, it was 7.5% (11/146). In 2007 to 2009, risk of CIN 3+ for women with cytology of atypical squamous cells of undetermined significance (ASC-US) with positive HR-HPV test result was 3.9% (60/1,540). Of the 1,726 women with negative cytology and positive HR-HPV test result in 2007, 381 (22.1%) were lost to follow-up. Of the 1,345 women with median follow-up of 44 months, 602 (44.8%) had 1 or 2 subsequent negative cytology and negative HR-HPV test results and 180 had subsequent positive HR-HPV test result without biopsy. Of the 563 women with biopsy, there were 711 evaluations. Invasive cancer was found in 4 and CIN 3 in 54 (cumulative CIN 3+ of 4.3%, 58/1,345). Half (29/58) of the cumulative CIN 3+ was diagnosed after subsequent abnormal cytology and positive HR-HPV test result. If referral to colposcopy of women with cervical cytology of ASC-US and positive HR-HPV test result (CIN 3+, 3.9%) is justified, referral to colposcopy of women with negative cytology and positive HR-HPV test results is justified if they have previous abnormal cervical cytology, CIN, or HR-HPV greater than 35 months ago but have not had previous colposcopy (CIN 3+=11.9%) or are persistently HR-HPV positive for 20 to 35 months (CIN 3+, 7.5%). The risk of CIN 3+ in women with previous abnormal cytology, CIN, or HR-HPV who have previous colposcopy (2.7%) is lower because these women have incident rather than prevalent CIN 3+.