Abstract
The lymph node ratio (LNR) (i.e. the number of metastatic lymph nodes divided by the number of totally resected lymph nodes) has recently emerged as an important prognostic factor in colorectal cancer (CRC). However, the tumor node metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a meta-analysis to evaluate the prognostic role of the LNR in node positive CRC. A systematic search was performed in PubMed, Embase and the Cochrane Library for relevant studies up to November 2015. As a result, a total of 75,838 node positive patients in 33 studies were included in this meta-analysis. Higher LNR was significantly associated with shorter overall survival (OS) (HR = 1.91; 95% CI 1.71–2.14; P = 0.0000) and disease free survival (DFS) (HR = 2.75; 95% CI: 2.14–3.53; P = 0.0000). Subgroup analysis showed similar results. Based on these results, LNR was an independent predictor of survival in colorectal cancer patients and should be considered as a parameter in future oncologic staging systems.
Highlights
Colorectal cancer (CRC) is the third most common cancer and the third leading cause of cancer death in the United States [1]
The prognosis of patients with colorectal cancer was largely related to the lymph node status, which helps in tumor staging and clinical decision
According to the current tumor node metastasis (TNM) staging system proposed by the AJCC/ UICC [2], N categories were determined by the absolute number www.impactjournals.com/oncotarget of involved lymph nodes (N1, one to three; N2, four or more)
Summary
Colorectal cancer (CRC) is the third most common cancer and the third leading cause of cancer death in the United States [1]. Lymph node status is accepted as one of the most important prognostic factors in colorectal cancer [2]. Lymph node ratio (LNR) has recently emerged as an important prognostic factor and a suitable staging method for node positive patients [3,4,5]. A previous systematic review considered the evidence on LNR as a prognostic factor in the colorectal cancer [3]. The main research tool for this study is systemic review (only four series submitted for meta analysis).Since many new studies in the last years have investigated this topic and the last review date was around ten year ago, we aimed to clarify the prognostic role of NLR in patients with lymph node-positive colorectal cancer and conduct the first meta-analysis on this topic
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