SIMULTANEOUS VS STAGED RESECTIONS IN COLON CANCER PATIENTS WITH SYNCHRONOUS LIVER METASTASES: PROGNOSTIC IMPACT OF LYMPH NODE RATIO AND TUMOR BURDEN SCORE.

The presence and number of nodal metastasis significantly impact colon cancer prognosis. Similarly, the number of resected/evaluated nodes impacts staging accuracy. This ratio of metastatic to examined nodes or lymph node ratio (LNR) may have independent prognostic value in colon carcinoma. : To evaluate the impact of LNR on overall survival in colon cancer patients with fewer than 12 or 12 examined nodes or more. Patients (n = 36,712) with node-positive nonmetastatic colon cancer diagnosed between 1992 and 2004 were identified from the Surveillance, Epidemiology, and End Results database and stratified according to LNR and number of nodes examined. Survival was estimated by Kaplan-Meier method, and differences analyzed by log-rank test. A Cox proportional hazards model was used for multivariate analysis. Patients with fewer than 12 nodes were older and male and had lower primary tumor stage, grade, and N stage (P < 0.01). Survival appeared greater with 12 total nodes examined or more (median 53 vs. 66 months, P < 0.001). Within each LNR stratum, survival with 12 nodes or more was improved for those with less than 10% of nodes positive for cancer, but was worse with higher LNRs (P < 0.01). Lymph node ratio was significantly associated with survival independent of total nodes (HR 1.24-5.12, P < 0.001). Other significant factors included age, race, tumor grade, stage, location, and N stage. Metastatic LNR independently estimates survival in Stage III colon cancer, irrespective of number of nodes examined. However, statistically significant differences in each LNR stratum between those with resection of fewer than 12 or 12 nodes or more would indicate that a 12-node minimum may still be necessary for accurate staging.

Background Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer-related mortality, with survival outcomes heavily influenced by lymph node (LN) involvement. The TNM staging system introduced a refined nodal classification but does not define the optimal number of examined LN ratio, risking stage migration. The lymph node ratio (LNR), calculated as metastatic LNs/total resected LNs, has been proposed as a better prognostic marker than absolute node count. This study examined the prognostic impact of LNR in ESCC, comparing it with TNM staging, to improve risk stratification and guide treatment strategies for better patient outcomes. Methods This study examined the prognostic impact of lymph node ratio (LNR) on survival outcomes in esophageal squamous cell carcinoma (ESCC). Data from electronic medical records included demographics, tumor characteristics, lymph node status, and survival outcomes. Patients were categorized based on LNR cutoffs (&amp;lt;0.2, 0.2–0.4, &amp;gt;0.4). Survival analysis was conducted using the Kaplan–Meier method, with log-rank tests for comparisons. Cox proportional hazards regression identified LNR’s independent prognostic significance. SPSS software was used, with p &amp;lt; 0.05 considered statistically significant. Results This study analyzed 250 ESCC patients, stratified by lymph node ratio (LNR) categories to assess survival impact. Higher LNR (&amp;gt;0.4) correlated with poorer outcomes, with overall survival of 15.3 vs. 28.5 months in LNR &amp;lt;0.2 (p &amp;lt; 0.001). Patients in LNR 0.2–0.4 had 46% lower odds of survival, while LNR &amp;gt;0.4 had 67% lower survival odds compared to LNR &amp;lt;0.2 (p &amp;lt; 0.001). Most patients were male (70%), smokers (60%), and had T3 tumors (50%) with nodal metastasis (70%). R0 resection was achieved in 95%, but 40% had lymphovascular invasion and 35% had perineural invasion. Conclusion This study confirms lymph node ratio (LNR) as an independent prognostic factor in esophageal squamous cell carcinoma (ESCC). Higher LNR (&amp;gt;0.4) significantly reduced survival, making it a more reliable predictor than TNM staging. Patients with advanced disease (T3 tumors, nodal metastasis in 70%) had poorer outcomes, especially with lymphovascular (40%) and perineural invasion (35%). R0 resection was achieved in 95%, but higher LNR correlated with lower survival odds. These findings suggest that LNR should be integrated into ESCC staging models to improve risk stratification and treatment decisions, with further research needed for validation.

Objective: The purpose of this study was to evaluate the application of lymph node count (LNC) and lymph node ratio (LNR) in the surgical prognostic assessment of colon cancer. Methods: To analyze the correlation among LNC, LNR, and clinicopathological features including systemic inflammatory response (SIR) in patients undergoing colon cancer surgery. To provide a new evaluation idea for clinicians to evaluate the prognosis of colon cancer surgery. The methods of this study was to retrospectively analyze the clinical data of patients who underwent colon cancer resection at the Affiliated Bozhou Hospital of Anhui Medical University from August 1, 2013 to August 1, 2023. LNC (&lt;12 / ≥12) and LNR (&lt;0.25 / ≥0.25) were analyzed using Chi-square test and logistic regression, as well as clinicopathological characteristics including modified Glasgow Prognostic Score, C-reactive protein and albumin, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, and lymphocyte to monocyte ratio. Univariate and multifactorial analyses were performed to analyze the relationship between LNR (&lt;0.25 / ≥0.25) and clinicopathological characteristics and LNC≥12. Results: In multifactorial analysis, significant differences were found between T stage, N stage, LNR (≥0.25), luminal / open, and COPD (P&lt;0.05). Among patients with LNC≥12 and positive lymph nodes, multivariate analysis showed that elevated LNR (≥0.25) was linked to T stage, NLR, and peritoneal invasion. Conclusion: LNC and LNR were unrelated with SIR labeling. The LNC and LNR, on the reverse hand, are directly related. In quality surgical and pathologic practice, when compared to N stage, LNR offers a better prognostic value for patients having surgery for colon cancer.The findings of this study demonstrate that LNR is dependent on LNC and has prognostic value in colon cancer patients.

Lymph node ratio is a strong prognostic factor after minimally invasive surgery radical hysterectomy of early-stage cervical cancer

PurposeTo determine whether the prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, differs between open and minimally invasive surgical approaches for radical hysterectomy (RH) in node-positive, early-stage cervical cancer.Materials and MethodsWe retrospectively identified 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 patients who underwent primary type C RH between 2010 and 2018. Among them, only those with pathologically proven lymph node metastases who received adjuvant radiation therapy were included. The prognostic significance of LNR was investigated according to open surgery and minimally invasive surgery (MIS).ResultsIn total, 55 patients were included. The median LNR (%) was 9.524 (range, 2.083–62.500). Based on receiver operating characteristic curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR (<8.831%, n=26) (p=0.027), whereas no difference in overall survival was observed. Multivariate analyses adjusting for clinicopathologic factors revealed that DFS was adversely affected by both MIS [adjusted hazard ratio (HR), 8.132; p=0.038] and high LNR (adjusted HR, 10.837; p=0.045). In a subgroup of open surgery cases, LNR was not associated with disease recurrence. However, in a subgroup of MIS cases, high LNR was identified as an independent poor prognostic factor for DFS (adjusted HR, 14.578; p=0.034).ConclusionIn patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.

The Barcelona Clinic Liver Cancer (BCLC) staging system has been recommended for prognostic prediction. However, prognosis is variable at different BCLC stages. We aimed to evaluate whether the radiographic tumor burden score (TBS) could be used to stratify prognosis in different BCLC stages. Hepatocellular carcinoma (HCC) patients undergoing liver resection (LR) at BCLC-0, -A, or -B stage in our institution in 2007-2018 were divided into derivation and validation cohorts. Overall survival (OS) was analyzed according to the TBS and BCLC stage. TBS cutoff values for OS were determined with X-tile. Of the 749 patients in the derivation cohort, 138 (18.4%) had BCLC-0, 542 (72.3%) BCLC-A, and 69 (9.2%) BCLC-B HCC; 76 (10.1%) had a high TBS (> 7.9), 477 (63.7%) a medium TBS (2.6-7.9), and 196 (26.2%) a low TBS (< 2.6). OS worsened progressively with increasing TBS in the cohort (p < 0.001) and in BCLC-A (p = 0.04) and BCLC-B (p = 0.002) stages. Multivariate analysis showed that the TBS was associated with OS of patients with BCLC-A (medium vs. low TBS: hazard ratio [HR] = 2.390, 95% CI = 1.024-5.581, p = 0.04; high vs. low TBS: HR = 3.885, 95% CI = 1.443-10.456, p = 0.007) and BCLC-B (high vs. medium TBS: HR = 2.542, 95% CI = 1.077-6.002, p = 0.033) HCC. The TBS could also be used to stratify the OS of patients in the validation cohort (p < 0.001). The TBS could be used to stratify the OS of the entire cohort and BCLC stages A and B of HCC patients undergoing LR.

Simple SummaryHepatocellular carcinoma (HCC) tumor burden score (TBS) and α-fetoprotein (AFP) have been considered important predictors of outcomes among patients with resectable HCC; yet, the interplay of TBS (i.e., tumor morphology) and AFP (i.e., surrogate for tumor biology) in HCC has not been examined to date. The current study aimed to investigate the interplay of HCC TBS and AFP among patients undergoing resection for HCC. Both TBS and serum AFP levels were strong predictors of outcomes and demonstrated a synergistic impact on prognosis, with higher serum AFP predicting worse outcomes among patients with HCC of a certain TBS class after resection. Both tumor morphology (i.e., tumor burden) and tumor-specific biomarkers (i.e., serum AFP) may be important when assessing the prognosis of patients who undergo resection for HCC.Introduction: The prognostic role of tumor burden score (TBS) relative to pre-operative α -fetoprotein (AFP) levels among patients undergoing curative-intent resection of HCC has not been examined. Methods: Patients who underwent curative-intent resection of HCC between 2000 and 2017 were identified from a multi-institutional database. The impact of TBS on overall survival (OS) and cumulative recurrence relative to serum AFP levels was assessed. Results: Among 898 patients, 233 (25.9%) patients had low TBS, 572 (63.7%) had medium TBS and 93 (10.4%) had high TBS. Both TBS (5-year OS; low TBS: 76.9%, medium TBS: 60.9%, high TBS: 39.1%) and AFP (>400 ng/mL vs. <400 ng/mL: 48.5% vs. 66.1%) were strong predictors of outcomes (both p < 0.001). Lower TBS was associated with better OS among patients with both low (5-year OS, low–medium TBS: 68.0% vs. high TBS: 47.7%, p < 0.001) and high AFP levels (5-year OS, low–medium TBS: 53.7% vs. high TBS: not reached, p < 0.001). Patients with low–medium TBS/high AFP had worse OS compared with individuals with low–medium TBS/low AFP (5-year OS, 53.7% vs. 68.0%, p = 0.003). Similarly, patients with high TBS/high AFP had worse outcomes compared with patients with high TBS/low AFP (5-year OS, not reached vs. 47.7%, p = 0.015). Patients with high TBS/low AFP and low TBS/high AFP had comparable outcomes (5-year OS, 47.7% vs. 53.7%, p = 0.24). The positive predictive value of certain TBS groups relative to the risk of early recurrence and 5-year mortality after HCC resection increased with higher AFP levels. Conclusion: Both TBS and serum AFP were important predictors of prognosis among patients with resectable HCC. Serum AFP and TBS had a synergistic impact on prognosis following HCC resection with higher serum AFP predicting worse outcomes among patients with HCC of a certain TBS class.

Survival following early-stage colon cancer: an ACCENT-based comparison of patients versus a matched international general population

BackgroundThe lymph node ratio (LNR), i.e. the number of positive lymph nodes (LN) divided by the total number of analyzed LN, has been described as a strong outcome predictor in node-positive colon cancer patients. However, most published analyses are constrained by relatively low numbers of analyzed LN. Therefore, the objective of the present study was to evaluate the prognostic impact of LNR in colon cancer patients with high numbers of analyzed LN.MethodsOne hundred sixty-six colon cancer patients underwent open colon resection. All node-positive patients were analyzed for this study. The number of analyzed LN, of positive LN, the disease-free (DFS) and overall survival (OS) time were prospectively recorded. Patients were dichotomously allocated to a high or a low LNR-group, respectively, with the median LNR (0.125) as a cut-off value. Median follow-up was 34.3 months.ResultsFifty-eight patients (34.9%) were node-positive. The median number of analyzed LN was 23 (range 8–54). DFS and OS were significantly shorter in pN2 vs pN1 patients (p < 0.001, and p = 0.001, respectively), and in LNR high vs low patients (p = 0.032, and p = 0.034, respectively). pN2 (vs pN1) disease showed hazard ratios (HR) of 6.2 (p < 0.001), and 6.8 (p < 0.005; for DFS and OS, respectively), while LNR high (vs low) showed HR of 3.0 (p =0.041), and 4.5 (p = 0.054).ConclusionsLNR is a reasonable outcome predictor in node-positive colon cancer patients. However, LNR is inferior to pN-stage in predicting survival in patients with high number of harvested lymph nodes.

Albumin-Bilirubin Grade and Tumor Burden Score Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma After Hepatic Resection: a Multi-Institutional Analysis

e14595 Background: The American Joint Committee on Cancer (AJCC) uses the number of positive lymph nodes removed as one of their staging criteria for colorectal cancer. However, in recent years, many studies have shown lymph node ratio (LNR; ratio of positive lymph nodes to the total number dissected) to be a more significant prognostic factor. Methods: We performed a retrospective study of all patients diagnosed with node-positive colorectal cancer in a single institution between January 1, 2000 and December 31, 2011. End points were overall survival (OS) and disease-free survival (DFS). Patients were stratified into LNR groups 1 (LNR≤0.11), 2 (0.11 0.27). Results: 172 patients met the inclusion criteria (109 colon, 63 rectal). In the colon cancer patients, 5-year OS decreased significantly (p<0.05) with increasing LNR: 75.8% (LNR1), 62.5% (LNR2) and 41% (LNR3). Similarly, 5-year DFS decreased significantly (p<0.05) from 75.5% (LNR1) to 38.8% (LNR3). Conversely, in the rectal cancer...

Objective: The objectives of our retrospective analysis were to estimate the oncological long-term results of patients with ypN2 and to evaluate the impact of lymph node ratio (LNR) on overall (OS) and disease-free survival (DFS). Methods: We analysed all consecutive patients (n=85) undergoing neoadjuvant chemotherapy (NAC) and surgery for pre-operative pathologically proven stage IIIA-B (N2) NSCLC from 2014 to 2020. Median LNR (0.29 or 29%) was selected as threshold for grouping. Survival was estimated using the Kaplan-Meier method. Cox regression was used to test the association between OS, DFS and covariates. Results: Post-operative mortality was 3.5%. The median follow-up was 21 months (range 6-69 months). The 5-year OS and DFS of the cohort were 41% and 20%. Patients with LNR&gt;0.29 (n=13; 15.3%) showed a trend toward worse survival than patients with LNR0 (n=44; 51.8%) with a 5-year OS of 56% VS 14% (p=0.077), confirmed as a trend at the multivariable analysis (HR 2.28; p=0.066). At the univariate analysis a worse DFS was observed for ypN2 patients (n=58; 68.2%) compared with nodal downstaging (46% vs 25% 3-year DFS, p=0.039). DFS was different according to LNR: 3-year DFS was 14% in patients with LNR&gt;0.29 while it reached 44% in patients with LNR 0 (p=0.043) and 62% in LNR&lt;0.29 (p=0.03). LNR&gt;0.29 was the only significant predictor (HR 2.89; p=0.047) of reduced DFS at the multivariable analysis. Conclusion: patients with ypN2 disease after NAC showed acceptable oncological outcomes and this finding is true for patients with low burden of nodal disease assessed by LNR.

PurposeTo evaluate the prognostic impact of the lymph node ratio (LNR) in ypStage III rectal cancer patients who were treated with neoadjuvant chemoradiotherapy (NCRT).Materials and MethodsWe retrospectively reviewed the data of 638 consecutive patients who underwent NCRT followed by total mesorectal excision, and postoperative adjuvant chemotherapy for rectal cancer from 2004 to 2011. Of these, 125 patients were positive for lymph node (LN) metastasis and were analyzed in this study.ResultsThe median numbers of examined and metastatic LNs were 17 and 2, respectively, and the median LNR was 0.143 (range, 0.02–1). Median follow-up time was 55 months. In multivariate analyses, LNR was an independent prognostic factor for overall survival (OS) (hazard ratio [HR] 2.17, p = 0.041), disease-free survival (DFS) (HR 2.28, p = 0.005), and distant metastasis-free survival (DMFS) (HR 2.30, p = 0.010). When ypN1 patients were divided into low (low LNR ypN1 group) and high LNR (high LNR ypN1 group) according to a cut-off value of 0.152, the high LNR ypN1 group had poorer OS (p = 0.043) and DFS (p = 0.056) compared with the low LNR ypN1 group. And there were no differences between the high LNR ypN1 group and the ypN2 group in terms of the OS (p = 0.703) and DFS (p = 0.831).ConclusionsFor ypN-positive rectal cancer patients, the LNR was a more effective prognostic marker than the ypN stage, circumferential resection margin, or tumor regression grade after NCRT, and could be used to discern the high-risk group among ypN1 patients.

Resection of Colorectal Liver Metastasis: Prognostic Impact of Tumor Burden vs KRAS Mutational Status

Tumor burden score predicts tumor recurrence of non-functional pancreatic neuroendocrine tumors after curative resection