Lymph Node Ratio Groups Research Articles

The Tumor-Log Odds of Positive Lymph Nodes-Metastasis Staging System, a Promising New Staging System for Gastric Cancer after D2 Resection in China

BackgroundIn this study, we established a hypothetical tumor-lodds-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. Moreover, we compared them with the 7th edition of American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM) staging system in gastric cancer patients after D2 resection.MethodsA total of 1000 gastric carcinoma patients receiving treatment in our center were selected for the analysis. Finally, 730 patients who received D2 resection were retrospectively studied. Patients were staged using the TLM, TRM and the 7th edition AJCC TNM system. Survival analysis was performed with a Cox regression model. We used two parameters to compare the TNM, TRM and TLM staging system, the −2log likelihood and the hazard ratio.ResultsThe cut points of lymph node ratio (LNR) were set as 0, 0–0.3, 0.3–0.6, 0.6–1.0. And for the log odds of positive lymph nodes (LODDS), the cut points were established as≤−0.5, −0.5-0, 0-0.5, >0.5. There were significant differences in survival among patients in different LODDS classifications for each pN or LNR groups. When stratified by the LODDS classifications, the prognosis was highly homologous between those in the according pN or LNR classifications. Multivariate analysis showed that TLM staging system was better than the TRM or TNM system for the prognostic evaluation.ConclusionsThe TLM system was superior to the TRM or TNM system for prognostic assessment of gastric adenocarcinoma patients after D2 resection.

Dukes C colorectal cancer: is the metastatic lymph node ratio important?

Although the regional lymph node status is essential for staging of colorectal cancer, the importance of the total number of collected nodes remains controversial. Our aim was to examine the impact of the metastatic lymph node ratio (LNR) on the survival of patients with Dukes C colorectal cancer. All patients with Dukes C histology were selected from a prospectively collected database of all colorectal cancers resected between 1997 and 2007 at our institution. Demographic, histopathological and adjuvant treatment data were collected. The total number of positive lymph nodes was divided by the total number of lymph nodes examined to calculate the LNR. Patients were categorised into LNR groups 1 to 5 according to cut-off points: ≤0.1, 0.21, 0.36, 0.6 and ≥0.61. Survival from the date of operation was calculated using Kaplan-Meier estimates. Multivariate analysis was performed to identify those factors influencing survival. Of 1,098 patients who underwent colorectal cancer resections, 41% were staged as Dukes C. Sixty-four percent of patients received chemotherapy. The median number of lymph nodes harvested and positive for tumour were 11 (range 1-52) and 4 (range 1-28), respectively. In patients who received chemotherapy, 5-year survival was 69.3% for LNR 1 and 23.6% for LNR 5. When no chemotherapy was given, the 5-year survival was 43.1% for LNR 1 and 8.7% for LNR 5. Current evaluation of positive lymph nodes may not accurately stage Dukes C colorectal cancer. The assessment of the LNR is a useful prognostic method in this heterogenous group of patients.

Lymph node ratio and pN staging in patients with node-positive breast cancer: a report from the Korean breast cancer society

Patients with node-positive breast cancer are currently classified according to pN stage. Lymph node ratio (LNR), the ratio of positive to total removed lymph nodes, maybe a more useful prognostic factor in these patients. We therefore compared LNR and pN staging as prognostic factors in patients with node-positive breast cancer. Using two large prospective databases of the Korean Breast Cancer Registry (KBCR) and the Asan Medical Center (AMC) Breast Cancer Center of patients with LN-positive breast cancer from 1988 to 2005, we compared the ability of LNR and pN stage to predict patient survival by Cox regression analysis in the overall patient cohort and in subgroups categorized by age and intrinsic subtype. Patients were categorized into low- (≤ 0.20), intermediate- (>0.20 and ≤ 0.65), and high-risk (>0.65) LNR groups. The difference in mortality risk was greater among LNR groups than among patients staged pN1, pN2, and pN3, as assessed by disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates. In contrast to LNR risk categories, the survival curves for pN1 and pN2 stage patients overlapped in those aged <35 years and those with her2/neu-enriched or triple-negative tumors. These findings were validated by analyzing a nationwide registry of 15,488 node-positive patients, which showed that patients with pN1 and intermediate LNR risk had poorer DFS (HR 1.7, 95% CI 1.4-2.2) and CSS (HR 1.6, 95% CI 1.1-2.2) than patients with pN2 and low LNR risk. LNR is a better predictor of prognosis than pN stage in women with breast cancer, especially in high-risk patients, including younger women and women with her2/neu-enriched or triple-negative tumors. Treatment decisions should be based on LNR rather than on pN stage.

Lymph node ratio is a powerful prognostic index in patients with stage III distal rectal cancer: a Japanese multicenter study

The present study aims to define the prognostic impact of the lymph node ratio (LNR) in patients with stage III distal rectal cancer. We analyzed data from 501 patients who underwent curative resection (total mesorectal excision, TME) for stage III distal rectal cancer at 12 institutions between 1991 and 1998. Patients were divided into four groups according to quartiles based on LNR. Among the 501 patients, 381 underwent TME with pelvic sidewall dissection (PSD). The median numbers of lymph nodes retrieved with and without PSD were 45 and 17, respectively (P < 0.0001). Forty-nine patients with lymph node retrieved less than 12 were excluded from further analyses. Among various clinicopathological parameters, univariate analysis identified age (P = 0.0059), histological grade (P < 0.0001), depth of tumor invasion (P = 0.0003), and number of positive nodes (P < 0.0001) and LNR (P < 0.0001) as prognostic factors. The Cox proportional hazards model revealed that age (P = 0.014), histological grade (P < 0.0001), depth of tumor invasion (P = 0.0002), and LNR (group 3, P = 0.0012; group 4, P < 0.0001) were independent prognostic factors. When the American Joint Committee on Cancer (AJCC) seventh staging system was added as a covariate, both AJCC stage (P < 0.0001) and LNR (P < 0.0001) were independent prognostic factors. Adding the LNR concept to the AJCC cancer staging system will improve accuracy in evaluating the nodal status of distal rectal cancer.

The correlation between the number of lymph nodes identified and treatment outcomes in colorectal cancer patients: Single-institution experience.

e14096 Background: Colorectal cancer is the third leading cause of cancer-related death in the Western world. International guidelines recommend evaluating at least 12 locoregional lymph nodes (LNs) on curative surgery to obtain optimal staging information and satisfactory long-term outcomes. In the United States, adequate number of LN identified is achieved in 37% of cases. This study aimed to evaluate the impact of LN status on survival rates in colorectal cancer patients in a single institution setting. Methods: We analyzed data on all patients undergoing radical surgery for colorectal cancer in the Bon Secours Hospital Cork in Ireland between years 2000 and 2006. Numbers of LN identified and number of LN infiltrated were recorded. The lymph node ratio (LNR) was calculated using following formula: LNR = LN infiltrated/LN identified. Overall survival (OS) was used as a primary endpoint. Multivariate analyses were performed on all patients and on following LNR groups: LNR < 0.05, 0.05-0.19, 0.2-0.39, and 0.4-1.0. Covariates included were age, sex, tumor grade, tumor location, lymphovascular and perineural invasion. Results: In total 265 patients were included in this study. The median age was 66 years (range 34 to 89). One hundred and thirty-three patients (50.2%) had 11 or less LNs examined, and 132 patients (49.8%) had 12 or more LNs examined. Mean OS was 73 months for all patients. Patients in the Dukes C2 category (> 3 LN infiltrated and/or tumour infiltrating adjacent structure) who had 12 or more LNs identified had a better OS compared to those who had 11 or less LNs investigated (hazard ratio 0.677 [95%CI 0.45-1.01]). Patients in all Dukes categoreis who had a lower LNR had a significantly better OS than those with a higher LNR (p < 0.0001). Conclusions: Nearly 50% of patients with colorectal cancer undergoing radical surgery had 12 or more lymph nodes investigated. A higher number of LN identified was associated with better survival in the Dukes C2 category. A higher number of LN infiltrated was associated with shorter survival. No significant financial relationships to disclose.

Metastatic lymph node ratio is a more precise predictor of prognosis than number of lymph node metastases in stage III colon cancer

The objective of this study is to assess the value of metastatic lymph node ratio (LNR) in predicting disease-free survival (DFS) in patients with stage III adenocarcinoma of the colon. From 1995 to 2003 inclusively, a total of 624 patients featuring stage III adenocarcinoma of the colon underwent curative resection. Of the 624 patients, an adequate number of lymph nodes (n > or = 12) had been harvested in 490 patients. These patients were stratified into LNR groups 1 (LNR < or = 0.4), 2 (0.4 < LNR < or = 0.7), and 3 (LNR > 0.7). Kaplan-Meier survival curve and log-rank test were used to evaluate the prognostic value of LNR. A Cox regression model was used for multivariate analyses. The 5-year DFS rate was 66.7% for patients with LNR1, 35.1% for those with LNR2, and 0% for patients with LNR3 (p < 0.0001). In T3/4LNR1 patients (n = 411), there was no difference in survival between those with N1 stage and those with N2 stage. Cox proportional hazards regression analysis revealed that N stage (number of positive lymph nodes) was not a significant factor when LNR was taken into consideration. LNR is a more precise predictor of 5-year DFS than number of positive lymph nodes (N stage) in patients with stage III colon cancer.

Metastatic lymph node ratio as an independent prognostic variable in colorectal cancer: study of 113 patients

In patients with colorectal cancer, involvement of the lymph nodes is one of the most important prognostic factors. The aim of this study was to determine the independent prognostic value of the lymph node ratio (LNR), that is the relationship between the involved and examined lymph nodes, in patients with colorectal cancer. Included in the study were 113 patients with colorectal adenocarcinoma. The patients were divided into three groups according to the proportion of involved lymph nodes: LNR-0, when there was no lymph node involvement; LNR-1, when there was involvement of up to 20% of the examined lymph nodes, and LNR-2, when there was involvement of 21% or more of the examined nodes. The relationship between lymph node ratio, the number of lymph nodes removed, and the number of lymph nodes involved by cancer was determined. The 5-year survival was evaluated using the Kaplan-Meier test. There was a significant difference in 5-year overall between patients in the different LNR groups (p=0.009). Patients in the LNR-0 group had a 5-year overall survival greater than 80%, while those in the LNR-1 and LNR-2 groups had 5-year overall survival rates less than 60% and 40%, respectively. Multivariate analysis demonstrated that the LNR is an independent prognostic variable in 5-year overall survival (p=0.009). The results showed that the LNR can be considered an independent prognostic variable in overall survival of patients with colorectal cancer.

A study of lymph node ratio in stage IV colorectal cancer

BackgroundThe finding of metastasis in colorectal cancer, stage IV disease, has a major impact on prognosis and treatment strategy. Known important factors include the extent of the metastasis and the patients' performance status. The lymph node factors are of known importance in earlier cancer stages but less described in metastatic disease. The aim of the study was to evaluate lymph node status and ratio as prognostic markers in stage IV colorectal cancer.MethodsThe study was retrospective and assessing all patients operated, with bowel resection, for an initial stage IV colorectal cancer during 1999–2003 (n = 136). Basic demographic data as well as given treatment was assessed. The Lymph node ratio (LNR), the quota between the number of lymph node metastasis and assessed lymph nodes, was calculated. LNR groups were created by ratio thirds, 3 equally sized groups. The analysis was made by LNR group and by eligibility for chemotherapy with cancer specific survival as outcome parameter.ResultsThe median survival (CSS) for the entire group was 431 days with great variability. For the patients eligible for chemotherapy it ranged from 791 days in LNR-group 1 to 433 days for the patients in group 3. For patients ineligible for chemotherapy the corresponding figures were 209 and 91 days. The eligibility for chemotherapy was a major prognostic factor which also takes co-morbidity, age and performance status into consideration. The LNR (p < 0.01) and the tumour differentiation grade were also significant (p < 0.05) factors regarding survival. The LNR group 3 was also associated with a higher frequency of multiple metastasis locations (p < 0.05) and of more side effects with chemotherapy and thus of reductions in dosage or pre-emptive treatment ending (p < 0.05).ConclusionStage IV colorectal cancer is a heterogeneous group regarding the survival prognosis. The lymph node ratio was found to be a significant marker for the survival prognosis (p < 0.0049). High and low risk groups could be identified with a survival difference of up to one year. It could be of importance when planning a treatment strategy or evaluating clinical data materials. A pathology report should include a node assessment even at presence of synchronous metastasis.

The impact of lymph node ratio (LNR) on survival in patients with colorectal cancer

15053 Background: The reason for improved survival in colorectal cancer subjects with increased numbers of lymph nodes (LN) removed is controversial. An inverse relationship has been shown between lymph node ratio (LNR, ratio of positive to total number of LN removed) and survival in subjects with non-metastatic disease when at least 10 lymph nodes are sampled. To assess the effect on those with less than 10 nodes removed, a retrospective study of subjects treated at the Central Arkansas Veterans Healthcare System (CAVHS) was conducted. Methods: Data on subjects with a diagnosis of colorectal cancer attending CAVHS from January 1991 to October 2005 was obtained from the tumor registry. The number of LNs dissected, the number of positive and negative LNs, LNR, treatment and overall survival was analyzed. The number of resected nodes was grouped as follows: none (LNG0, n=150), 1–10 (LNG1, n=320), 11–14 (LNG2, n=35), and >14 (LNG3, n=26). LNR groups were analyzed as follows: LNR <0.05 (n=275), 0.05–0.19 (n=1...

A study of lymph node ratio as a prognostic marker in colon cancer

Aim The aim of this study was to evaluate and describe the lymph node ratio (LNR) as a prognostic parameter for patients with colon cancer. As lymphatic involvement is the key, focus was set at stage III disease. Interest was directed at the possibility of identifying high-risk groups and the clinical implementation and consequence. Method The study was retrospective using a database of clinical data of all cancer patients treated at our unit. It has been continuous in registration, inclusion and update since 1999 including survival and clinical features. All patients ( n = 265) diagnosed with stage III colon cancer during 1999–2003 were included for the study. LNR was calculated and quartile groups were created. LNR and associated parameters were analysed towards 3-year disease-free survival (DFS). Basic patient data as well as surgery, pathology and postoperative treatment were taken into consideration. Results Significant differences in disease-free survival were found for TNM N-status, tumour differentiation grade and LNR quartile group. There was a difference in 3-year DFS from 80% in LNR group 1 compared with less than 30% in group 4. These results were of prognostic interest both independently and in interaction with each other. High-risk groups could be identified and in the worst prognosis LNR group we also found a tendency towards more side effects with adjuvant chemotherapy. Conclusion The lymph node ratio, the quota between the number of lymph node metastasis and assessed lymph nodes, is a highly significant ( p < 0.001) prognostic factor in stage III colon cancer. It can be an aid in identifying risk groups that could benefit from a more intense postoperative surveillance and possibly bring changes in adjuvant treatment strategy. More studies of clinical data, genetic and biochemical markers are needed in this patient group to understand the possible difference in tumour behaviour and tailor the treatment.