Metastatic Lymph Node Ratio Research Articles

Comparison of clinicopathological characteristics of endogenous and exogenous cervical cancer with its clinical significance

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Cervical cancer is the third leading cause of cancer death in women of less developed countries due to poor screening and decreased diagnostic approaches. We aimed to investigate and differentiate the distinct clinicopathological characteristics and prevalence of endogenous and exogenous cervical in hospitalized patients<span lang="EN-US">.</span></p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>A study was performed contained 663 patients that were enrolled and underwent for screening of endogenous and exogenous cervical cancer in Qilu Hospital of Shandong University, from January 2010 to March 2015. </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>Our results indicated that combined examination of thin-prep liquid-based cytology test and human papillomavirus (HPV)-DNA are effective for diagnosis of endogenous and exogenous cervical cancer. The clinicopathological characteristics based on tumor growth pattern, and high risk HPV-DNA incidence had no significant difference (p>0.05) in endogenous and exogenous cervical cancer patients. The higher ratio of lymph node metastasis in endogenous cervical cancer and exogenous cervical cancer during IB1-stage (24.3% vs 12.9%), and in IIA2-stage (36.4% vs 25%) was observed respectively. In addition, our data provide compelling evidence that the level of deep interstitial infiltration, and lymphatic vascular infiltration in endogenous cervical cancer was collectively higher (82.7% and 33%) compared to exogenous cervical cancer (62.4% and 18.3%) respectively during all stages<span lang="EN-US">.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>The higher percentage of lymph node metastasis,<strong> </strong>deep interstitial infiltration, and lymphatic vascular infiltration was observed in endogenous cervical cancer which might be the biomarker and differential key points for the diagnosis of endogenous cervical cancer. Taken together, our study provides clinicopathological features to diagnose, and differentiate the endogenous and exogenous type cervical cancer with its prevalence.</p>

Cancer gland rupture as a potential risk factor for lymph node metastasis in early colorectal adenocarcinoma with deep submucosal invasion.

AimsLymph node metastasis (LNM) has not been found in more than 85% of patients with early invasive colorectal adenocarcinoma (T1‐CRAC) who undergo surgery after therapeutic endoscopy due to the risk for LNM. Better histological risk assessment for LNM of endoscopically resected T1‐CRAC is important to avoid unnecessary additional surgery.Methods and resultsWe evaluated cancer gland rupture (CGR), i.e. cancer glands with a discontinuous epithelial lining, at the invasive front, as a potential risk factor for LNM by histological examination of differentiated T1‐CRAC from 217 patients who underwent surgery with or without therapeutic endoscopy. CGR was represented by C‐shaped neoplastic glands with a variable inflammatory or stromal reaction, and was occasionally accompanied by mucus lake or abscess formation. CGR was observed in 168 (77%) cases, including all 20 cases with LNM, and the odds ratio of LNM was higher for CGR than for deep invasion (depth of submucosal invasion ≥1000 μm). All cases with LNM were found among 148 cases with deep invasion and positive CGR, whereas no LNM was detected in 29 cases with deep invasion and negative CGR, regardless of vascular invasion or tumour budding. In the 148 cases, LNM was detected in 18 (19%) of 93 cases with positive vascular invasion or high‐grade tumour budding, and in two (4%) of 55 cases without either.ConclusionsOur findings suggest that CGR is an easily applied and objective histological finding for predicting LNM that could be useful for assessing the risk for LNM of endoscopically resected T1‐CRAC with deep invasion.

Comparison of S-1 plus oxaliplatin (SOX) and capecitabine plus oxaliplatin (XELOX) as adjuvant chemotherapies for stage II and III gastric cancer after D2 resection: A single-center retrospective study.

BackgroundCapecitabine plus oxaliplatin (XELOX) as adjuvant therapy for gastric cancer (GC) reduces cancer recurrence and improves survival. S‐1 plus oxaliplatin (SOX) is well‐tolerated and effective against advanced GC, and also be used widely in adjuvant treatment. However, data comparing SOX and XELOX as adjuvant treatments are lacking.MethodData on treatment modalities, adverse events, recurrence and metastasis were collected from 180 patients with stage II and III GC, who received SOX or XELOX after D2 gastrectomy between January 2012 and December 2015, and analyzed retrospectively. The primary endpoint was 3‐year disease‐free survival (DFS) rate.ResultsMedian follow was 52.9 months; 3‐year DFS rate and overall survival (OS) rate were 75.2% and 67.6% (P = 0.359) and 81.2% and 83.3% (P = 0.77) in the SOX and XELOX groups, respectively. There was no significant difference in peritoneal metastasis rates in the SOX and XELOX groups (8.6% vs 15%, respectively; P = 0.232). Compound recurrent disease was associated with significantly shorter OS. Multivariate analysis identified metastatic lymph node ratio (LNR) as an independent prognostic factor for OS (P = 0.036; hazard ratio = 2.875; 95% confidence interval, 1.069–7.729); the LNR ≥17% group had inferior 3‐year OS rate to the LNR <17% group (P = 0.001). The incidence of grades 3 and 4 adverse events was similar in both groups; however, grade ≥2 hand–foot syndrome was significantly less frequent in the SOX group (P = 0.01).ConclusionSOX has similar survival benefits to XELOX and is well‐tolerated in Chinese patients with GC following D2 gastrectomy.

Risk Factors and Outcomes of Postoperative Recurrent Well-Differentiated Thyroid Cancer: A Single Institution's 15-Year Experience.

Identify risk factors and outcomes of recurrent well-differentiated thyroid cancer. Retrospective case-control analysis. Tertiary care academic center in Nashville, Tennessee. This single-center analysis reviews 478 patients who underwent initial surgical management of well-differentiated thyroid carcinoma between 2002 and 2017. Patients were dichotomized with or without recurrent well-differentiated thyroid cancer. Demographic and clinicopathologic risk factors were carefully reviewed. Univariate, multiple regression, and survival analyses were used to evaluate predictors of recurrence. Thirty-eight patients (7.9%) who received initial surgical intervention for well-differentiated thyroid carcinoma at our institution recurred, with an average time to recurrence of 24 months. Male sex, tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, number of positive lymph nodes, and low lymph node yield were all significantly associated with locoregional recurrence (P < .05). Multiple regression analysis showed that extrathyroidal extension, number of positive lymph nodes, and low lymph node yield were independent factors predictive of posttreatment recurrence (P < .05). Metastatic lymph node ratio, the ratio of positive lymph nodes extracted to lymph node yield, of ≥0.3 is associated with increased risk of recurrence (P < .001) and decreased 5-year recurrence free survival (P < .001). Extrathyroidal extension, number of positive lymph nodes, and low lymph node yield are independent clinicopathologic risk factors for postoperative recurrence of well-differentiated thyroid cancer. Metastatic lymph node ratio is uncommonly used but can be an important prognosticator of recurrence. Patients with metastatic lymph node ratio ≥0.3 should be counseled on their increased risk of recurrence and should undergo close surveillance following surgery.

Patterns and risk factors of lymph node metastasis in locally advanced supraglottic squamous cell carcinoma

Objective To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3, T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume. Methods Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed. All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ). The LNM ratio of each node level was calculated. The risk factors of LNM were identified by univariate and multivariate logistic regression analyses. Results LNM was found in 156 of 272 patients (57.1%). According to the location of primary lesions, all patients were divided into group A (n=72; unilateral without midline involvement), group B (n=86; unilateral with midline involvement) and group C (n=114; giant or central). In group A, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and Ⅳ was 36.3%, 26.4% and 6.9%, whereas 13.9%, 8.3% and 1.4% at the contralateral level, respectively. In group B, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and IV was 1.9%, 29.1% and 11.6%, whereas 18.6%, 14.0% and 1.2% at the contralateral level, respectively. In group C, the LNM ratio at the left neck level Ⅱ, Ⅲ and Ⅳ was 24.6%, 23.7% and 2.6%, whereas 21.9%, 26.3% and 6.1% at the right neck, respectively. Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3%, 25.0%, P=0.093). Ipsilateral level Ⅲ metastasis (OR=2.929, 95%CI 1.041-8.245, P=0.042) and clinical N stage (OR=0.082, 95%CI 0.018-0.373, P=0.001) were associated with contralateral LNM. Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009) metastasis were risk factors of the ipsilateral level Ⅳ metastasis. Conclusions Neck levels Ⅱ and Ⅲ are the high-risk LNM regions, whereaslevels Ⅳ and V are the low-risk areas. Ipsilateral level Ⅱ or Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM. Contralateral neck LNM rarely occurs in cN0 stage patients. Key words: Locally advanced laryngeal cancer; Squamous cell carcinoma; Lymph node metastasis; Risk factor

Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery.

Objective: We compared the prognostic accuracy of four lymph node (LN) staging systems - the 2018 International Federation of Gynecology and Obstetrics (FIGO) stage, number of positive lymph node (PLN), metastatic lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) systems - in patients with node-positive cervical squamous cell carcinoma (CSCC) following radical surgery and explored the optimal choice for clinical applications.Materials and methods: Data were retrospectively collected from 928 node-positive CSCC patients who underwent radical surgery between 2006 and 2014 in our center. Tree-based recursive partitioning was applied to split variables (PLN, LNR, and LODDS) into low-risk and high-risk groups. The log-rank test was used to compare survival curves, and Cox regression analysis was performed to identify prognostic factors. The relative discriminative abilities of the different staging systems were assessed using Harrell's concordance index (C index) and the Akaike information criterion (AIC).Results: The mean number of PLNs was 3.8 (range: 1-44 nodes). According to the 2018 FIGO staging system, 831 patients had stage IIIC1, and 97 had stage IIIC2. For the PLN system, 761 patients were included in the low-risk group, and 167 were included in the high-risk group. For the LNR system, 658 patients were included in the low-risk group, and 270 were included in the high-risk group. The low-risk LODDS group included 694 patients, while the high-risk LODDS group included 234 patients. All four staging systems had a significant influence on patients' progression-free survival (PFS, P < 0.001) and overall survival (OS, P < 0.001). Univariate analysis and multivariate Cox analysis adjusted for significant factors indicated that the four staging systems were significant prognostic factors for PFS and OS. Among them, the PLN system was noted to have the best prognostic performance for both PFS (C index: 0.582; AIC: 8213.33) and OS (C index: 0.624; AIC: 8433.80).Conclusion: The PLN system seemed to be the most accurate LN staging method for predicting node-positive CSCC following radical surgery.

Prognostic nomogram based on the metastatic lymph node ratio for gastric neuroendocrine tumour: SEER database analysis

ObjectiveThe prediction of survival of gastric neuroendocrine tumours (g-NETs) is controversial. Prognostic effects of the metastatic lymph node ratio (LNR) in patients with g-NET were explored, and a nomogram was plotted to predict the survival rates of patients.MethodsA longitudinal study conducted on the basis of the Surveillance, Epidemiology, and End Results database. The association between LNR and survival were investigated by using Pearson correlation and Cox regression. Overall survival (OS) and cancer-specific survival (CSS) rates were predicted with the help of nomograms.ResultsA total of 315 patients with g-NET diagnosed from 2004 to 2015 were included in this study. LNR was discovered to have a negative correlation with OS and CSS (Pearson correlation coefficients: 0.343 (p<0.001) and 0.389 (p<0.001), respectively). The multivariate analyses indicated age, tumour site, differentiation, T staging, M staging, chemotherapy and LNR to be independent prognostic factors for both OS and CSS. Surgery was also a prognostic determinant for CSS (p=0.003). Concordance indices of the nomograms for OS and CSS were higher than those of the TNM classification (0.772 vs 0.730 and 0.807 vs 0.768, respectively). As per the area under the receiver operating characteristic curve, predictive ability of the nomograms for survival of 1, 3 and 5 years was all better than that of TNM classification.ConclusionsLNR is an independent predictor of g-NETs. The nomograms plotted in this study have a satisfying predictive ability of survival risks and are capable of guiding tailored treatment strategies for patients with g-NET.

Prophylactic central node dissection in differentiated thyroid cancer: A prospective tertiary care center experience

BACKGROUNDWith increasing incidence of thyroid carcinoma, the optimal management of central lymph nodes remains an unanswered question although central neck nodes represent the most common site of recurrence. The aim of this study was to determine the morbidity of prophylactic central neck dissection in differentiated thyroid cancer and to evaluate histopathological correlation between nodal metastases and histological features. METHODThis was a prospective, observational study of 2 years duration (May 2017 to May 2019) involving 30 patients with proven differentiated thyroid cancers and clinicoradiologically negative lymph node with no history of neck surgeries. They all underwent total thyroidectomy with bilateral central neck dissection. Surgical outcomes in the form of transient or permanent hypoparathyroidism, transient and permanent recurrent nerve palsy were assessed along with histopathological correlation of primary tumor with central node positivity. DISCUSSIONClassical histology (p = 0.05), >4 cm tumor size (p = 0.04), lymphovascular invasion (p = 0.04) and multifocality (p = 0.04) were all significantly associated with increased risk of central lymph nodal metastasis. The incidence of transient and permanent hypoparathyroidism was 36.3% and 10% respectively. Metastatic lymph node ratio of >60% is significantly associated with increased preablative serum thyroglobulin levels. Around 35% of the pT1 or T2 lesions were upstaged for postoperative radioiodine ablation CONCLUSIONAn important role of prophylactic central neck dissection may lie in male patients, age > 45years, tumor size >4 cm, extrathyroidal extension, lymphovascular invasion and multifocality in accurate staging and can be performed with minimal morbidity at a high volume center.

Long-term Outcomes of Laparoscopy-assisted Gastrectomy for T4a Advanced Gastric Cancer: A Single-center Retrospective Study

Laparoscopy-assisted gastrectomy (LAG) has been proven to be feasible and oncologically safe for early gastric cancer. Despite the rapid increase in the number of LAG cases, there are few reports on the long-term outcomes of T4a (serosalinvasion) gastric cancer after LAG. The aim of the present study was to evaluate the long-term clinical outcomes in patients with stage T4a gastric cancer after laparoscopic gastrectomy. A total of 578 patients with gastric cancer were treated with LAG between February 2004 and December 2014. Among these patients, 224 patients were pathologically confirmed with T4a advanced gastric cancer. The clinical and follow-up data were retrospectively analyzed, the survival rates were estimated using the Kaplan-Meier method, and the risk factors for overall and disease-free survival (DFS) were evaluated by Cox regression. Among these 224 patients, 129 patients were above 60 years old, and the male-to-female ratio was 157:67. Furthermore, among these patients, 125 patients received laparoscopy-assisted distal gastrectomy, whereas 99 patients received laparoscopy-assisted total gastrectomy. Forty (17.90%) patients experienced postoperative complications according to the Clavien-Dindo classification. Median follow-up time was 32 months. Recurrence was observed in 99 (44.20%) patients. The cumulative 5-year overall survival (OS) and DFS rates were 47.20% and 43.60%, respectively. The 5-year OS and DFS rates were 72.50% and 70.00% for stage N0, 57.00% and 53.90% for stage N1, 41.60% and 37.00% for stage N2, and 23.30% and 21.30% for stage N3, respectively. In the univariate analysis, tumor size, tumor location, N stage and metastatic lymph node ratio (MLR) were correlated with OS and DFS. The MLR was identified as an independent predictor for OS (P<0.05; hazard ratio=1.828; 95% confidence interval, 1.353-2.469) and DFS (P<0.05; hazard ratio=1.197; 95% confidence interval, 0.945-1.516). The long-term outcomes of LAG for T4a (M0) gastric cancer were acceptable, compared with previous reports. Therefore, this treatment could be considered as an alternative operative approach for T4a gastric cancer. The MLR was an independent predictor for OS and DFS.

Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

Prognostic Significance of Metastatic Lymph Node Ratio in Gastric Cancer

Prognostic Significance of Metastatic Lymph Node Ratio in Gastric Cancer

Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems

BackgroundMetastatic regional lymph nodes (LN) is a strong predictor of worse long-term outcome. Therefore, different LN staging systems have been proposed in recent years. In this study, we proposed a modified lymph node ratio (mLNR) as a new lymph node staging system and then compared the prognostic performance of mLNR with American Joint Committee on Cancer N stage, lymph node ratio (LNR) and log odds of metastatic lymph nodes in breast cancer patients. MethodsBreast cancer patients who underwent surgery between 2004 and 2012 were identified from the Surveillance, Epidemiology, and End Results database. Restricted cubic spline functions were calculated to characterize the association between variables and the risk of death. The Cox proportional hazards models were constructed to assess the predictive ability of different lymph node staging systems using the Akaike’s Information Criterion (AIC) and Harrell’s concordance index (C-index). ResultsA total of 264,096 breast cancer patients were enrolled and 187,785 (71.1%) patients had a limited number of LNs harvested. In the limited LN harvest cohort, the prognostic performance of LNR decreased and mLNR could greatly solve this problem. In addition, among the entire cohort, mLNR modeled as a continuous value had the best predictive ability (AIC: 922021.9 and C-index: 0.727) than other lymph node staging systems. ConclusionsThe predictive ability of LNR is restricted by a limited LN harvest. However, mLNR shows superiority to LNR and other lymph node staging systems especially in a limited LN harvest cohort, making mLNR the most powerful lymph node staging systems.

Lymphocyte-Monocyte Ratio Significantly Predicts Recurrence in Papillary Thyroid Cancer

BackgroundA growing body of evidences shows that systemic inflammatory responses are involved in patient prognosis in multiple cancers. Combinations of peripheral leukocyte fractions have been shown to be useful markers for the inflammatory responses. However, significance of such systemic inflammatory responses is still unknown in thyroid cancer. Accordingly, we aimed to clarify clinical impact of peripheral leukocyte fractions in papillary thyroid cancer (PTC). MethodsClinicopathological analyses were performed including preoperative leukocyte fractions in 570 patients with curatively resected PTC. Receiver operating characteristic curves were used to determine cutoffs of leukocyte fraction or inflammation indexes such as lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio. A Kaplan–Meier analysis and a Cox's proportional hazard model were used to conduct prognostic analysis. A multivariable logistic regression analysis was performed for correlation assay. ResultsPreoperative low LMR predicted recurrence with high sensitivity (63.3%) and specificity (68.7%) (P = 0.002). The multivariable prognostic analyses revealed that preoperative low LMR (P = 0.025), pathological N1b (P = 0.019), high metastatic lymph node ratio (node density) (P = 0.014), and high thyroglobulin level (P = 0.002) independently predicted worse prognosis. The combination of these independent parameters clearly enriched high-risk patients (P < 0.001). Of note, low LMR was dramatically associated with recurrence especially in patients with advanced PTC. ConclusionsPreoperative low LMR dramatically predicts high-risk patients for recurrences. The results in this study give rational to focusing on immune cell profiles to tackle advanced PTC.

Prognostic Implication of pN Stage Subdivision Using Metastatic Lymph Node Ratio in Resected Pancreatic Ductal Adenocarcinoma.

In this meta-analysis, we aimed to evaluate the prognostic implication of the metastatic lymph node ratio (mLNR) and its optimal criterion in pancreatic ductal adenocarcinoma (PDAC) with lymph node metastasis (LNM). The present study included 3735 patients with PDAC who had LNM, from 11 eligible studies. We carried out a meta-analysis to determine the correlation between a high mLNR and PDAC prognosis. The estimated mean numbers of examined and metastatic lymph nodes were 22.396 (95% confidence interval [CI] = 19.681-25.111) and 6.496 (95% CI = 4.646-8.345), respectively. A high mLNR was significantly correlated with worse overall survival (hazard ratio = 1.344, 95% CI = 1.276-1.416). In 3 subgroups based on high mLNR criteria (>0 and <0.2, ≥0.2 and <0.4, and ≥0.4), there were significant correlations between a high mLNR and worse survival. A cutoff of 0.200 showed the highest hazard ratio (1.391, 95% CI = 1.268-1.525), which was statistically significant. Our results showed that mLNR is a useful prognostic factor for PDAC with LNM. Although the optimal criterion of high mLNR may be 0.200, further cumulative studies are required before this can be applied in daily practice.

Prognostic Implication of Metastatic Lymph Node Ratio in Colorectal Cancers: Comparison Depending on Tumor Location.

Background: The proportion of the number of involved lymph nodes (LNs) to the number of examined LNs—defined as metastatic LN ratio (mLNR)—has been considered as a prognostic parameter. This study aims to elucidate the prognostic implication of the mLNR in colorectal cancer (CRC) according to the tumor location. Methods: We evaluated the correlation between prognoses and the involved and examined LNs as well as mLNR according to the tumor location in 266 surgically resected human CRCs. Besides, to evaluate the optimal cutoff for high and low mLNRs, we investigated the correlation between mLNR and survival according to the various cutoffs. Results: LN metastasis was found in 146 cases (54.9%), and colon and rectal cancers were found in 116 (79.5%) and 30 (20.5%) of the cases, respectively. The mean mLNRs were significantly higher in rectal cancer than in colon cancer (0.38 ± 0.28 vs. 0.21 ± 0.24, P = 0.003). Besides this, the number of involved LNs in rectal cancer was significantly high compared to colon cancer (11.83 ± 10.92 vs. 6.37 ± 7.78, P = 0.014). However, there was no significant difference in the examined LNs between the rectal and colon cancers (31.90 ± 12.28 vs. 36.60 ± 18.11, P = 0.181). In colon cancer, a high mLNR was significantly correlated with worse survival for all cutoffs (0.1, 0.2, 0.3, and 0.4). However, rectal cancer only showed a significant correlation between high mLNR and worse survival in the subgroup with a cutoff of 0.2. Conclusions: Our results showed that high mLNR was significantly correlated with worse survival. The number of involved LNs and mLNRs were significantly higher in rectal cancer than in colon cancer. The cutoff of 0.2 can be useful for the differentiation of prognostic groups, regardless of tumor location.

Safety and efficacy of laparoscopic gastrectomy in obese patients with gastric cancer

The present study aimed to investigate the safety and short-term outcome of laparoscopy-assisted distal radical gastrectomy in treating gastric cancer among obese patients.Perioperative outcomes were compared between 67 gastric cancer patients with a body mass index (BMI) ≥25 kg/m2 (obese group) and 198 ones with BMI <25 kg/m2 (non-obese group). All the cases underwent laparoscopic radical resection between April 2009 and October 2013.The value of BMI was 27.3 ± 2.67 kg/m2 in the obese group and 21.3 ± 2.64 kg/m2 in non-obese group. There were no significant differences between 2 groups in age, sex, presence of diabetes, tumor size, number of metastatic lymph nodes, or metastatic lymph node ratio. Postoperative complications did not differ between the 2 groups (P > .05). There were significant differences between the 2 groups in operation time (non-obese: [234.2 ± 67.1] minutes vs obese group: [259.4 ± 78.5]; P = .017), postoperative hospital stay (obese group [19.7 ± 14.8] day vs non-obese [15.4 ± 7.1], P = .002), and retrieved lymph nodes ([27.6 ± 11.0] day vs non-obese [31.9 ± 12.5] day, P = .002).Obesity may prolong operation time and postoperative hospital stay, and cause less retrieved lymph nodes, but does not increase the incidence of postoperative complications. The experienced center can properly conduct laparoscopic assisted radical gastrectomy in obese patients.

157P - Lymph node ratio (LNR) a better prognostic factor after D2 gastrectomy

BackgroundGastric cancer (GC) is among the most common malignancy worldwide. The UICC/AJCC TNM classification is the most commonly used classification system. For adequate N staging at least 15 lymph nodes should be retrieved. In some countries, this amount of lymph nodes is not met, which can lead to understaging. The phenomenon of stage migration is caused by an insufficient number of lymph nodes examined. In order to reduce stage migration, some investigators have proposed using the metastatic lymph node ratio (LNR), namely the ratio between positive lymph nodes compared with the total number of lymph nodes examined, as a new prognostic indicator for gastric cancer. MethodsTotal 116 patients who underwent upfront D2 gastrectomy between 2012 to 2017 were included. LNR has classified into 4 groups: LNR0; 0, LNR1; >0-0.13; LNR2; 0.14-0.40 and LNR3; 0.41-1. We have used Kaplan-Meier method to calculate survival rates and log rank test to compare survival curves between groups. ResultsMales (58.6%) were more common than females (41.4%). Mean age at presentation was 56.12 years. Most common mode of presentation was pain abdomen (53.8%). Most common location of tumor was distal part (81%). Most commonly done procedure was distal radical gastrectomy (56.9%) followed by subtotal gastrectomy (32.8%). Median number of lymph nodes isolated was 14. 54 patients received adjuvant chemotherapy while 32 patients adjuvant chemoradiation. At a median followup of 14 months (range, 2–78 months), overall 5-year survival was 23.75%. (Median survival: 24 months). The 5-year survival for Stages I–III was 100%, 26.25%, and 11.25%, respectively (P < 0.001). In the univariate analysis; sex (p < 0.05), tumor grade (p < 0.001), T stage (p < 0.001), N stage (p < 0.001), TNM stage (p < 0.001), and LNR (p < 0.001) were statistically significant. The multivariate analysis showed that tumor grade, T stage, N stage, TNM stage and LNR still had statistical significance. In subgroup analysis of patients with less than 15 obtained lymph nodes, LNR was still a significant predictor of survival. ConclusionsLNR can estimate prognosis of patients who undergo D2 gastrectomy, regardless of the number of lymph nodes examined. Thus LNR may become a new indicator to evaluate prognosis after D2 gastrectomy. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Metastatic Lymph Node Ratio (mLNR) is a Useful Parameter in the Prognosis of Colorectal Cancer; A Meta-Analysis for the Prognostic Role of mLNR.

Background and objectives: The presenting study aimed to elucidate the prognostic role of the metastatic lymph node ratio (mLNR) in patients with colorectal cancer (CRC), using a meta-analysis. Materials and Methods: Using data from 90,274 patients from 14 eligible studies, we performed a meta-analysis for the correlation between mLNR and survival rate. Besides, subgroup analyses were performed, based on tumor stage, tumor location, and mLNR. Results: A high mLNR showed significant correlation with worse overall survival and disease-free survival rates in CRC patients (hazard ratio (HR), 1.617, 95% confidence interval (CI) 1.393–1.877, and HR 2.345, 95% CI 1.879–2.926, respectively). In patients with stage III, who had regional LN metastasis, the HRs were 1.730 (95% CI 1.266–2.362) and 2.451 (95% CI 1.719–3.494) for overall and disease-free survival, respectively. According to tumor location, rectal cancer showed a worse survival rate when compared to colon cancer. In the analysis for overall survival, when mLNR was 0.2, HR was the highest across the different subgroups (HR 5.040, 95% CI 1.780–14.270). However, in the analysis for disease-free survival, the subgroup with an mLNR < 0.2 had a higher HR than the other subgroups (HR 2.878, 95% CI 1.401–5.912). Conclusions: The mLNR may be a useful prognostic factor for patients with CRC, regardless of the tumor stage or tumor location. Further studies are necessary for the detailed criteria of mLNR before its application in daily practice.

The prognostic value of systemic immune-inflammation index (SII) in patients after radical operation for carcinoma of stomach in gastric cancer.

The inflammatory reaction, which plays a key role in tumor microenvironment, is associated with the tumor development, progression and metastasis. We aim to estimate the potential prognostic value of systemic immune-inflammation index (SII) in patients after radical operation for carcinoma of stomach in gastric cancer. One hundred and eighty-two patients with gastric cancer who underwent radical operation for carcinoma of stomach from January 2009 to December 2012 were enrolled and divided into a low SII group (<600×109 cells/L) and a high SII group (SII ≥600×109 cells/L) based on the optimal cutoff value of SII. The clinicopathological features were analyzed and compared between the two groups of patients. We analyzed the disease-free survival (DFS) and the overall survival (OS) by Kaplan Meier survival curve and log-rank test. The prognostic factors were used to evaluate by univariate analysis, and the independent prognostic factors were assessed by using multivariate Cox proportional hazards regression model. The median DFS and OS of all patients were 18.67 and 22.83 months, respectively. According to the univariate and multivariate analysis, the optimal cutoff value of SII had prognostic significance on DFS and OS. The median DFS and OS in low SII group were longer than those in high SII group (21.43 vs. 17.57 months, 28.03 vs. 18.30 months, respectively). The radical resection, type of surgery, metastatic lymph nodes ratio (MLNR), lymphocyte, SII, carcinoembryonic antigen (CEA) and Borrmann classification were the independent prognostic factors in gastric carcinoma. At the same time, the patients with MLNR in low SII group had longer DFS and OS than those with MLNR in high SII group, especially in patients with high MLNR. SII may serve as a convenient, low-cost and noninvasive prognostic marker for patients after radical operation for carcinoma of stomach in gastric cancer.

1396P - Establishment of prognostic nomogram based on the metastatic lymph nodes ratio for patients with gastric neuroendocrine tumour

BackgroundWe aimed to validate the prognostic effects of the metastatic lymph nodes ratio (LNR) in patients with gastric neuroendocrine tumour (G-NET), and establish a nomogram to predict the survival of patients. MethodsA total of 315 patients with G-NET in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 were included. Pearson correlation and Cox regression were performed to identify the association between LNR and survival. Nomograms were adopted to predict overall survival (OS) and cancer-specific survival (CSS). ResultsLNR has a negative correlation with OS and CSS (Pearson correlation coefficients: 0.343, P<0.001; 0.389, P<0.001, respectively). The multivariate analyses indicated age, tumour site, differentiation, T staging, M staging, chemotherapy and LNR were independent prognostic factors for both OS and CSS. The concordance index (C-index) of the nomograms for OS and CSS were superior to those of the TNM classification (0.773 vs. 0.731; 0.807 vs. 0.769, respectively). According to the area under the ROC curve (AUC), the predictive ability of the new nomogram for 3- and 5-year OS was better than TNM classification (0.908 vs. 0.846, P=0.004; 0.899 vs. 0.827, P<0.001, respectively). And the predictive ability of the new nomogram for 1-, 3- and 5-year CSS was better than TNM classification (0.936 vs. 0.848, P=0.007; 0.910 vs. 0.855, P=0.003; 0.894 vs. 0.836, P=0.001, respectively). ConclusionsLNR was an independent predictor of OS and CSS in G-NET. The nomograms based on the LNR were superior to the TNM classification in predicting the clinical outcomes for G-NET patients. Legal entity responsible for the studyYaobin Lin. FundingThe Fujian Province Natural Science Foundation (2017J01260), Joint Funds for the Innovation of Science and Technology, Fujian province (2017Y9074), and the Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (2017 Open Project-9). DisclosureAll authors have declared no conflicts of interest.