1
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Ichhpuniani S, McKechnie T, Lee J, Biro J, Lee Y, Park L, Doumouras A, Hong D, Eskicioglu C. Lymph Node Ratio as a Predictor of Survival for Colon Cancer: A Systematic Review and Meta-Analysis. Am Surg 2024; 90:840-850. [PMID: 37967460 DOI: 10.1177/00031348231209532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Lymph node ratio is the number of lymph nodes with evidence of metastases on pathological review compared to the total number of lymph nodes harvested during oncologic resection. Lymph node ratio is a proven predictor of long-term survival. These data have not been meta-analyzed to determine the prognosis associated with different lymph node ratio cut-offs in colon cancer. METHODS Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared 5-year overall survival (OS) or disease-free survival (DFS) between different lymph node ratios for patients undergoing oncologic resection for stages I-III colon cancer. Pairwise meta-analyses using inverse variance random effects were performed. RESULTS From 2587 citations, nine studies with 97,631 patients (female: 51.9%, median age: 61.65 years) were included. A lymph node ratio above .1 resulted in a 49% decrease in the odds of 5-year OS (2 studies; OR: 0.51, 95% CI: 0.49-.53, P < .00001). A lymph node ratio above .25 resulted in a 56% decrease in the odds of 5-year OS (3 studies; OR: 0.44, 95% CI: 0.43-.45, P < .00001). A lymph node ratio above .5 resulted in a 65% decrease in the odds of 5-year OS (3 studies; OR: 0.35, 95% CI: 0.33-.37, P < .00001). CONCLUSIONS Lymph node ratios from .1 to .5 are effective predictors of 5-year OS for colon cancer. There appears to be an inverse dose-response relationship between lymph node ratio and 5-year OS. Further study is required to determine whether there is an optimal lymph node ratio cut-off for prognostication and whether it can inform which patients may benefit from more aggressive adjuvant therapy and follow-up protocols.
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Affiliation(s)
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jay Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeremy Biro
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lily Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
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2
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Morini A, Annicchiarico A, De Giorgi F, Ferioli E, Romboli A, Montali F, Crafa P, Costi R. Local excision of T1 colorectal cancer: good differentiation, absence of lymphovascular invasion, and limited tumor radial infiltration (≤4.25 mm) may allow avoiding radical surgery. Int J Colorectal Dis 2022; 37:2525-2533. [PMID: 36335216 DOI: 10.1007/s00384-022-04279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early colorectal cancer (ECC) is defined as T1NXM0 colorectal cancer (CRC). Although a non-negligible number of T1-CRCs presents metastatic lymph-nodes, local excision is increasingly proposed as alternative to radical resection. Several criteria have been suggested to identify low-risk T1-CRC, but recommendations on this topic are still heterogeneous. This study aims to identify criteria associated with N+ T1-CRC, to select patients to undergo (or not) local excision. METHODS A retrospective analysis of demographic, clinical, and histology criteria of 122 consecutive T1-CRC patients undergoing radical resection at Parma University Hospital between 2000 and 2018 has been performed. RESULTS Lymph-node metastasis (LNM) was observed in 15/122 patients (12.3%). No LNM was observed among well-differentiated (G1) tumors (0/37), while 10/65 (15.4%) G2 cases as well as 5/20 (25%) G3 patients presented LNM. G1 was associated with absence of LNM (p = 0.013). After excluding G1 patients, the rate of N + T1-CRC was 17.6% (15/85). LNM was observed in 4/8 (50%) patients with lymphovascular invasion (LVI) and in 11/77 (14.2%) without LVI. LVI resulted being associated with LNM (p < 0.042). LNM was reported in 28.3% of cases with a tumor infiltration >4.25 mm (13/46), compared to 5.1% in cases with an infiltration ≤4.25 mm (2/39) (p = 0.012). In Cox regression analysis, the higher hazard ratio (HR) was reported for the LVI + and infiltration >4.25 mm (HR 24.849). CONCLUSIONS In patients with ECC (pT1NXM0), good differentiation (G1), absence of lymphovascular invasion (LVI-), and tumor radial infiltration ≤4.25 mm may allow performing local resection and avoiding radical surgery.
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Affiliation(s)
- Andrea Morini
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità di Chirurgia Oncologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italia
| | - Alfredo Annicchiarico
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia. .,Unità Operativa di Chirurgia Generale, Sede Ulteriore dell'Università di Parma, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza (Parma), Italia.
| | - Federica De Giorgi
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Anatomia Patologica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italia
| | - Elena Ferioli
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Anatomia Patologica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italia
| | - Andrea Romboli
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Filippo Montali
- Unità Operativa di Chirurgia Generale, Sede Ulteriore dell'Università di Parma, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza (Parma), Italia
| | - Pellegrino Crafa
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Anatomia Patologica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italia
| | - Renato Costi
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Sede Ulteriore dell'Università di Parma, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza (Parma), Italia
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3
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Zhang H, Liu Y, Wang C, Guan Z, Yu H, Xu C, Zheng M, Wang Y, Hu H, Huang R, Wang G. A Modified Tumor-Node-Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined. World J Surg 2021; 45:2601-2609. [PMID: 33914132 DOI: 10.1007/s00268-021-06141-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To construct a modified tumor-node-metastasis (TNM) staging system for stage I-III colon cancer patients with lymph nodes examined (LNE) < 12. METHODS The clinicopathological and survival data of 3870 stage I-III colon cancer patients with LNE < 12 from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 (development cohort) and 126 stage I-III patients with LNE < 12 from the Second Affiliated Hospital of Harbin Medical University between 2011 and 2015 (validation cohort) were identified. The optimal stratification of LNR for cancer-specific survival (CSS) was achieved using X-tile software. The predictive accuracy of the modified stage (mStage) was determined by the concordance index (C-index). RESULTS The modified N stage (mN stage) was built based on the LNR (mN0: LNR = 0, mN1: 0 < LNR < 0.4 or cancer nodule formation and mN2: 0.4 ≤ LNR ≤ 1). Preferable C-indices could be found for mStage compared with TNM stage in both development (0.750 vs 0.727) and validation cohorts (0.682 vs 0.646). Besides, patients with mStage A and B diseases could not benefit from adjuvant chemotherapy, while in patients with mStage C-F diseases, those receiving radical surgery plus adjuvant chemotherapy presented better CSS than those with radical surgery alone. CONCLUSIONS The mStage system could predict the prognosis of colon cancer patients with LNE < 12 accurately and showed superior predictive power compared with conventional TNM staging system. Moreover, adjuvant chemotherapy might play inequable roles in patients with different mStage diseases.
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Affiliation(s)
- Hao Zhang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Yunxiao Liu
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Chunlin Wang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Zilong Guan
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Hang Yu
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Chao Xu
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Mingyu Zheng
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Yuliuming Wang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Hanqing Hu
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Rui Huang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China
| | - Guiyu Wang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang, China. .,Department of Colorectal Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou, Zhejiang, China.
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4
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Kim SI, Kim TH, Lee M, Kim HS, Chung HH, Lee TS, Jeon HW, Kim JW, Park NH, Song YS. Lymph Node Ratio Is a Strong Prognostic Factor in Patients with Early-Stage Cervical Cancer Undergoing Minimally Invasive Radical Hysterectomy. Yonsei Med J 2021; 62:231-239. [PMID: 33635013 PMCID: PMC7934101 DOI: 10.3349/ymj.2021.62.3.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/05/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To 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 METHODS We 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). RESULTS In 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). CONCLUSION In 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.
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Affiliation(s)
- Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Tae Hun Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hye Won Jeon
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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5
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Morini A, Annicchiarico A, Romboli A, Ricco' M, Crafa P, Montali F, Dell'Abate P, Costi R. Retrospective survival analysis of stage II-III rectal cancer: tumour regression grade, grading and lymphovascular invasion are the only predictors. ANZ J Surg 2020; 91:E112-E118. [PMID: 33319510 DOI: 10.1111/ans.16476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tumour regression grade is gaining interest as a prognostic factor of patients undergoing neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer. METHODS A series of 68 consecutive patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy and surgery between 2010 and 2016 was retrospectively studied. The impact on disease-free survival (DFS) and overall survival (OS) of several criteria was analysed. Univariate analysis was performed through Kaplan-Meier statistics. Multivariate analysis was performed through Cox regression model. Using criteria found to be related to long-term outcomes, a predictive model of patient's OS was calculated. RESULTS Poor tumour regression grade - TRG3 (P = 0.010), poor grading - G3 (P = 0.001) and lymphovascular invasion (LVI; P = 0.030) were associated with short OS at univariate analysis. OS was associated with TRG3 and G3 at multivariate analysis (P = 0.016 and P = 0.027, respectively). DFS was associated with LVI (P = 0.001), G3 tumours (P = 0.046) and TRG3 (P = 0.045) at univariate analysis. At multivariate analysis, only LVI was associated with DFS (P = 0.041). A score, pondering the impact of three parameters (2 points for TRG3, 2 for G3 and 1 for LVI), was created and resulted to predict patient OS (P = 0.008), ranging from 94.5 months (score = 0-1) to 32 months (score = 3-5). CONCLUSION TRG3 and G3 were associated with poor OS, and LVI was the most significant predictor of DFS. An easy-to-use score may allow for a more accurate prediction of OS.
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Affiliation(s)
- Andrea Morini
- General Surgery Unit, University Hospital of Parma, Parma University, Parma, Italy
| | | | - Andrea Romboli
- General Surgery Unit, University Hospital of Parma, Parma University, Parma, Italy
| | - Matteo Ricco'
- Department of Public Health, Service for Health and Safety in the Workplace, Local Health Unit of Reggio Emilia - Regional Health Service of Emilia Romagna, Reggio Emilia, Italy
| | - Pellegrino Crafa
- General Surgery Unit, University Hospital of Parma, Parma University, Parma, Italy.,Pathological Anatomy and Histology Unit, University Hospital of Parma, Parma University, Parma, Italy
| | - Filippo Montali
- General Surgery Unit, Hospital of Vaio, Fidenza (Parma), Local Health Unit of Parma - Regional Health Service of Emilia Romagna, Parma, Italy
| | - Paolo Dell'Abate
- General Surgery Unit, University Hospital of Parma, Parma University, Parma, Italy.,General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Renato Costi
- General Surgery Unit, University Hospital of Parma, Parma University, Parma, Italy.,General Surgery Unit, Hospital of Vaio, Fidenza (Parma), Local Health Unit of Parma - Regional Health Service of Emilia Romagna, Parma, Italy
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6
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Wang L, Xiao J, Li MZ, Teng WH, Jia J, Lin L, Liu S, Ye XM, Zang WD, Chen Y. Performance of a Nomogram Based on the Integration of Inflammation Markers with Tumor Staging in Prognosis Prediction of Stage III Colorectal Cancer. Cancer Manag Res 2020; 12:7077-7085. [PMID: 32821170 PMCID: PMC7423355 DOI: 10.2147/cmar.s263577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/24/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction The aim of the present study was to evaluate a nomogram model for predicting the 5-year overall survival (OS) in lymph node-metastatic colorectal cancer (CRC) patients by combining inflammation markers with some traditional prognostic factors. Methods A total of 399 patients with stage III (pTXN1-3M0) CRC operated from January 2007 to December 2012 were enrolled in this retrospective study. All patients underwent D2 lymphadenectomy in the hospital. A prognostic nomogram based on the integration of traditional prognostic factors and NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) was established and compared with the nomogram based on the traditional prognostic factors alone. ROC curves were further applied to verify the predictive accuracy of the established model. Results Both NLR (P=0.00) and PLR (P=0.01) predicted the 5-year OS. In multivariate analysis, age, T3 category, T4 category, N2 category, N3 category, Pgp (P-glycoprotein), NLR and PLR are proven to be independent (all P≤0.05). The established nomogram showed better predictive power than that of traditional profile (c-index: 0.66 versus 0.63) in both training and validation cohorts. External assessment by ROC curve analysis demonstrated that the established model had a good prediction accuracy of 5-year OS in stage III CRC patients, with area under curve values of 0.657 and 0.629 in training and validating sets, respectively. Conclusion A nomogram based on the integration of traditional prognostic factors and inflammatory markers (NLR and PLR) could provide more precise long-term prognosis information for lymph node-metastatic CRC patients than the model based on traditional profile alone. This model might be useful for clinical application in personalized evaluation.
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Affiliation(s)
- Lin Wang
- Central Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Jun Xiao
- Department of Gastrointestinal Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Min-Zhe Li
- General Surgery Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100000, People's Republic of China
| | - Wen-Hao Teng
- Department of Gastrointestinal Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Jing Jia
- Central Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Lu Lin
- Central Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Sheng Liu
- Department of Gastrointestinal Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Xing-Ming Ye
- Central Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Wei-Dong Zang
- Department of Gastrointestinal Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
| | - Ying Chen
- Central Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People's Republic of China
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7
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Xu X, Yang Y, Cao L, Li F, Zhao J, Guo B, Cui X, He M. Lymph Node Metastasis and Recurrence in Primary Small Cell Carcinoma of the Esophagus: A Retrospective Study of 125 Cases. Cancer Biother Radiopharm 2019; 34:459-463. [PMID: 31120315 DOI: 10.1089/cbr.2019.2800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to investigate and analyze the prognostic factors affecting lymph node (LN) metastasis and postoperative recurrence in patients with primary small cell carcinoma of the esophagus (SCCE). Methods: A total of 125 primary SCCE patients who received surgical resection in the Fourth Hospital of Hebei Medical University between March 2005 and August 2009 were included in this retrospective study. All the potential prognostic variables, including the patients' characteristics, tumor features, and treatment modalities, were analyzed by a Cox regression model to explore LN metastasis and the factors associated with postoperative recurrence. Results: LN metastasis rate was significantly correlated with depth of tumor invasion (p < 0.001) and tumor length (p = 0.006). LN metastasis ratio was positively correlated with pathological type (p < 0.001), tumor location (p = 0.002), depth of tumor invasion (p < 0.001), and tumor length (p < 0.001). LN stage and chemotherapy were found to be the independent risk factors for progression-free survival (PFS). Conclusion: Depth of tumor invasion and tumor length were main factors associated with LN metastasis in primary SCCE. The stage of LN metastasis and chemotherapy was independent factors affecting the postoperative PFS.
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Affiliation(s)
- Xinjian Xu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Yang Yang
- Department of Cardiothoracic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, P.R. China
| | - Limin Cao
- Department of Laboratory Medicine, Children's Hospital of Hebei Province, Shijiazhuang, P.R. China
| | - Fei Li
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Jidong Zhao
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Bin Guo
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Xing Cui
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Ming He
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
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8
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Li Destri G, Barchitta M, Pesce A, Latteri S, Bosco D, Di Cataldo A, Agodi A, Puleo S. Predictive Value of the Number of Harvested Lymph Nodes and Cut-Off for Lymph Node Ratio in the Prognosis of Stage II and III Colorectal Cancer Patients. J INVEST SURG 2019; 32:1-7. [PMID: 28972442 DOI: 10.1080/08941939.2017.1369605] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED Purpose/aim: The appropriate staging of colorectal cancer requires at least 12 lymph nodes to be sampled. We evaluated whether lymph node sampling (LNS) and lymph node ratio (LNR) can predict the prognosis of stage II-III patients. MATERIALS AND METHODS This is a retrospective study on 432 patients classified in LNS ≥12 and LNS <12. Disease-free survival (DFS) was computed using the Kaplan-Meier method. We stratified stage III patients into 4 quartiles base on LNR values. To determine the optimal LNR cut-off, receiver operating characteristic (ROC) curve analysis was performed. RESULTS There was a positive association between the number of lymph node sampled and the number of metastatic lymph nodes (p < 0.01). Among stage II patients, the DFS was 81% for LNS ≥ 12 and 72% for LNS < 12 (p = 0.158). Among stage III patients, the DFS was 58% (p < 0.001). We found a significant association between LNR quartiles and relapse in stage III patients but only in the LNS ≥ 12 group. ROC curve analysis indicated an ideal LNR cut-off value at 0.194 (sensitivity 65% and specificity 61%). The DFS of patients with LNR below 0.194 was 71%, and that of patients with LNR above 0.194 was 45% (log-rank test, p < 0.001). In the patients with LNS ≥ 12, the cut-off of 0.257 could predict recurrence (specificity 86%). CONCLUSIONS Stage II patients with LNS < 12 tend to have shorter DFS than stage II patients with LNS ≥ 12. In stage III patients, an appropriate LNR cut-off is a better prognostic predictor than LNR quartile, especially in patients with LNS ≥ 12.
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Affiliation(s)
- Giovanni Li Destri
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Martina Barchitta
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Antonio Pesce
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Saverio Latteri
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Dorotea Bosco
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Antonio Di Cataldo
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Antonella Agodi
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
| | - Stefano Puleo
- a Department of Medical and Surgical Sciences and Advanced Technology "G.F. Ingrassia" , University of Catania , Via Santa Sofia 86, Catania , Italia
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9
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Zhang CH, Li YY, Zhang QW, Biondi A, Fico V, Persiani R, Ni XC, Luo M. The Prognostic Impact of the Metastatic Lymph Nodes Ratio in Colorectal Cancer. Front Oncol 2018; 8:628. [PMID: 30619762 PMCID: PMC6305371 DOI: 10.3389/fonc.2018.00628] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/03/2018] [Indexed: 01/13/2023] Open
Abstract
Background: This study was designed to validate the prognostic significance of the ratio of positive to examined lymph nodes (LNR) in patients with colorectal cancer. Methods: 218,314 patients from the SEER database and 1,811 patients from the three independent multicenter were included in this study. The patients were divided into 5 groups on a basis of previous published LNR: LNR0, patients with no metastatic lymph nodes; LNR1, patients with the LNR between 0.1 and 0.17; LNR2, patients with the LNR between 0.18 and 0.41; LNR3, patients with the LNR between 0.42 and 0.69; LNR4, patients with the LNR >0.7. The 5-year OS and CSS rate were estimated using Kaplan-Meier method and the survival difference was tested using log-rank test. Multivariate Cox analysis was used to further assess the influence of the LNR on patients' outcome. Results: The 5-year OS rate of patients within LNR0 to LNR4 group was 71.2, 55.8, 39.3, 22.6, and 14.6%, respectively (p < 0.001) in the SEER database. While the 5-year OS rate of those with LNR0 to LNR4 was 75.2, 66.1, 48.0, 34.0, and 17.7%, respectively (p < 0.001) in the international multicenter cohort. In the multivariate analysis, LNR was demonstrated to be a strong prognostic factor in patients with < 12 and ≥12 metastatic lymph nodes. Furthermore, the LNR had a similar impact on the patients' prognosis in colon cancer and rectal cancer. Conclusion: The LNR allowed better prognostic stratification than the positive node (pN) in patients with colorectal cancer and the cut-off values were well validated.
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Affiliation(s)
- Chi-Hao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Yan Li
- Department of Radiation Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Alberto Biondi
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Fico
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Persiani
- Dipartimento Scienze Gastroenterologiche ed Endocrino-Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xiao-Chun Ni
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Luo
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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10
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Xu F, Xu P, Cui W, Gong W, Wei Y, Liu B, Dong J. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may aid in identifying patients with non-small cell lung cancer and predicting Tumor-Node-Metastasis stages. Oncol Lett 2018. [PMID: 29928436 DOI: 10.3892/ol.2018.8644)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The present study aimed to identify a high-risk population with non-small cell lung cancer (NSCLC) and to predict TNM stages using the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). This retrospective study included preoperative data of 171 patients and 105 controls. Compared with healthy controls, patients with NSCLC had higher levels of NLR and PLR (NLR, 2.719±0.183 vs. 1.813±0.079, P<0.01; PLR, 135.800±4.778 vs. 112.000±5.651, P<0.01, respectively). The associations between Tumor-Node-Metastasis stages and the aforementioned parameters were detected (both P<0.01). NLR and PLR improved the rate of early diagnosis of NSCLC, particularly for stages III and IV with a higher area under curve value (0.752 and 0.759, respectively) compared with stage I and II NSCLC. In addition, PLR with a T stage-dependent increase may be a potential and independent predictive marker for T stage (P<0.05); the NLR exhibited an N stage-dependent increase (except for stage N3) and was identified as a marker for N stage (P<0.0001). It was subsequently concluded that NLR and PLR are useful biomarkers in the early diagnosis of NSCLC; that these two parameters were capable of indicating advanced stages, III and IV; and that PLR and NLR were independent predictors for T and N stages, respectively.
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Affiliation(s)
- Fei Xu
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Pengliang Xu
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Wenqiang Cui
- Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Institute of Acupuncture Research, School of Basic Medical Science, Fudan University, Shanghai 200032, P.R. China
| | - Weiyi Gong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Ying Wei
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Baojun Liu
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jingcheng Dong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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11
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Xu F, Xu P, Cui W, Gong W, Wei Y, Liu B, Dong J. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may aid in identifying patients with non-small cell lung cancer and predicting Tumor-Node-Metastasis stages. Oncol Lett 2018; 16:483-490. [PMID: 29928436 DOI: 10.3892/ol.2018.8644] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 02/27/2018] [Indexed: 12/16/2022] Open
Abstract
The present study aimed to identify a high-risk population with non-small cell lung cancer (NSCLC) and to predict TNM stages using the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). This retrospective study included preoperative data of 171 patients and 105 controls. Compared with healthy controls, patients with NSCLC had higher levels of NLR and PLR (NLR, 2.719±0.183 vs. 1.813±0.079, P<0.01; PLR, 135.800±4.778 vs. 112.000±5.651, P<0.01, respectively). The associations between Tumor-Node-Metastasis stages and the aforementioned parameters were detected (both P<0.01). NLR and PLR improved the rate of early diagnosis of NSCLC, particularly for stages III and IV with a higher area under curve value (0.752 and 0.759, respectively) compared with stage I and II NSCLC. In addition, PLR with a T stage-dependent increase may be a potential and independent predictive marker for T stage (P<0.05); the NLR exhibited an N stage-dependent increase (except for stage N3) and was identified as a marker for N stage (P<0.0001). It was subsequently concluded that NLR and PLR are useful biomarkers in the early diagnosis of NSCLC; that these two parameters were capable of indicating advanced stages, III and IV; and that PLR and NLR were independent predictors for T and N stages, respectively.
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Affiliation(s)
- Fei Xu
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Pengliang Xu
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Wenqiang Cui
- Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Institute of Acupuncture Research, School of Basic Medical Science, Fudan University, Shanghai 200032, P.R. China
| | - Weiyi Gong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Ying Wei
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Baojun Liu
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jingcheng Dong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.,Institute of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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12
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Wu Z, Qin G, Zhao N, Jia H, Zheng X. Assessing the adequacy of lymph node yield for different tumor stages of colon cancer by nodal staging scores. BMC Cancer 2017; 17:498. [PMID: 28743236 PMCID: PMC5526283 DOI: 10.1186/s12885-017-3491-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022] Open
Abstract
Background According to the current official guidelines, at least 12 lymph nodes (LNs) are qualified as an adequate sampling for colon cancer patients. However, patients evaluated with less nodes were still common in the United States, and the prevalence of positive nodal disease may be under-estimated because of the false-negative assessment. In this study, we present a statistical model that allows preoperative determination of the minimum number of lymph nodes needed to confirm a node-negative disease with certain confidence. Methods Adenocarcinoma colon cancer patients with stage T1-T3, diagnosed between 2004 and 2013, who did not receive neoadjuvant therapies and had at least one lymph node pathologically examined, were extracted from the Surveillance, Epidemiology and End Results (SEER) database. A beta binomial distribution was used to estimate the probability of an occult nodal disease is truly node-negative as a function of total number of LNs examined and T stage. Results A total of 125,306 patients met study criteria; and 47,788 of those were node-positive. The probability of falsely identifying a patient as node-negative decreased with an increasing number of nodes examined for each stage, and was estimated to be 72% for T1 and T2 patients with a single node examined and 57% for T3 patients with a single node examined. To confirm an occult nodal disease with 90% confidence, 3, 8, and 24 nodes need to be examined for patients from stage T1, T2, and T3, respectively. Conclusions The false-negative rate of diagnosed node negative, together with the minimum number of examined nodes for adequate staging, depend preoperatively on the clinical T stage. Predictive tools can recommend a threshold on the minimum number of examined nodes regarding to the favored level of confidence for each T stage. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3491-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhenyu Wu
- Department of Biostatistics and Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, 200032, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 130 Dongan Road, Shanghai, 200032, China
| | - Guoyou Qin
- Department of Biostatistics and Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, 200032, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 130 Dongan Road, Shanghai, 200032, China
| | - Naiqing Zhao
- Department of Biostatistics and Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Huixun Jia
- Center for Biomedical Statistics, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Xueying Zheng
- Department of Biostatistics and Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, 200032, China. .,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 130 Dongan Road, Shanghai, 200032, China.
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13
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Zhao Y, Zhong S, Li Z, Zhu X, Wu F, Li Y. Pathologic lymph node ratio is a predictor of esophageal carcinoma patient survival: a literature-based pooled analysis. Oncotarget 2017; 8:62231-62239. [PMID: 28977940 PMCID: PMC5617500 DOI: 10.18632/oncotarget.19258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/11/2017] [Indexed: 12/31/2022] Open
Abstract
The positive lymph node ratio (LNR) has been suggested as a predictor of survival in patients with esophageal carcinoma (EC). However, existed evidences did not completely agree with each other. We sought to examine whether LNR was associated with overall survival (OS). Electronic database was searched for eligible literatures. The primary outcome was the relationship between LNR and OS, which was presented as hazard ratio (HR) with 95% confidence intervals (CIs). All statistical analyses were performed using STATA 11.0 software. A total of 18 relevant studies which involved 7,664 cases were included. Patients with an LNR of 0.3 or greater had an increased risk of death compared to those with an LNR of less than 0.3(HR = 2.33; 95% CI 2.03-2.68; P<0.01). Similarly, patients with an LNR greater than 0.5 was also associated with a decreased OS(HR = 1.95; 95% CI 1.52-2.50; P<0.01). No publication bias was found. This meta-analysis confirmed that LNR was a significant predictor of survival in patients with EC and should be considered in prognostication.
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Affiliation(s)
- Yuming Zhao
- Department of Cardiothoracic Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, China
| | - Shengyi Zhong
- Department of Cardiothoracic Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, China
| | - Zhenhua Li
- Department of Cardiothoracic Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, China
| | - Xiaofeng Zhu
- Department of Cardiothoracic Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, China
| | - Feima Wu
- Department of Cardiothoracic Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, China
| | - Yanxing Li
- Department of Cardiothoracic Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437100, China
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14
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Mohan HM, Walsh C, Kennelly R, Ng CH, O'Connell PR, Hyland JM, Hanly A, Martin S, Gibbons D, Sheahan K, Winter DC. The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer. Colorectal Dis 2017; 19:165-171. [PMID: 27317165 DOI: 10.1111/codi.13410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/21/2016] [Indexed: 12/13/2022]
Abstract
AIM The ratio of positive nodes to total nodes, the lymph node ratio (LNR), is a proposed alternative to the current N1/N2 classification of nodal disease. The true clinical benefit of adopting the LNR, however, has not been definitively demonstrated. This study compared the LNR with the current N1/N2 classification of Stage III colon cancer. METHOD Patients with Stage III colon cancer were identified from a prospectively maintained database (1996-2012). The specificity and sensitivity of the N1/N2 classification in the prediction of overall survival were determined using R. A cut-off point for the LNR was determined by setting the specificity the same as for the N1/N2 classification. The sensitivity of the two methods was then compared, and bootstrapping 1000-fold was performed. This was then repeated for disease-specific survival. RESULTS The specificity and sensitivity of the N1/N2 classification in predicting 3-year overall survival in this cohort (n = 402) was 62.2% and 52.1%, respectively. The cut-off point for the LNR was determined to be 0.27 for these data. On comparing LNR with the N1/N2 classification showed that for a given specificity, the LNR did not provide a statistically significant improvement in sensitivity (52.8% vs 52.1%, P = 0.31). For disease-specific death at 3 years, the specificity and sensitivity were 60.8% and 54.6%, respectively. The LNR did not provide a statistically significant improvement (55.4% vs 54.6%, P = 0.44). CONCLUSION Both the N1/N2 system and the LNR predict survival in colon cancer, but both have low specificity and sensitivity. The LNR does not provide additional prognostic value to current staging for overall or disease-specific survival for a given cut-off point.
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Affiliation(s)
- H M Mohan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - C Walsh
- Department of Statistics, Trinity College Dublin, Dublin, Ireland.,Department of Mathematics and Statistics, University of Limerick, Dublin, Ireland
| | - R Kennelly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - C H Ng
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - P R O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - J M Hyland
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - A Hanly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - S Martin
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - D Gibbons
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - K Sheahan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - D C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
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15
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Clinical Significance of International Union Against Cancer pN Staging and Lymph Node Ratio in Node-Positive Colorectal Cancer after Advanced Lymph Node Dissection. Dis Colon Rectum 2016; 59:386-95. [PMID: 27050600 DOI: 10.1097/dcr.0000000000000569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lymph node retrieval in colorectal cancer can be improved by using advanced histopathological techniques like methylene blue-assisted lymph node dissection, which results in a doubling or even tripling of the lymph node count in comparison with conventional lymph node dissection techniques. However, it is not clear whether the established lymph node staging systems are suitable for predicting patients' prognoses under these circumstances. OBJECTIVE The aim of this study was to determine whether the current lymph node staging systems are suitable when advanced dissection methods are used. DESIGN This is a retrospective cohort study. SETTING AND PATIENTS We formed a study group (methylene blue-assisted lymph node dissection) of 293 patients and a control group (conventional lymph node dissection) of 232 patients, each with node-positive cases. Conventional pN staging according to the International Union Against Cancer, seventh edition, and lymph node ratio were applied. MAIN OUTCOME MEASURES Overall survival was compared by using the different staging systems in a uni- and multivariable fashion. RESULTS The lymph node ratio values were reduced in the advanced methylene blue-assisted lymph node dissection group in comparison with the conventional lymph node dissection group (0.1 vs 0.3, p < 0.001). Although pN staging proved to be reliable, the cutoff values for lymph node ratio staging had to be adapted. The new cutoffs (0.07, 0.15, and 0.34) were prognostic. However, multivariable analysis revealed pN staging and vascular invasion, but not lymph node ratio, as independently prognostic in the methylene blue-assisted lymph node dissection group. LIMITATIONS The study group and historical control group are not perfectly balanced because the case number in the stage III subgroup of the control group is small. CONCLUSIONS pN staging proved to be a robust prognostic marker in colorectal cancer under the circumstances of improved lymph node harvest. After adaptation of the cutoff values, lymph node ratio is also prognostic but not superior to pN staging.
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16
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Huang J, Hu W, Pang L, Chen J, Yang H. Value of Positive Lymph Node Ratio for Predicting Postoperative Distant Metastasis and Prognosis in Esophageal Squamous Cell Carcinoma. Oncol Res Treat 2015; 38:424-8. [PMID: 26406168 DOI: 10.1159/000439038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between positive lymph node ratio (PLNR) and postoperative distant metastasis and prognosis in esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS 167 ESCC patients with regional lymph node metastasis, who underwent radical esophagectomy and lymphadenectomy at the Ningbo Yinzhou People's Hospital between October 2005 and December 2010, were enrolled in this study. The prognostic value of PLNR was calculated by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. RESULTS After a median follow-up time of 34 months, 88 (52.7%) of the 167 patients had distant metastasis and 76 (45.5%) had died. Patients with a PLNR of less than 0.15 had a 5-year distant metastasis-free survival (DMFS) rate of 33.3% while those with a PLNR greater than 0.15 had a 5-year DMFS rate of 25.5% (log-rank test, p = 0.002). Multivariate analysis indicated that a PLNR > 0.15 was an independent poor prognostic factor for DMFS (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.21-3.05) and overall survival (OS) (HR 2.08, 95% CI 1.26-3.43). This analysis was adjusted for patient age, sex, smoking behavior, and pT stage. CONCLUSION The PLNR is an independent prognostic factor for predicting postoperative distant metastasis and prognosis in ESCC, and patients with a PLNR ≤ 0.15 have better OS.
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Affiliation(s)
- Jia Huang
- Department of Radiotherapy, Yinzhou People's Hospital, Ningbo, Zhejiang, P.R. China
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17
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Chen SC, Shyr YM, Chou SC, Wang SE. The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection. World J Surg Oncol 2015. [PMID: 26205252 PMCID: PMC4513626 DOI: 10.1186/s12957-015-0643-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lymph node involvement is one of the well-demonstrated prognostic factors in ampullary carcinoma. The aim of this study is to clarify the role of lymph nodes in predicting the survival outcome of ampullary carcinoma. METHODS A cohort of consecutive curative pancreaticoduodenectomies for ampullary carcinoma from 1999 to 2014 was retrospectively analyzed. The effect of node-associated variables, including lymph node status, positive lymph node number, total harvested lymph node (THLN) number, and lymph node ratio (LNR) was examined using univariate and multivariate analyses for survival outcome prediction. RESULTS In 194 evaluable patients, univariate analysis demonstrated that stage, cell differentiation, perineural invasion, and nodal status were significant conventional prognostic factors. Concerning the node-associated variables, positive nodal status, positive lymph node number≥2, THLN number<14, and LNR≥0.15 were significantly associated with poorer survival outcomes, with a 5-year survival rate of 20.3, 38.9, 25.4, and 18%, respectively. By multivariate analysis, nodal status and THLN number were two independent predictors of survival. The most favorable 5-year survival rate was 84.4% in patients with negative nodal involvement and THLN number≥14, compared with the poorest 5-year survival rate of 16.1% in those with positive nodal status and THLN number<14. CONCLUSIONS Tumor biology reflected by lymph node status is the most important independent prognostic factor; nevertheless, surgical radicality based on THLN number also plays a significant role in the survival outcome for patients with ampullary carcinoma after curative pancreaticoduodenectomy.
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Affiliation(s)
- Shih-Chin Chen
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan.
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan.
| | - Shu-Cheng Chou
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan.
| | - Shin-E Wang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei, 112, Taiwan.
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