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Jiang Q, Zeng X, Zhang C, Yang M, Fan J, Mao G, Shen Q, Yin Y, Liu W, Tao K, Zhang P. Lymph node ratio is a prospective prognostic indicator for locally advanced gastric cancer patients after neoadjuvant chemotherapy. World J Surg Oncol 2022; 20:261. [PMID: 35978363 PMCID: PMC9382835 DOI: 10.1186/s12957-022-02725-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 12/15/2022] Open
Abstract
Background The accuracy of lymph node ratio (LNR) as a prognostic index remains to be proven for gastric cancer patients after neoadjuvant chemotherapy (NACT). This study sought to investigate the prognostic value of LNR in locally advanced gastric cancer (LAGC) patients after NACT. Methods LAGC patients with clinical TNM stages 2–3, Her2(−), and Eastern Cooperative Oncology Group, scores 0–2 are routinely scheduled with NACT. Patients with LAGC after NACT and surgical operation between January 2012 and October 2020 were retrospectively reviewed. The correlation between LNR and survival was investigated. Results Overall, 148 patients were enrolled: 103 with low-LNR (LNR ≤ 30%) and 45 with high-LNR (LNR > 30%). Approximately, 50.5% and 24.4% patients responded to NACT at the primary site in the low-LNR and high-LNR groups, respectively. The overall survival (OS) and progression-free survival (PFS) of low-LNR group were considerably better than those of high-LNR group (3-year OS: 81.9% vs 18.5%, P < 0.001; 3-year PFS: 72.6% vs 13.5%, P < 0.001). In the low-LNR group, OS and PFS were superior in patients with tumor regression grade (TRG) 0–2 than in those with TRG 3 (3-year OS: 89.2% vs 73.2%, P = 0.086; 3-year PFS: 80.3% vs 66.5%, P = 0.036). In association with OS and PFS, the degree of tumor differentiation, TRG, and LNR were identified as predictive factors, and LNR was identified as the independent prognostic factor in univariate and multivariate analyses, respectively. Conclusions LNR is a prospective index of prognosis in patients with LAGC after NACT. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02725-9.
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Affiliation(s)
- Qi Jiang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xiangyu Zeng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Chenggang Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ming Yang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Jun Fan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Gan Mao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Qian Shen
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yuping Yin
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Weizhen Liu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Villalabeitia Ateca I, Perfecto Valero A, Serrano Hermosilla C, Marcaida Salazar A, Pérez Fernández S, Sarriugarte Lasarte A. Prognostic value of the nodal ratio in gastric cancer: unicentric analysis of 199 patients. Cir Esp 2022; 100:266-273. [PMID: 35487434 DOI: 10.1016/j.cireng.2022.04.003] [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] [Received: 01/22/2021] [Accepted: 03/30/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In the gastric cancer the most widely used classification is the AJCC TNM system. However, it presents limitations, such as staging migration in cases with suboptimal lymphadenectomies. The nodal ratio has been proposed as an alternative system, proving to be a good prognostic predictor of survival. The aim was to assess the influence of the nodal ratio measured in tertiles [tNR] as a prognostic factor and compare with the TNM systems (7th ed.) and log odds of positive lymph nodes [LODDS]. MATERIAL AND METHODS Retrospective and single-center study on 199 patients operated on with curative intent between 2010 and 2014. For each system an univariate and multivariate analysis was performed and the overall survival rates [OS] were compared by the ROC test. RESULTS The prognostic factors that showed statistical significance in the multivariate analysis were: tRN2 (HR2.87) and tRN3 (HR7.29); LODDS 2 (HR1.55), LODDS3 (HR2.6) and LODDS4 (HR4.9); pN2 (HR1.84) and pN3 (HR2.91). The 5-year OS was 75.8%, 61.4%, 25.8%, and 3.84% for tRN0, tRN1, tRN2 and tRN3; 72.4%, 60%, 29.1% and 13.9% for LODDS1, LODDS2, LODDS3 and LODDS4; and 77.6%, 59.4%, 28.8% and 25.5% for pN0, pN1, pN2 and pN3, respectively. The three systems behaved as good predictors, with areas under the curve >0.75. CONCLUSION tNR was an independent prognostic factor for estimating survival in gastric cancer. Furthermore, the ease of its calculation in clinical practice could reduce the effect of staging migration.
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Affiliation(s)
| | - Arkaitz Perfecto Valero
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Clara Serrano Hermosilla
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Ainhoa Marcaida Salazar
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain; UPV/EHU Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Vizcaya, Spain
| | | | - Aingeru Sarriugarte Lasarte
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain; Instituto de Investigación Sanitaria Biocruces, Barakaldo, Vizcaya, Spain; UPV/EHU Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Vizcaya, Spain
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Batra A, Kong S, Hannouf MB, Cheung WY. A Population-Based Study to Evaluate the Associations of Nodal Stage, Lymph Node Ratio and Log Odds of Positive Lymph Nodes with Survival in Patients with Small Bowel Adenocarcinoma. Curr Oncol 2022; 29:1298-1308. [PMID: 35323310 PMCID: PMC8947592 DOI: 10.3390/curroncol29030110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose: This study aimed to determine the real-world prognostic significance of lymph node ratio (LNR) and log odds of positive lymph nodes (LOPLN) in patients with non-metastatic small bowel adenocarcinoma. Methods: Patients diagnosed with early-stage small bowel adenocarcinoma between January 2007 and December 2018 from a large Canadian province were identified. We calculated the LNR by dividing positive over total lymph nodes examined and the LOPLN as log ([positive lymph nodes + 0.5]/[negative lymph nodes + 0.5]). The LNR and LOPLN were categorized at cut-offs of 0.4 and −1.1, respectively. Multivariable Cox proportional hazards models were constructed for each nodal stage, LNR and LOPLN, adjusting for measured confounding factors. Harrell’s C-index and Akaike’s Information Criterion (AIC) were used to calculate the prognostic discriminatory abilities of the different models. Results: We identified 141 patients. The median age was 67 years and 54.6% were men. The 5-year overall survival rates for patients with stage I, II and III small bowel adenocarcinoma were 50.0%, 56.6% and 47.5%, respectively. The discriminatory ability was generally comparable for LOPLN, LNR and nodal stage in the prognostication of all patients. However, LOPLN had higher discriminatory ability among patients with at least one lymph node involvement (Harrell’s C-index, 0.75, 0.77 and 0.82, and AIC, 122.91, 119.68 and 110.69 for nodal stage, LNR and LOPLN, respectively). Conclusion: The LOPLN may provide better prognostic information when compared to LNR and nodal stage in specific patients.
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Affiliation(s)
- Atul Batra
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB T2N 4N2, Canada;
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (M.B.H.)
| | - Shiying Kong
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (M.B.H.)
| | - Malek B. Hannouf
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (M.B.H.)
| | - Winson Y. Cheung
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB T2N 4N2, Canada;
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (M.B.H.)
- Correspondence: ; Tel.: +1-403-521-3565; Fax: +1-403-944-2331
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Villalabeitia Ateca I, Perfecto Valero A, Serrano Hermosilla C, Marcaida Salazar A, Pérez Fernández S, Sarriugarte Lasarte A. Prognostic value of the nodal ratio in gastric cancer: Unicentric analysis pf 199 patients. Cir Esp 2021; 100:S0009-739X(21)00131-7. [PMID: 33896606 DOI: 10.1016/j.ciresp.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/03/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In the gastric cancer the most widely used classification is the AJCC TNM system. However, it presents limitations, such as staging migration in cases with suboptimal lymphadenectomies. The nodal ratio has been proposed as an alternative system, proving to be a good prognostic predictor of survival. The aim was to assess the influence of the nodal ratio measured in tertiles [tNR] as a prognostic factor and compare with the TNM systems (7th ed.) and log odds of positive lymph nodes [LODDS]. MATERIAL AND METHODS Retrospective and single-center study on 199 patients operated on with curative intent between 2010 and 2014. For each system an univariate and multivariate analysis was performed and the overall survival rates [OS] were compared by the ROC test. RESULTS The prognostic factors that showed statistical significance in the multivariate analysis were: tNR2 (HR 2.87) and tNR 3 (HR 7.29); LODDS 2 (HR 1.55), LODDS3 (HR 2.6) and LODDS4 (HR 4.9); pN2 (HR 1.84) and pN3 (HR 2.91). The 5-year OS was 75.8, 61.4, 25.8 and 3.84% for tNR0, tNR1, tNR2 and tNR3; 72.4, 60, 29.1 and 13.9% for LODDS1, LODDS2, LODDS3 and LODDS4; and 77.6, 59.4, 28.8 and 25.5% for pN0, pN1, pN2 and pN3, respectively. The three systems behaved as good predictors, with areas under the curve >0.75. CONCLUSION tNR was an independent prognostic factor for estimating survival in gastric cancer. Furthermore, the ease of its calculation in clinical practice could reduce the effect of staging migration.
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Affiliation(s)
| | - Arkaitz Perfecto Valero
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - Clara Serrano Hermosilla
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - Ainhoa Marcaida Salazar
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España; UPV/EHU Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Vizcaya, España
| | | | - Aingeru Sarriugarte Lasarte
- Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España; UPV/EHU Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Vizcaya, España
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Park J, Jeon CH, Kim SJ, Seo HS, Song KY, Lee HH. A Novel Approach for Gastric Cancer Staging in Elderly Patients Based on the Lymph Node Ratio. J Gastric Cancer 2021; 21:84-92. [PMID: 33854816 PMCID: PMC8020007 DOI: 10.5230/jgc.2021.21.e9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To date, no studies have been performed on staging based on the lymph node ratio (LNR) in elderly patients with gastric cancer who may require limited lymph node (LN) dissection due to morbidity and tissue fragility. We aimed to develop a new N staging system using the LNR in elderly patients with gastric cancer. Materials and Methods The present study included patients aged over 75 years who underwent curative gastrectomy between January 1989 and December 2018. Clinicopathological data including the number of retrieved and metastatic LNs were collected and the LNR values were obtained (LNR = the number of metastatic LNs/the number of retrieved LNs). Eleven LNR groups with intervals of 0.1 were divided into four stages based on the inflection points at which the hazard ratio (HR) increased. Survival analysis was performed to evaluate the prognostic value of the LNR. Results The four LNR stages included LNR0 (n=364), LNR1 (n=128), LNR2 (n=103), and LNR3 (n=10). In the multivariate analysis, both N staging and LNR staging exhibited significant prognostic values for predicting survival outcomes. However, the incremental change in the hazard ratio (HR) between consecutive stages was greater for the LNR staging than for the N staging (HRs: 1.607, 2.758, and 3.675 for N staging; 1.583, 3.514, and 10.261 for LNR staging). Conclusions LNR staging is more useful than N staging in predicting the prognosis in elderly patients with gastric cancer and may be used as a complement or alternative to N staging.
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Affiliation(s)
- Joonseon Park
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Hyo Jeon
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Jung Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Accurate Risk Stratification of Patients with Node-Positive Gastric Cancer by Lymph Node Ratio. World J Surg 2020; 44:4184-4192. [PMID: 32892273 DOI: 10.1007/s00268-020-05739-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed to clarify the utility of lymph node ratio (LNR) for assessing the prognosis of patients with node-positive gastric cancer after curative gastrectomy. METHODS We retrospectively analyzed data of 973 patients with node-positive gastric cancer who had undergone curative gastrectomy at nine institutions from 2010 to 2014. Survival analysis was performed by comparing LNR low and high groups according to the optimal cutoff value of LNR, which was determined using receiver operating characteristic curve analysis. RESULTS LNR high was significantly associated with shorter disease-free survival and was an independent predictor of recurrence in all patients. Moreover, we obtained the similar results from analysis of each N stage. The prevalence of lymph node and peritoneal recurrence appeared to be higher in the LNR high group. Correlation analysis showed that LNR was negatively correlated with the number of retrieved nodes within every N stage; however, disease-free survival did not differ significantly between LNR low and high groups of each N stage with 16-30, 31-40, or >40 retrieved nodes. CONCLUSIONS LNR is a strong prognostic factor and predictor of recurrence in patients with node-positive gastric cancer who have undergone curative gastrectomy. The combination of LNR and N staging permits more accurate prognostic stratification of patients with gastric cancer and may contribute to developing novel prognostic models.
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da Costa PM, Lages P, Onofre S, Ribeiro RM. The impact of negative lymph nodes in the survival outcomes of pN+ patients following radical gastrectomy: the inverse lymph node ratio as a better score to study negative lymph nodes. Updates Surg 2020; 72:1031-1040. [PMID: 32388806 DOI: 10.1007/s13304-020-00757-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
The impact of negative lymph nodes (LNs) on survival of pN+ patients has been recognized. The weight of negative LNs in an inverse lymph node ratio (nR) should be related to its prognostic impact. Five hundred and two consecutive gastric cancer patients, who underwent radical gastrectomy, were included. Patients were split into groups according to the number of harvested nodes and a cross-tabulation with pTNM stages was performed to test differences in the tumor burden. pN+ patients (n = 296) were split into groups of negative LNs harvested. We tested an alternative formula for computing a lymph node ratio: nR = total number of harvested nodes/total number of positive nodes. The median number of negative LNs was significantly different (p < 0.01) between dissection groups, but not the median of positive nodes (p > 0.05). No difference in pTNM percentage distribution was found between these groups (p > 0.05). When tested, the overall survival improved significantly for groups with larger numbers of negative LNs (p < 0.001). A cutoff of nR ≥ 6 was an independent prognostic factor for survival (p = 0.001), and the survival of pN+ patients with nR ≥ 6 was not different from pN0 patients. The impact of the number of negative LNs on the survival of the pN+ patients was demonstrated. The higher numbers in the numerator of the nR was due to the disproportion between harvested negative LNs and metastatic LNs. Larger ratios imply more negative lymph nodes in relation to positive lymph nodes, which was significantly associated with survival. We believe that the proposed nR is a friendlier to use format because of its intuitive interpretation.
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Affiliation(s)
- Paulo Matos da Costa
- Serviço de Cirurgia Geral, Hospital Garcia de Orta, Almada, Portugal.
- Centro Académico de Medicina de Lisboa, Lisboa, Portugal.
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| | - Patrícia Lages
- Serviço de Cirurgia Geral, Hospital Garcia de Orta, Almada, Portugal
- Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Susana Onofre
- Serviço de Cirurgia Geral, Hospital Garcia de Orta, Almada, Portugal
- Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Ruy M Ribeiro
- Laboratório de Biomatemática, Lisboa, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Supsamutchai C, Wilasrusmee C, Jirasiritham J, Rakchob T, Phosuwan S, Chatmongkonwat T, Choikrua P, Thampongsa T. Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study. Ann Med Surg (Lond) 2020; 54:57-61. [PMID: 32373343 PMCID: PMC7191314 DOI: 10.1016/j.amsu.2020.04.002] [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: 11/01/2019] [Revised: 03/18/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction D2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). Number of lymph nodes (LN) harvested is an important factor for accurate staging. The number of LN retrieved and the metastasis LN status are also important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection. Patients and methods Single center retrospective cohort study of GC patients underwent curative resection from January 1995 to December 2016 was conducted. The patients were categorized into 3 groups based on LNR (0.00-0.35, >0.35-0.75, and >0.75-1.00) and 2 groups based on number of LN retrieved (<15 and ≥ 15). Kaplan-Meier method was used to estimate recurrence-free survival. Cox-regression were used to determine the association between LNR/other factors and the disease recurrence. Results One-hundred fifty-three patients were included in analysis. Univariate analysis showed that LNR >0.35, pathologic LN stages (pN) 2-3, higher number of LN metastasis, and TNM stage III were significantly recurrence risk factors. After adjusting for several covariates, LNR >0.35 still was significant predictor (adjusted HR [95%CI], 8.53 [1.97, 36.86]; p = 0.004) while number of LN retrieved or number of metastasis LN were not. Conclusion LNR could be a strong indicator for the recurrence of GC after curative resection while the number of LN retrieved or metastasis did not predict the recurrence. Future studies, such as prospective studies, are needed to confirm and identify the optimum LNR cut-off.
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Affiliation(s)
- Chairat Supsamutchai
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Chumpon Wilasrusmee
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Jakrapan Jirasiritham
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Teerawut Rakchob
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Songpol Phosuwan
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Tanet Chatmongkonwat
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Pattawia Choikrua
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Tharin Thampongsa
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
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Widschwendter P, Polasik A, Janni W, de Gregorio A, Friedl TWP, de Gregorio N. Lymph Node Ratio Can Better Predict Prognosis than Absolute Number of Positive Lymph Nodes in Operable Cervical Carcinoma. Oncol Res Treat 2020; 43:87-95. [PMID: 31935729 DOI: 10.1159/000505032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nodal status is the most important prognostic factor in cervical cancer. However, further risk stratification in node positive cervical cancer patients is warranted for optimal therapeutic decisions. MATERIAL AND METHODS Nodal positive patients (n = 86) were retrospectively stratified into two groups according to either number of positive nodes (>3 vs. 1-3) or lymph node ratio (LNR) (≥10 vs. <10% and >6.6 vs. ≤6.6%). Univariable log-rank tests and both univariable and adjusted multivariable Cox regression models were used to evaluate the association between number of positive nodes or LNR and disease-free survival (DFS) and overall survival (OS). RESULTS LNR was significantly associated with worse DFS in adjusted multivariable analysis, both when categorized as ≥10 versus <10% (HR 2.25, 95% CI 1.06-4.76, p = 0.034) and when categorized as >6.6 versus ≤6.6% (HR 2.79, 95% CI 1.23-6.37, p = 0.015). However, we found no significant association between number of positive nodes or LNR and OS. DISCUSSION In operable node-positive cervical cancer, both number of positive lymph nodes and LNR can be used for further risk stratification with regard to DFS but not OS.
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Affiliation(s)
- Peter Widschwendter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany,
| | - Arkadius Polasik
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Amelie de Gregorio
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Liang Y, Cui J, Cai Y, Liu L, Zhou J, Li Q, Wu J, He D. "D2 plus" lymphadenectomy is associated with improved survival in distal gastric cancer with clinical serosa invasion: a propensity score analysis. Sci Rep 2019; 9:19186. [PMID: 31844139 PMCID: PMC6914783 DOI: 10.1038/s41598-019-55535-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/30/2019] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to elucidate the potential impact of “D2 plus” lymphadenectomy on the long-term survival of distal gastric cancer (GC) patients with clinical serosa invasion. A total of 394 distal GC patients with clinical serosa invasion who underwent at least standard D2 lymphadenectomy were enrolled. Patients were categorized into two groups according to the extent of lymphadenectomy: D2 group and “D2 plus” group. Propensity score matching was used to adjust for the differences in baseline characteristics. In the multivariate analysis for the whole study series, extent of lymphadenectomy was an independent prognostic factor for GC patients (P = 0.011). With the strata analysis, the significant prognostic differences between the two groups were only observed in patients at the IIIa-b or N1-3a stages. After matching, patients in “D2 plus” group still demonstrated a significantly higher 5-year overall survival rate than those in D2 group (55.3% versus 43.9%, P = 0.042). The common therapeutic value index of No. 12b, No. 12p, No. 14v and No. 13 LNs was 4.6, which was close to that of No. 5 LN station. In conclusion, “D2 plus” lymphadenectomy may be associated with improved overall survival in distal GC with clinical serosa invasion.
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Affiliation(s)
- Yuexiang Liang
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Jingli Cui
- Department of general surgery, Weifang People's Hospital, Guangwen street, Kuiwen District, Weifang City, 261000, Shandong Province, China
| | - Yaoqing Cai
- Department of gastrointestinal surgery, Hainan Cancer Hospital, Changbinxi Road, Xiuying District, Haikou City, 570102, Hainan Province, China
| | - Lijie Liu
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Jianghao Zhou
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Qiang Li
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Junmei Wu
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China
| | - Donglei He
- Department of gastrointestinal oncology, The First Affiliated Hospital of Hainan Medical University, Longhua Road, Longhua District, Haikou City, 570100, Hainan Province, China.
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11
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Fulop ZZ, Gurzu S, Bara T, Dragus E, Bara T, Voidazan S, Banias L, Jung I. Lymph node ratio, an independent prognostic factor for patients with stage II-III rectal carcinoma. Pathol Res Pract 2019; 215:152384. [PMID: 30910253 DOI: 10.1016/j.prp.2019.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identification of the proper surgical method and the most reliable prognostic parameters of rectal carcinomas is a challenging issue. The aim of this paper was to determine the possible prognostic role of the number of harvested lymph nodes versus lymph node ratio (LNR) in patients with rectal carcinomas, and the proper value of LNR that can be used as prognostic parameter. MATERIALS AND METHODS A retrospective study was performed in 186 consecutive patients with rectal carcinomas that underwent surgical resection. The LNR was calculated for cases from stage II-III, and was correlated with classic prognostic parameters and overall survival (OS). RESULTS A statistically significant difference was found between LNR of 0.15 and OS (p = 0.03), respectively LNR > 0.15 and TNM stage (p < 0.0001), but also tumor infiltration level (p < 0.05). The number of harvested lymph nodes was not correlated with the tumor stage (r = 0.148, p = 0.06) and this parameter did not influence the OS, when the number of 12 or 14 lymph nodes was used as the ideal value (p = 0.6 and p = 0.66, respectively). CONCLUSION In patients with rectal carcinomas that underwent preoperative chemoradiotherapy, a LNR of 0.15 is a parameter with independent prognostic value, comparing with the number of harvested lymph nodes. The specific LNR should be calculated in larger cohorts.
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Affiliation(s)
- Zsolt Zoltan Fulop
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania; Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania; Department of Pathology, CCAMF - Research Center, Targu Mures, Romania.
| | - Tivadar Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Emoke Dragus
- Department of Urology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Tivadar Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Septimiu Voidazan
- Department of Epidemiology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Laura Banias
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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12
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Rubinstein JC, Dinauer C, Herrick-Reynolds K, Morotti R, Callender GG, Christison-Lagay ER. Lymph node ratio predicts recurrence in pediatric papillary thyroid cancer. J Pediatr Surg 2019; 54:129-132. [PMID: 30361076 DOI: 10.1016/j.jpedsurg.2018.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Regional lymph node (LN) metastasis at the time of presentation plays a significant role in predicting recurrence in patients with papillary thyroid cancer (PTC). Multiple studies in the adult population have demonstrated that the lymph node ratio (LNR) in both the central and lateral neck can improve the accuracy of recurrence prediction, but this ratio has not been studied in the pediatric population. In this study, we sought to investigate the LNR in the central and lateral compartments as a prognostic predictor for recurrence in pediatric patients with PTC. METHODS A retrospective analysis of pediatric patients (≤21 years old) at a single institution between 2002 and 2014 who underwent total thyroidectomy with prophylactic central neck dissection (TTpCND) with at least 3 sampled nodes or total thyroidectomy with unilateral modified radical neck dissection (TTMRND) with at least 10 sampled nodes, and on whom at least 24 months of follow up data were available was performed. The LNR was defined as the ratio of metastatic LNs to total number of investigated LNs. Recurrence after TTpCND and TTMRND was examined separately as a function of LNR, using the value of 0.45 as a cutoff. RESULTS Forty-eight patients met inclusion criteria. Thirty-two underwent TTpCND, and sixteen underwent TTMRND. Median age at time of operation was 17 years (range 6-20), and median duration of follow-up was 53.5 months (range 24-183). In the TTpCND, LNR ranged from 0 to 1.0. There were two recurrences among the eight patients (25%) undergoing TTpCND in patients with LNRs >0.45 and a single recurrence among the 24 patients (4.2%) undergoing TTpCND with an LNR ≤0.45. In the TTMRND, LNR ranged from 0.1 to 1.0. There were 3 recurrences in 12 patients with LNR ≤0.45 (30.8%%) and 4 recurrences in 4 patients with LNR >0.45 (100%) (p = 0.03). CONCLUSIONS Although limited by small sample size, LNR may be a useful predictor to stratify the likelihood of recurrence in pediatric patients undergoing TTpCND or TTMRND for pathologic N1a or N1b PTC. TYPE OF STUDY Prognosis study / retrospective case series. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | - Raffaella Morotti
- Yale School of Medicine, Department of Pathology, New Haven, CT 06520
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Kim YJ, Chung WC, Youn GJ, Jun KH, Chin HM. The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:537-542. [DOI: 10.17235/reed.2019.6041/2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Hu M, Zhang S, Yang X, Shen Y, Li Z, Zhao Y, Xu F, Jiang D, Wang X, Wang Y. The prognostic value of lymph node ratio for local advanced gastric cancer patients with adjuvant chemoradiotherapy after D2 gastrectomy. Medicine (Baltimore) 2018; 97:e13079. [PMID: 30383693 PMCID: PMC6221689 DOI: 10.1097/md.0000000000013079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to find the prognostic factors of local advanced gastric cancer patients with adjuvant concurrent chemoradiotherapy after radical D2 gastrectomy, and explore the prognostic value of lymph node ratio (LNR).We retrospectively analyzed 164 gastric cancer patients enrolled in West China Hospital from 2006 to 2013, who underwent D2 radical gastrectomy and adjuvant chemoradiotherapy. With univariate analysis and the Cox regression model, we evaluated the association of LNR and other clinical pathological characteristics with overall survival (OS) and relapse-free survival (RFS) of patients.Of 164 gastric cancer patients, the median age at diagnosis was 60 (IQR 51-66), with 121 males (73.78%) and 43 females (26.22%). The median follow-up time was 41.5 months. One-year and 3-year OS rate of the whole cohort was 97.6% and 88.4%, with 1-year RFS rate of 90.2% and 3-year RFS rate of 76.8%, respectively. In the univariate analysis, we found that age >60years (P = .025), TNM stage III (P = .014), LNR >0.25 (P = .006) and radiation dose <45Gy (P = .048) predicted worse OS. Further multivariate analysis indicated that age >60y (HR 2.375, 95% CI 1.100-5.128; P = .028), TNM stage III (HR 7.692, 95% CI 1.009-58.824; P = .049) and LNR >0.25 (HR 2.439, 95% CI 1.075-5.525; P = .033) were independent prognostic factors for unfavorable OS. The COX analysis showed that related prognostic factors of worse RFS were TNM stage III (HR 3.802, 95% CI 1.506-9.615; P = .049) and LNR >0.25 (HR 2.326, 95% CI 1.332-4.065; P = .003).LNR can be used as an important prognostic indicator for gastric cancer patients with D2 resection and adjuvant chemoradiotherapy, and LNR more than 0.25 indicates poor prognosis.
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Affiliation(s)
- Min Hu
- Department of Abdominal Oncology
- State Key Laboratory of Biotherapy, Cancer Center
- West China School of Medicine, West China Hospital of Sichuan University
| | | | - Xue Yang
- Department of Oncology, First People's Hospital of Ziyang, Ziyang, Sichuan Province
| | - Yali Shen
- Department of Abdominal Oncology
- State Key Laboratory of Biotherapy, Cancer Center
| | | | | | - Feng Xu
- Department of Abdominal Oncology
| | - Dan Jiang
- Department of Pathology, West China Hospital, Sichuan University
| | - Xin Wang
- Department of Abdominal Oncology
- State Key Laboratory of Biotherapy, Cancer Center
| | - Yongsheng Wang
- State Key Laboratory of Biotherapy, Cancer Center
- Department of Thoracic Oncology, Cancer Center, West China Hospital, China
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15
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Zhang X, Yu F, Zhao Z, Mai J, Zhou Y, Tan G, Liu X. The Prognostic Significance of Lymph Node Ratio and Log Odds Ratio in Laryngeal Squamous Cell Carcinoma. OTO Open 2018; 2:2473974X18792008. [PMID: 31535064 PMCID: PMC6737873 DOI: 10.1177/2473974x18792008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate whether lymph node ratio (LNR) and log odds ratio (LODDS) have prognostic significance for overall survival (OS) and disease-free survival (DFS) in patients with laryngeal squamous cell cancer (LSCC) treated with curative intent. Study Design Case-control study. Setting University hospital. Subjects and Methods Records of 229 patients with LSCC who underwent surgery with a curative intent with or without adjuvant treatment from 2000 to 2014 were reviewed. The clinicopathological parameters LNR and LODDS were analyzed; univariate and multivariate analysis was performed to evaluate the prognosis of each for OS and DFS. Results The 5-year OS was 81.7% for LNR ≤0.233 and 47.1% for LNR >0.233, and the 5-year OS was 79.6% for LODDS ≤–0.1 and 51.8% for LODDS >–0.1, respectively. In the univariate analysis, the independent variables were subsites, pT stage (pT1 and pT2 vs pT3 and pT4), pN, pTNM, alcohol consumption, and LNR and LODDS (P < .05). By multivariate analysis, we determined that subsites, pT stage, alcohol consumption, LNR, and LODDS were independent prognostic predictors of survival (P < .05). Univariate and multivariate models identified that both LNR and LODDS were significant prognostic factors for survival. However, the hazard ratio (HR) for LNR >0.233 vs ≤0.233 was 8.95 (95% confidence interval [CI], 3.18-25.16; P < .001) in OS, and the HR was 11.37 (95% CI, 4.02-32.15; P < .001) in DFS. The risk of LNR was noticeably greater than other factors. Conclusions LNR and LODDS were both prognostic factors for OS and DFS. However, LNR was confirmed as a more reliable indicator for evaluating the prognosis, and it can be used to increase the prognostic value of the traditional TNM classification of LSCC.
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Affiliation(s)
- Xinrui Zhang
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Feng Yu
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Zheng Zhao
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Junhao Mai
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Yibo Zhou
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Guojie Tan
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Xuekui Liu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
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16
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Wu H, Liu C, Xu M, Guo M, Xu S, Xie M. Prognostic value of the number of negative lymph nodes in esophageal carcinoma without lymphatic metastasis. Thorac Cancer 2018; 9:1129-1135. [PMID: 29952086 PMCID: PMC6119623 DOI: 10.1111/1759-7714.12796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 01/10/2023] Open
Abstract
Background The impact of the number of negative lymph nodes (LNs) on survival in patients with esophageal cancer remains a controversial issue. This study investigated the association between the number of resected LNs and the prognosis of patients with node‐negative esophageal carcinoma. Methods A retrospective review was performed of the data of 429 patients who underwent esophagectomy with modern two‐field lymphadenectomy for the treatment of esophageal cancer between January 1998 and December 2008. Histopathology showed no LN involvement in the patient sample. The prognostic impact of the number of negative LNs and the clinicopathological factors were analyzed. Results The overall median survival time and the one, three, and five‐year overall survival rates were 63.0 months and 78.5%, 64.0%, and 51.2%, respectively. Survival analysis confirmed that the number of negative LNs and the depth of tumor invasion were independent prognostic factors. Patients with a high number of negative LNs had a better overall survival rate than patients with a low number of negative LNs (P < 0.001). Patients with dissected LNs > 14 for pT1 tumors (P < 0.001) and > 19 for pT2–3 tumors (P < 0.001 and P = 0.001, respectively) had better long‐term survival outcomes. Conclusions The number of negative LNs is an independent prognostic factor for node‐negative esophageal carcinoma. Extended LN dissection is recommended to improve the survival of patients with node‐negative esophageal carcinoma.
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Affiliation(s)
- HanRan Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei City, China
| | - ChangQing Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei City, China
| | - MeiQing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei City, China
| | - MingFa Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei City, China
| | - ShiBin Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei City, China
| | - MingRan Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei City, China
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17
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Reply to Kadri Altundag: Do cut-off values of lymph node ratio and presence of perineural invasion affect survival in breast cancer patients with pathologic N3a lymph node stage? Breast 2017; 35:218-219. [DOI: 10.1016/j.breast.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 11/17/2022] Open
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