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Prognostic Significance of Metastatic Lymph Node Ratio in Node-Positive Colon Carcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to evaluate the prognostic significance of the lymph node ratio between metastatic and examined lymph nodes (LNR) in patients with stage III colon cancer.

Methods

A review was made of 201 patients (106 men) with stage III colon cancer of R0 resection. Lymph node (LN) disease was stratified both by the American Joint Committee on Cancer and the International Union Against Cancer nodal staging system (pN) and by quartiles of the LNR. Survival curves were made by Kaplan-Meier analysis and assessed by the log rank test. Multivariate analysis was performed by the Cox proportional hazard model. Patients ranged in age from 22 to 82 (median, 59) years with median follow-up of 52 (range, 13–96) months.

Results

The LNR increased as a function of the number metastatic LNs (P < .0001; 95% confidence interval [95% CI], .7155–.8265). Cutoff points of LNR quartiles to be the best separating patients with regard to 5-year disease-free survival (DFS) were between quartile 1 and 2, and between 3 and 4 (pNr1, 2, and 3); the 5-year DFS according to such stratification was 83.6%, 61.1%, and 20% in pNr1, pNr2, and pNr3, respectively (P < .0001). The Cox model identified the pNr as the most statistically significant covariate: pNr2 was three times (95% CI, 1.407–6.280) and pNr3 eight times more risky than pNr1 (95% CI, 3.739–18.704).

Conclusions

Ratio-based LN staging, which reflects the number of LNs examined and the quality of LN dissection, is a potent modality for prognostic stratification in patients with LN-positive colon cancer.

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References

  1. Hermanek P. pTNM and residual tumor classifications: problems of assessment and prognostic significance. World J Surg 1995; 19:184–90

    Article  PubMed  CAS  Google Scholar 

  2. Tang R, Wang JY, Chen JS, et al. Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg 1995; 180:705–12

    PubMed  CAS  Google Scholar 

  3. Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual. 6th ed. Springer-Verlag: New York, 2002

    Google Scholar 

  4. Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 2003; 21:2912–9

    Article  PubMed  CAS  Google Scholar 

  5. Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003; 10:65–71

    Article  PubMed  Google Scholar 

  6. Joseph NE, Sigurdson ER, Hanlon AL, et al. Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection. Ann Surg Oncol 2003; 10:213–8

    Article  PubMed  Google Scholar 

  7. Goldstein NS, Sanford W, Coffey M, Layfield LJ. Lymph node recovery from colorectal resection specimens removed for adenocarcinoma: trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 1996; 106:209–16

    PubMed  CAS  Google Scholar 

  8. Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS. Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 1999; 17:2896–900

    PubMed  CAS  Google Scholar 

  9. Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002; 9:775–84

    Article  PubMed  Google Scholar 

  10. Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol 2003; 10:1077–85

    Article  PubMed  Google Scholar 

  11. Rodriguez Santiago JM, Munoz E, Marti M, Quintana S, Veloso E, Marco C. Metastatic lymph node ratio as a prognostic factor in gastric cancer. Eur J Surg Oncol 2005; 31:59–66

    Article  PubMed  CAS  Google Scholar 

  12. Voordeckers M, Vinh-Hung V, Van de Steene J, Lamote J, Storme G. The lymph node ratio as prognostic factor in node-positive breast cancer. Radiother Oncol 2004; 70:225–30

    Article  PubMed  Google Scholar 

  13. Herr HW. Superiority of ratio based lymph node staging for bladder cancer. J Urol 2003; 169:943–5

    Article  PubMed  Google Scholar 

  14. Berger AC, Watson JC, Ross EA, Hoffman JP. The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 2004;70:235–40

    PubMed  Google Scholar 

  15. Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005; 23:8706–12

    Article  PubMed  Google Scholar 

  16. Kodera Y, Yamamura Y, Shimizu Y, et al. Lymph node status assessment for gastric carcinoma: is the number of metastatic lymph nodes really practical as a parameter for N categories in the TNM classification? J Surg Oncol 1998; 69:15–20

    Article  PubMed  CAS  Google Scholar 

  17. Inoue K, Nakane Y, Iiyama H, et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 2002;9:27–34

    Article  PubMed  Google Scholar 

  18. Megale Costa LJ, Soares HP, Gaspar HA, et al. Ratio between positive lymph nodes and total dissected axillaries lymph nodes as an independent prognostic factor for disease-free survival in patients with breast cancer. Am J Clin Oncol 2004;27:304–6

    Article  PubMed  Google Scholar 

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Acknowledgment

C.K. was supported by a Korea Research Foundation grant, funded by Korea Government (MOEHRD, Basic Research Promotion Fund, grant KRF-2005-070-C00020).

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Correspondence to Hong-Jo Choi MD, FACS.

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Lee, HY., Choi, HJ., Park, KJ. et al. Prognostic Significance of Metastatic Lymph Node Ratio in Node-Positive Colon Carcinoma. Ann Surg Oncol 14, 1712–1717 (2007). https://doi.org/10.1245/s10434-006-9322-3

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  • DOI: https://doi.org/10.1245/s10434-006-9322-3

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