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Prognostic Value of Metastatic Lymph Node Ratio and Identification of Factors Influencing the Lymph Node Yield in Patients Undergoing Curative Colon Cancer Resection.

作者信息

Mroczkowski Paweł, Kim Samuel, Otto Ronny, Lippert Hans, Zajdel Radosław, Zajdel Karolina, Merecz-Sadowska Anna

机构信息

Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland.

Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany.

出版信息

Cancers (Basel). 2024 Jan 2;16(1):218. doi: 10.3390/cancers16010218.


DOI:10.3390/cancers16010218
PMID:38201643
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10778473/
Abstract

Due to the impact of nodal metastasis on colon cancer prognosis, adequate regional lymph node resection and accurate pathological evaluation are required. The ratio of metastatic to examined nodes may bring an additional prognostic value to the actual staging system. This study analyzes the identification of factors influencing a high lymph node yield and its impact on survival. The lymph node ratio was determined in patients with fewer than 12 or at least 12 evaluated nodes. The study included patients after radical colon cancer resection in UICC stages II and III. For the lymph node ratio (LNR) analysis, node-positive patients were divided into four categories: i.e., LNR 1 (<0.05), LNR 2 (≥0.05; <0.2), LNR 3 (≥0.2; <0.4), and LNR 4 (≥0.4), and classified into two groups: i.e., those with <12 and ≥12 evaluated nodes. The study was conducted on 7012 patients who met the set criteria and were included in the data analysis. The mean number of examined lymph nodes was 22.08 (SD 10.64, median 20). Among the study subjects, 94.5% had 12 or more nodes evaluated. These patients were more likely to be younger, women, with a lower ASA classification, pT3 and pN2 categories. Also, they had no risk factors and frequently had a right-sided tumor. In the multivariate analysis, a younger age, ASA classification of II and III, high pT and pN categories, absence of risk factors, and right-sided location remained independent predictors for a lymph node yield ≥12. The univariate survival analysis of the entire cohort demonstrated a better five-year overall survival (OS) in patients with at least 12 lymph nodes examined (68% vs. 63%, = 0.027). The LNR groups showed a significant association with OS, reaching from 75.5% for LNR 1 to 33.1% for LNR 4 ( < 0.001) in the ≥12 cohort, and from 74.8% for LNR2 to 49.3% for LNR4 ( = 0.007) in the <12 cohort. This influence remained significant and independent in multivariate analyses. The hazard ratios ranged from 1.016 to 2.698 for patients with less than 12 nodes, and from 1.248 to 3.615 for those with at least 12 nodes. The LNR allowed for a more precise estimation of the OS compared with the pN classification system. The metastatic lymph node ratio is an independent predictor for survival and should be included in current staging and therapeutic decision-making processes.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79f5/10778473/ac785325b512/cancers-16-00218-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79f5/10778473/67ebf2e790c7/cancers-16-00218-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79f5/10778473/a76ad1c57dd0/cancers-16-00218-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79f5/10778473/ac785325b512/cancers-16-00218-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79f5/10778473/67ebf2e790c7/cancers-16-00218-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79f5/10778473/a76ad1c57dd0/cancers-16-00218-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79f5/10778473/ac785325b512/cancers-16-00218-g003.jpg

相似文献

[1]
Prognostic Value of Metastatic Lymph Node Ratio and Identification of Factors Influencing the Lymph Node Yield in Patients Undergoing Curative Colon Cancer Resection.

Cancers (Basel). 2024-1-2

[2]
[Effect of number of metastatic lymph nodes and metastatic lymph node ratio on the prognosis in patients with adenocarcinoma of the esophagogastric junction after curative resection].

Zhonghua Zhong Liu Za Zhi. 2014-2

[3]
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J Cancer. 2019-6-2

[4]
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Br J Cancer. 2015-7-14

[5]
The Prognostic Impact of the Metastatic Lymph Nodes Ratio in Colorectal Cancer.

Front Oncol. 2018-12-18

[6]
Prognostic significance of the metastatic lymph node ratio compared to the TNM classification in stage III gastric cancer.

Niger J Clin Pract. 2021-11

[7]
Log odds of positive lymph nodes is prognostically equivalent to lymph node ratio in non-metastatic colon cancer.

BMC Cancer. 2020-8-14

[8]
Lymph node ratio is inferior to pN-stage in predicting outcome in colon cancer patients with high numbers of analyzed lymph nodes.

BMC Surg. 2018-10-3

[9]
Prognostic assessment of different lymph node staging methods for pancreatic cancer with R0 resection: pN staging, lymph node ratio, log odds of positive lymph nodes.

Pancreatology. 2014

[10]
[Metastatic lymph node ratio and outcome of surgical patients with stage III colorectal cancer].

Nan Fang Yi Ke Da Xue Xue Bao. 2012-11

引用本文的文献

[1]
A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on lymphadenectomy during right hemicolectomy: Should anatomical variability of the right colic artery influence the surgical strategy?-CoDIG 2 database (ColonDx Italian Group).

Updates Surg. 2025-7-4

[2]
Development of a cancer-specific survival assessment for lymph node-positive colorectal cancer patients treated with adjuvant chemotherapy.

Front Surg. 2025-5-12

[3]
Lymph Node Yield and Lymph Node Ratio for Prognosis of Long-Term Survival in Gastric Carcinoma.

Cancers (Basel). 2025-1-27

本文引用的文献

[1]
Postoperative Chemotherapy After Surgical Resection of Metachronous Metastases of Colorectal Cancer: A Systematic Review.

World J Oncol. 2023-2

[2]
Colorectal cancer statistics, 2023.

CA Cancer J Clin. 2023

[3]
The Position of Circulating Tumor DNA in the Clinical Management of Colorectal Cancer.

Cancers (Basel). 2023-2-17

[4]
Using Circulating Tumor DNA in Colorectal Cancer: Current and Evolving Practices.

J Clin Oncol. 2022-8-20

[5]
General insight into cancer: An overview of colorectal cancer (Review).

Mol Clin Oncol. 2021-12

[6]
Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care.

BMC Fam Pract. 2021-7-8

[7]
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

CA Cancer J Clin. 2021-5

[8]
Adjuvant Chemotherapy for Stage III Colon Cancer.

Cancers (Basel). 2020-9-19

[9]
ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper.

Nat Rev Clin Oncol. 2020-12

[10]
How does lymph node yield affect survival outcomes of stage I and II colon cancer?

World J Surg Oncol. 2020-1-29

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