Annals of Surgical Oncology

, Volume 15, Issue 6, pp 1600–1608

Lymph Node Ratio: Role in the Staging of Node-Positive Colon Cancer

Authors

    • Department of SurgeryUniversity at Buffalo, State University of New York
    • Department of BiostatisticsUniversity at Buffalo, State University of New York
  • James M. Hassett
    • Department of SurgeryUniversity at Buffalo, State University of New York
  • Merril T. Dayton
    • Department of SurgeryUniversity at Buffalo, State University of New York
  • Mahmoud N. Kulaylat
    • Department of SurgeryUniversity at Buffalo, State University of New York
Gastrointestinal Oncology

DOI: 10.1245/s10434-007-9716-x

Cite this article as:
Wang, J., Hassett, J.M., Dayton, M.T. et al. Ann Surg Oncol (2008) 15: 1600. doi:10.1245/s10434-007-9716-x

Abstract

Background

Recent literature has shown that lymph node ratio (LNR) is superior to the number of positive lymph nodes (pLNs) in predicting the prognosis in several malignances other than colon cancer. We hypothesize that LNR may play a similar role in stage III colon cancer.

Methods

We included 24,477 stage III colon cancer cases from the Surveillance, Epidemiology, and End Results cancer registry. Patients were categorized into four groups, LNR1 to 4, according to cutoff points \( \raise0.5ex\hbox{$\scriptstyle 1$} \kern-0.1em/\kern-0.15em \lower0.25ex\hbox{$\scriptstyle {14}$} \), 0.25, and 0.50. Kaplan-Meier and Cox proportional hazard model were used to evaluate the prognostic effect and estimate the relative risk (RR) and 95% confidence interval (CI) of LNR.

Results

The 5-year survival for patients with stage IIIA, IIIB, and IIIC was 71.3%, 51.7%, and 34.0%, respectively (P < .0001). There was no survival difference among LNR1 to LNR4 for stage IIIA patients. In stage IIIB patients, the 5-year survival for those with LNR1 to LNR4 was 63.5%, 54.7%, 44.4%, and 34.2%, respectively (P < .0001). In stage IIIC patients, the 5-year survival for those with LNR2 to LNR4 was 49.6%, 41.7%, and 25.2%, respectively (P < .0001). LNR is an independent predictor of survival after adjusting patient’s age, tumor size, tumor grade, race, number of pLNs, and total number of LNs harvested. (RR 2.30, 95% CI 2.08–2.55).

Conclusion

Patients with stage IIIB and IIIC colon cancer represent a heterogeneous group of patients with the majority either overstaged or understaged. LNR is a more accurate prognostic method for stage III colon cancer patients. We propose an algorithm to incorporate LNR into current AJCC staging system.

Keywords

Colon cancerStageLymph nodeLymph node ratioPrognosis

Copyright information

© Society of Surgical Oncology 2007