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Techniques in Coloproctology

, Volume 18, Issue 9, pp 805–811 | Cite as

The prognostic value of lymph node ratio and updated TNM classification in rectal cancer patients with adequate versus inadequate lymph node dissection

  • T. JungingerEmail author
  • U. Goenner
  • A. Lollert
  • D. Hollemann
  • M. Berres
  • M. Blettner
Original Article

Abstract

Background

The aim of this study was to clarify whether the lymph node ratio (LNR) is superior to the updated TNM classification regarding the prognosis of stage III rectal cancer patients who have not undergone neoadjuvant therapy. The TNM system is based on the absolute number of lymph nodes involved, and the LNR takes into account involved and examined nodes.

Methods

In 237 patients with stage III rectal cancer, we evaluated prognostic factors for 5-year overall survival (OS), disease-free survival (DFS), and risk of distant metastases (DM) using the Kaplan–Meier method, with patients divided based on adequate versus inadequate lymph node dissection (≥12 vs. <12 lymph nodes examined). The updated TNM divides patients into four groups (1, 2–3, 4–6, and ≥7 involved nodes), while LNR divides patients into quartiles. Multivariate Cox regression analyses were performed.

Results

Among patients with adequate lymph node dissection, the distributions within the two systems were in agreement in 141/178 (79.2 %, kappa 0.721), and the predictive values for OS, DFS, and DM were similar. In patients with inadequate lymph node dissection, the classifications of both systems were concordant in only 13/59 (22 %, kappa 0.021). The pN system significantly under-staged patients, while the LNR classification was a better predictor of OS, DFS, and DM.

Conclusions

In patients with adequate lymph node dissection, LNR staging does not add substantial information to the predictions of updated TNM lymph node staging. However, in patients with inadequate lymph node harvesting, the LNR compensates for the under-staging of the TNM classification and provides a better estimation of prognosis than the updated TNM system.

Keywords

Rectal cancer Lymph node involvement Lymph node ratio Lymph node dissection TNM staging Prognosis 

Notes

Conflict of interest

None.

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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • T. Junginger
    • 1
    Email author
  • U. Goenner
    • 1
  • A. Lollert
    • 2
  • D. Hollemann
    • 3
  • M. Berres
    • 4
  • M. Blettner
    • 5
  1. 1.Department of General and Abdominal SurgeryUniversity Medical Centre of the Johannes Gutenberg University MainzMainzGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Medical Centre of the Johannes Gutenberg UniversityMainzGermany
  3. 3.Department of PathologyUniversity Medical Centre of the Johannes Gutenberg UniversityMainzGermany
  4. 4.Institute of Medical Biostatistics, Epidemiology and InformaticsUniversity Medical Centre of the Johannes Gutenberg University, Mainz Rhein Ahr CampusRemagenGermany
  5. 5.Institute of Medical Biostatistics, Epidemiology and InformaticsUniversity Medical Centre of the Johannes Gutenberg UniversityMainzGermany

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