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Lymph node ratio is a powerful prognostic index in patients with stage III distal rectal cancer: a Japanese multicenter study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The present study aims to define the prognostic impact of the lymph node ratio (LNR) in patients with stage III distal rectal cancer.

Methods

We analyzed data from 501 patients who underwent curative resection (total mesorectal excision, TME) for stage III distal rectal cancer at 12 institutions between 1991 and 1998. Patients were divided into four groups according to quartiles based on LNR.

Results

Among the 501 patients, 381 underwent TME with pelvic sidewall dissection (PSD). The median numbers of lymph nodes retrieved with and without PSD were 45 and 17, respectively (P < 0.0001). Forty-nine patients with lymph node retrieved less than 12 were excluded from further analyses. Among various clinicopathological parameters, univariate analysis identified age (P = 0.0059), histological grade (P < 0.0001), depth of tumor invasion (P = 0.0003), and number of positive nodes (P < 0.0001) and LNR (P < 0.0001) as prognostic factors. The Cox proportional hazards model revealed that age (P = 0.014), histological grade (P < 0.0001), depth of tumor invasion (P = 0.0002), and LNR (group 3, P = 0.0012; group 4, P < 0.0001) were independent prognostic factors. When the American Joint Committee on Cancer (AJCC) seventh staging system was added as a covariate, both AJCC stage (P < 0.0001) and LNR (P < 0.0001) were independent prognostic factors.

Conclusions

Adding the LNR concept to the AJCC cancer staging system will improve accuracy in evaluating the nodal status of distal rectal cancer.

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Authors and Affiliations

  1. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113–8519, Japan

    Hirotoshi Kobayashi, Masamichi Yasuno & Kenichi Sugihara

  2. Department of Surgery, National Defense Medical College, Saitama, Japan

    Hidetaka Mochizuki

  3. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan

    Tomoyuki Kato

  4. Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Takeo Mori

  5. Second Department of Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Shingo Kameoka

  6. Department of Surgery, School of Medicine, Kurume University, Fukuoka, Japan

    Kazuo Shirouzu

  7. Department of Surgery, International Medical Center of Japan, Tokyo, Japan

    Yukio Saito

  8. Department of Surgery, Kitasato University Hospital, Kanagawa, Japan

    Masahiko Watanabe

  9. Depatment of Surgery II, Hirosaki University School of Medicine, Aomori, Japan

    Takayuki Morita

  10. Department of Surgery, Kinki University School of Medicine, Osaka, Japan

    Jin-ichi Hida

  11. Department of Surgery, Cancer Institute Hospital, Tokyo, Japan

    Masashi Ueno

  12. Department of Surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Masato Ono

Authors
  1. Hirotoshi Kobayashi
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  2. Hidetaka Mochizuki
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  3. Tomoyuki Kato
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  4. Takeo Mori
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  9. Takayuki Morita
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  10. Jin-ichi Hida
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  11. Masashi Ueno
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  12. Masato Ono
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  13. Masamichi Yasuno
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  14. Kenichi Sugihara
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Consortia

Study Group for Rectal Cancer Surgery of the Japanese Society for Cancer of the Colon and Rectum

Corresponding author

Correspondence to Hirotoshi Kobayashi.

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Kobayashi, H., Mochizuki, H., Kato, T. et al. Lymph node ratio is a powerful prognostic index in patients with stage III distal rectal cancer: a Japanese multicenter study. Int J Colorectal Dis 26, 891–896 (2011). https://doi.org/10.1007/s00384-011-1173-0

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  • DOI: https://doi.org/10.1007/s00384-011-1173-0

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