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The Lymph Node Ratio Is a Powerful Prognostic Factor of Node-Positive Colon Cancers Undergoing Potentially Curative Surgery

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Abstract

Background

The number of harvested (LNs) and metastatic nodes (LNs+) represents the most significant factor to define postoperative treatment and prognosis in colon cancer. However, its assessment may be inadequate causing an incorrect cancer staging. The lymph node ratio (LNR: the ratio between metastatic and resected nodes) has shown prognostic significance in many tumors; however, its role in colon cancer is not clearly elucidated. This study investigated LNR as a prognostic factor in node-positive colon cancers.

Methods

A total of 145 consecutive patients with node-positive colon cancer who underwent curative surgery and adjuvant chemotherapy in a single oncologic unit entered this study.

Results

LNR ranged from 0.0416 to 0.9; it was clearly lower in pN1 than pN2 patients, and increased as tumor stage worsened. ROC analysis selected 0.1818 as the best LNR cutoff value. Low LNR patients did significantly better than high LNR patients; this difference was not dependent on the number of LNs and stronger than differences observed by grouping patients according to LNs or LNs+. When stratified by low and high LNR value, pN1 and pN2 patients, as well as stage III subgroups were shown to display substantially different outcomes. LNR was an independent prognostic factor for disease-specific survival, and the only covariate related to disease-free survival.

Conclusions

LNR was a robust prognostic indicator for node-positive colon cancers undergoing curative surgery. Because this ratio-based staging was demonstrated to reduce stage migration and to aid in identifying high-risk patients, it should be proposed as a standard tool for colon cancer staging.

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References

  1. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  2. Rosenberg R, Friederichs J, Schuster T et al (2008) Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg 248:968–978

    Article  PubMed  Google Scholar 

  3. Le Voyer TE, Sigurdson ER, Hanlon AL et al (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21:2912–2919

    Article  CAS  PubMed  Google Scholar 

  4. Derwinger K, Carlsson G, Gustavsson B (2008) A study of lymph node ratio as a prognostic marker in colon cancer. Eur J Surg Oncol 34:771–775

    CAS  PubMed  Google Scholar 

  5. AJCC Cancer staging manual (2002) 6th edn. Springer-Verlag, New York, pp 113–123

  6. Van Cutsem EJD, Oliveira J (2008) Colon cancer: ESMO clinical recommendations for diagnosis, adjuvant treatment and follow-up. Ann Oncol 19(Suppl 2):ii29–ii30

    Article  PubMed  Google Scholar 

  7. Baxter NN, Virnig DJ, Rothenberger DA et al (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225

    Article  PubMed  Google Scholar 

  8. Vather R, Sammour T, Kahokehr A et al (2009) Lymph node evaluation and long-term survival in stage II and stage III colon cancer: a national study. Ann Surg Oncol 16:585–593

    Article  PubMed  Google Scholar 

  9. Johnson PM, Porter GA, Ricciardi R et al (2006) Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol 24:3570–3575

    Article  PubMed  Google Scholar 

  10. Chang GJ, Rodriguez-Bigas MA, Skibber JM et al (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441

    Article  PubMed  Google Scholar 

  11. Telian SH, Bilchik AJ (2008) Significance of the lymph node ratio in stage III colon cancer. Ann Surg Oncol 15:1557–1558

    Article  PubMed  Google Scholar 

  12. Sargent D, Sobrero A, Grothey A et al (2009) Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 27:872–877

    Article  PubMed  Google Scholar 

  13. Wong SL, Ji H, Hollenbeck BK, Morris AM et al (2007) Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 298:2149–2154

    Article  CAS  PubMed  Google Scholar 

  14. Evans MD, Barton K, Rees A et al (2008) The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease. Colorectal Dis 10:157–164

    CAS  PubMed  Google Scholar 

  15. Kelder W, Inberg B, Plukker JT et al (2008) Effect of modified Davidson’s fixative on examined number of lymph nodes and TNM-stage in colon carcinoma. Eur J Surg Oncol 34:525–530

    CAS  PubMed  Google Scholar 

  16. Wang J, Hassett JM, Dayton MT et al (2008) Lymph node ratio: role in the staging of node-positive colon cancer. Ann Surg Oncol 15:1600–1608

    Article  PubMed  Google Scholar 

  17. Truong PT, Vinh-Hung V, Cserni G et al (2008) The number of positive nodes and the ratio of positive to excised nodes are significant predictors of survival in women with micrometastatic node-positive breast cancer. Eur J Cancer 44:1670–1677

    Article  PubMed  Google Scholar 

  18. Slidell MB, Chang DC, Cameron JL et al (2008) Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol 15:165–174

    Article  PubMed  Google Scholar 

  19. Mariette C, Piessen G, Briez N et al (2008) The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in oesophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg 247:365–371

    Article  PubMed  Google Scholar 

  20. Marchet A, Mocellin S, Ambrosi A et al (2008) The prognostic value of N-ratio in patients with gastric cancer. Validation in a large, multicenter series. Eur J Surg Oncol 34:159–165

    CAS  PubMed  Google Scholar 

  21. Berger AC, Sigurdson ER, LeVoyer T et al (2005) Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 23:8706–8712

    Article  PubMed  Google Scholar 

  22. De Ridder M, Vinh-Hung V, Van Nieuwenhove Y et al (2006) Prognostic value of the lymph node ratio in node positive colon cancer. Gut 55:1681

    Article  PubMed  Google Scholar 

  23. Lee HY, Choi HJ, Park KJ et al (2007) Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg Oncol 14:1712–1717

    Article  PubMed  Google Scholar 

  24. Schumacher P, Dineen S, Barnett C et al (2007) The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg 194:827–832

    Article  PubMed  Google Scholar 

  25. Peschaud F, Benoist S, Julié C et al (2008) The ratio of metastatic to examined lymph nodes is a powerful independent prognostic factor in rectal cancer. Ann Surg 248:1067–1073

    Article  PubMed  Google Scholar 

  26. Chapuis PH, Dent OF, Bokey EL et al (2004) Adverse histopathological findings as a guide to patient management after curative resection of node positive colon cancer. Br J Surg 91:349–354

    Article  CAS  PubMed  Google Scholar 

  27. Newell KJ, Sawka BW, Rudrick BF et al (2001) GEWF solution. An inexpensive, simple, and effective aid for the retrieval of lymph nodes from colorectal cancer resections. Arch Pathol Lab Med 125:642–645

    CAS  PubMed  Google Scholar 

  28. Bembenek A, Schneider U, Gretschel S et al (2005) Detection of lymph node micrometastases and isolated tumor cells in sentinel and nonsentinel nodes of colon cancer patients. World J Surg 29:1172–1175

    Article  PubMed  Google Scholar 

  29. de Haas RJ, Wicherts DA, Hobbelink MG et al (2007) Sentinel lymph node mapping in colon cancer: current status. Ann Surg Oncol 14:1070–1080

    Article  PubMed  Google Scholar 

  30. Galizia G, Lieto E, Ferraraccio F et al (2004) Determination of molecular marker expression can predict clinical outcome in colon carcinomas. Clin Cancer Res 10:3490–3499

    Article  CAS  PubMed  Google Scholar 

  31. Chan YH (2004) Biostatistics 203. Survival analysis. Singapore Med J 45:249–256

    CAS  PubMed  Google Scholar 

  32. Compton CC, Fielding LP, Burgart LJ et al (2000) Prognostic factors in colorectal cancer: College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994

    CAS  PubMed  Google Scholar 

  33. Greene FL, Stewart AK, Norton J (2002) A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg 236:416–421

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, “F. Magrassi, A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, c/o II Policlinico, Edificio 17, Via Pansini, 5, 80131, Naples, Italy

    Gennaro Galizia, Paolo Castellano, Margherita Pinto, Anna Zamboli, Carlo Pignatelli & Eva Lieto

  2. Division of Medical Oncology, “F. Magrassi, A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy

    Michele Orditura, Sabrina Cecere & Ferdinando De Vita

  3. Division of Pathology, “F. Magrassi, A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy

    Francesca Ferraraccio

Authors
  1. Gennaro Galizia
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  2. Michele Orditura
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  3. Francesca Ferraraccio
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  4. Paolo Castellano
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  5. Margherita Pinto
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  6. Anna Zamboli
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  7. Sabrina Cecere
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  8. Ferdinando De Vita
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  9. Carlo Pignatelli
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  10. Eva Lieto
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Corresponding author

Correspondence to Gennaro Galizia.

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Galizia, G., Orditura, M., Ferraraccio, F. et al. The Lymph Node Ratio Is a Powerful Prognostic Factor of Node-Positive Colon Cancers Undergoing Potentially Curative Surgery. World J Surg 33, 2704–2713 (2009). https://doi.org/10.1007/s00268-009-0207-z

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  • DOI: https://doi.org/10.1007/s00268-009-0207-z

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