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Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision.
Medicine (Baltimore). 2016 Mar; 95(9):e2988.M

Abstract

Although the absolute number of positive lymph nodes (LNs) has been established as 1 of the most important prognostic factors in rectal cancers, many researchers have proposed that the lymph node ratio (LNR) may have better predicted outcomes. We conducted a retrospective study to compare the predictive ability of LNR and ypN category in rectal cancer. A total of 264 locally advanced rectal cancer (LARC) patients who underwent preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) between 2005 and 2012 were reviewed. All patients were categorized into 3 groups or patients with metastatic LNs were categorized into 2 groups according to the LNR. The prognostic effect on overall survival (OS) and disease-free survival (DFS) was evaluated. With a median follow-up of 45 months, the OS and DFS were 68.4% and 59.3% for the entire cohort, respectively. The respective 5-year OS and DFS rates for the 3 groups (LNR = 0, 0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were as follows: 83.2%, 72.6%, and 49.4% (P < 0.001) and 79.5%, 57.3%, and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that LNR and differentiation, but not the number of positive LNs, had independent prognostic value for OS (hazard ratio [HR] = 2.328, 95% confidence interval [CI]: 1.850-4.526, P < 0.001) and DFS (HR = 3.004, 95% CI: 1.616-5.980, P < 0.001). As for patients with positive LNs, the respective 5-year OS and DFS rates for the 2 groups (0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were 72.6% and 49.4% (P < 0.001) and 57.3% and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that only LNR was an independent factor for OS (HR = 3.214, 95% CI: 1.726-5.986, P < 0.001) and DFS (HR = 4.230, 95% CI: 1.825-6.458, P < 0.001). Subgroups analysis demonstrated that the ypN category had no impact on survival whereas increased LNR was a significantly prognostic indicator for worse survival in the LNs < 12 subgroup. LNR is an independent prognostic factor in LARC patients treated with preoperative CRT followed by TME. It may be a better independent staging method than the number of metastatic LNs when <12 LNs are harvested after preoperative CRT.

Authors+Show Affiliations

From the Department of Colorectal Surgery (Z-GZ, X-ZY, CX, X-BW, J-HC, Z-HZ, J-LL, H-YS, SCN), Department of Pathology (Z-QL, PL), and Central Laboratory (LJ), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou; Department of Colorectal Surgery, The Third People's Hospital of Hangzhou City, Hangzhou (X-FZ); and Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai (HW, Q-ZL), China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26945418

Citation

Zuo, Zhi-Gui, et al. "Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed By Total Mesorectal Excision." Medicine, vol. 95, no. 9, 2016, pp. e2988.
Zuo ZG, Zhang XF, Wang H, et al. Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision. Medicine (Baltimore). 2016;95(9):e2988.
Zuo, Z. G., Zhang, X. F., Wang, H., Liu, Q. Z., Ye, X. Z., Xu, C., Wu, X. B., Cai, J. H., Zhou, Z. H., Li, J. L., Song, H. Y., Luo, Z. Q., Li, P., Ni, S. C., & Jiang, L. (2016). Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision. Medicine, 95(9), e2988. https://doi.org/10.1097/MD.0000000000002988
Zuo ZG, et al. Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed By Total Mesorectal Excision. Medicine (Baltimore). 2016;95(9):e2988. PubMed PMID: 26945418.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision. AU - Zuo,Zhi-Gui, AU - Zhang,Xiu-Feng, AU - Wang,Hao, AU - Liu,Qi-Zhi, AU - Ye,Xing-Zhao, AU - Xu,Chang, AU - Wu,Xiang-Bin, AU - Cai,Jian-Hui, AU - Zhou,Zhen-Hua, AU - Li,Jin-Lei, AU - Song,Hua-Yu, AU - Luo,Zu-Qiang, AU - Li,Peng, AU - Ni,Shi-Chang, AU - Jiang,Lei, PY - 2016/3/6/entrez PY - 2016/3/6/pubmed PY - 2016/7/16/medline SP - e2988 EP - e2988 JF - Medicine JO - Medicine (Baltimore) VL - 95 IS - 9 N2 - Although the absolute number of positive lymph nodes (LNs) has been established as 1 of the most important prognostic factors in rectal cancers, many researchers have proposed that the lymph node ratio (LNR) may have better predicted outcomes. We conducted a retrospective study to compare the predictive ability of LNR and ypN category in rectal cancer. A total of 264 locally advanced rectal cancer (LARC) patients who underwent preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) between 2005 and 2012 were reviewed. All patients were categorized into 3 groups or patients with metastatic LNs were categorized into 2 groups according to the LNR. The prognostic effect on overall survival (OS) and disease-free survival (DFS) was evaluated. With a median follow-up of 45 months, the OS and DFS were 68.4% and 59.3% for the entire cohort, respectively. The respective 5-year OS and DFS rates for the 3 groups (LNR = 0, 0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were as follows: 83.2%, 72.6%, and 49.4% (P < 0.001) and 79.5%, 57.3%, and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that LNR and differentiation, but not the number of positive LNs, had independent prognostic value for OS (hazard ratio [HR] = 2.328, 95% confidence interval [CI]: 1.850-4.526, P < 0.001) and DFS (HR = 3.004, 95% CI: 1.616-5.980, P < 0.001). As for patients with positive LNs, the respective 5-year OS and DFS rates for the 2 groups (0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were 72.6% and 49.4% (P < 0.001) and 57.3% and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that only LNR was an independent factor for OS (HR = 3.214, 95% CI: 1.726-5.986, P < 0.001) and DFS (HR = 4.230, 95% CI: 1.825-6.458, P < 0.001). Subgroups analysis demonstrated that the ypN category had no impact on survival whereas increased LNR was a significantly prognostic indicator for worse survival in the LNs < 12 subgroup. LNR is an independent prognostic factor in LARC patients treated with preoperative CRT followed by TME. It may be a better independent staging method than the number of metastatic LNs when <12 LNs are harvested after preoperative CRT. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/26945418/Prognostic_Value_of_Lymph_Node_Ratio_in_Locally_Advanced_Rectal_Cancer_Patients_After_Preoperative_Chemoradiotherapy_Followed_by_Total_Mesorectal_Excision_ L2 - http://dx.doi.org/10.1097/MD.0000000000002988 DB - PRIME DP - Unbound Medicine ER -