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Negative to positive lymph node ratio is a superior predictor than traditional lymph node status in stage III colorectal cancer.
Oncotarget. 2016 11 01; 7(44):72290-72299.O

Abstract

Negative lymph node counts has recently attracted attention as a prognostic indicator in colorectal cancer (CRC). But little is known about prognostic significance of negative to positive lymph node ratio (NPR) in CRC. Our aim was to determine impact of NPR on oncological outcomes in patients with stage III CRC. This retrospective study included 2,256 patients with stage III CRC under curative resection at Fudan university Shanghai cancer center. Kaplan-Meier methods and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors. Accuracy of the NPR was assessed with the Harrell's concordance-index(C-index).X-tile program identified 2.38 or 0.55/2.38 as the optimal cutoff value for NPR to divide the cohort into high/low risk or high/middle/low risk subsets in terms of CRC cause specific survival (CCSS). In a multivariate analysis, NPR was significant independent prognostic factors for CCSS (P<0.05), notably, N classification was not an independently prognostic factor (P>0.05).Further analysis found NPR could give detailed prognostic classification for both N1 and N2 stage (P<0.05). Interestingly, patients in N2+ NPR >2.38 stage have similar survival outcome with N1+ NPR >2.38 stage (χ2=0.030, P=0.863), and better than those at N1+ NPR ≤2.38 and N2+ NPR ≤2.38 stage (P<0.001). The TNNPRM stage was more accurate for predicting CCSS (C-index = 0.659) than current TNM stage system(C-index = 0.628) (P<0.001). Collectively, NPR was an independent prognostic factor for stage III CRC patients, it could provide more accurate prognostic information than the current node stage system.

Authors+Show Affiliations

Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Center for Biomedical Statistics, Fudan University Shanghai Cancer Center, Shanghai, China.Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.Center for Biomedical Statistics, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27474167

Citation

Li, Qingguo, et al. "Negative to Positive Lymph Node Ratio Is a Superior Predictor Than Traditional Lymph Node Status in Stage III Colorectal Cancer." Oncotarget, vol. 7, no. 44, 2016, pp. 72290-72299.
Li Q, Liang L, Jia H, et al. Negative to positive lymph node ratio is a superior predictor than traditional lymph node status in stage III colorectal cancer. Oncotarget. 2016;7(44):72290-72299.
Li, Q., Liang, L., Jia, H., Li, X., Xu, Y., Zhu, J., & Cai, S. (2016). Negative to positive lymph node ratio is a superior predictor than traditional lymph node status in stage III colorectal cancer. Oncotarget, 7(44), 72290-72299. https://doi.org/10.18632/oncotarget.10806
Li Q, et al. Negative to Positive Lymph Node Ratio Is a Superior Predictor Than Traditional Lymph Node Status in Stage III Colorectal Cancer. Oncotarget. 2016 11 1;7(44):72290-72299. PubMed PMID: 27474167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Negative to positive lymph node ratio is a superior predictor than traditional lymph node status in stage III colorectal cancer. AU - Li,Qingguo, AU - Liang,Lei, AU - Jia,Huixun, AU - Li,Xinxiang, AU - Xu,Ye, AU - Zhu,Ji, AU - Cai,Sanjun, PY - 2015/12/23/received PY - 2016/07/14/accepted PY - 2016/7/31/pubmed PY - 2018/2/24/medline PY - 2016/7/31/entrez KW - colorectal cancer KW - lymph node ratio KW - prognosis analysis KW - surgical resection SP - 72290 EP - 72299 JF - Oncotarget JO - Oncotarget VL - 7 IS - 44 N2 - Negative lymph node counts has recently attracted attention as a prognostic indicator in colorectal cancer (CRC). But little is known about prognostic significance of negative to positive lymph node ratio (NPR) in CRC. Our aim was to determine impact of NPR on oncological outcomes in patients with stage III CRC. This retrospective study included 2,256 patients with stage III CRC under curative resection at Fudan university Shanghai cancer center. Kaplan-Meier methods and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors. Accuracy of the NPR was assessed with the Harrell's concordance-index(C-index).X-tile program identified 2.38 or 0.55/2.38 as the optimal cutoff value for NPR to divide the cohort into high/low risk or high/middle/low risk subsets in terms of CRC cause specific survival (CCSS). In a multivariate analysis, NPR was significant independent prognostic factors for CCSS (P<0.05), notably, N classification was not an independently prognostic factor (P>0.05).Further analysis found NPR could give detailed prognostic classification for both N1 and N2 stage (P<0.05). Interestingly, patients in N2+ NPR >2.38 stage have similar survival outcome with N1+ NPR >2.38 stage (χ2=0.030, P=0.863), and better than those at N1+ NPR ≤2.38 and N2+ NPR ≤2.38 stage (P<0.001). The TNNPRM stage was more accurate for predicting CCSS (C-index = 0.659) than current TNM stage system(C-index = 0.628) (P<0.001). Collectively, NPR was an independent prognostic factor for stage III CRC patients, it could provide more accurate prognostic information than the current node stage system. SN - 1949-2553 UR - https://www.unboundmedicine.com/medline/citation/27474167/Negative_to_positive_lymph_node_ratio_is_a_superior_predictor_than_traditional_lymph_node_status_in_stage_III_colorectal_cancer_ L2 - http://www.impactjournals.com/oncotarget/misc/linkedout.php?pii=10806 DB - PRIME DP - Unbound Medicine ER -