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Published in: Langenbeck's Archives of Surgery 7/2012

01-10-2012 | Original Article

Prognostic significance of lymph node ratio in patients undergoing abdominoperineal resection of rectum

Authors: M. Tayyab, A. Sharma, A. W. MacDonald, J. Gunn, J. E. Hartley, J. R. T. Monson

Published in: Langenbeck's Archives of Surgery | Issue 7/2012

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Abstract

Background

Lymph node ratio (LNR) has been shown to be an independent prognostic factor in stage III colorectal cancer. Abdominoperineal resection (APR) of rectum is historically associated with poorer oncological outcomes compared to other colorectal resections, and significance of LNR in this group of patients has not been studied.

Objective

Our aim was to determine impact of LNR on oncological outcomes in a series of patients with rectal cancers undergoing APR.

Patients and methods

A series of patients who had undergone APR and had lymph node metastasis were identified from a prospectively maintained clinical, histopathological and radiological database. LNR was calculated, and Cox regression was used to determine the impact of factors affecting local recurrence, distal metastases and overall survival.

Results

Fifty-eight (42 males) patients were identified to have rectal cancer with lymph node involvement. LNR was an independent predictor of distal metastasis and overall survival at cutoff levels of 0.17, 0.41 and 0.69.

Conclusion

Lymph node ratio is an independent predictor of survival outcomes in patients with stage III tumours undergoing APR. LNR may help improve stratification of this group of patients.
Literature
1.
go back to reference UK bowel cancer incidence statistics. Cancer Research UK, 2009 UK bowel cancer incidence statistics. Cancer Research UK, 2009
2.
go back to reference UK, C.R., UK bowel cancer mortality statistics, 2009 UK, C.R., UK bowel cancer mortality statistics, 2009
3.
go back to reference Newland RC et al (1981) The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases. Cancer 47(6):1424–9PubMedCrossRef Newland RC et al (1981) The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases. Cancer 47(6):1424–9PubMedCrossRef
4.
go back to reference Baxter NN et al (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97(3):219–25PubMedCrossRef Baxter NN et al (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97(3):219–25PubMedCrossRef
5.
go back to reference Vather R 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(3):585–93PubMedCrossRef Vather R 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(3):585–93PubMedCrossRef
6.
go back to reference Sobin LH, Fleming ID (1997) TNM classification of malignant tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer 80(9):1803–4PubMedCrossRef Sobin LH, Fleming ID (1997) TNM classification of malignant tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer 80(9):1803–4PubMedCrossRef
7.
go back to reference Park IJ, Choi GS, Jun SH (2009) Nodal stage of stage III colon cancer: the impact of metastatic lymph node ratio. J Surg Oncol 100(3):240–3PubMedCrossRef Park IJ, Choi GS, Jun SH (2009) Nodal stage of stage III colon cancer: the impact of metastatic lymph node ratio. J Surg Oncol 100(3):240–3PubMedCrossRef
8.
go back to reference Rosenberg R 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(6):968–78PubMedCrossRef Rosenberg R 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(6):968–78PubMedCrossRef
9.
go back to reference Kim YS et al (2009) Lymph node ratio as a prognostic factor in patients with stage III rectal cancer treated with total mesorectal excision followed by chemoradiotherapy. Int J Radiat Oncol Biol Phys 74(3):796–802PubMedCrossRef Kim YS et al (2009) Lymph node ratio as a prognostic factor in patients with stage III rectal cancer treated with total mesorectal excision followed by chemoradiotherapy. Int J Radiat Oncol Biol Phys 74(3):796–802PubMedCrossRef
10.
go back to reference Moug SJ et al (2009) Positive lymph node retrieval ratio optimises patient staging in colorectal cancer. Br J Cancer 100(10):1530–3PubMedCrossRef Moug SJ et al (2009) Positive lymph node retrieval ratio optimises patient staging in colorectal cancer. Br J Cancer 100(10):1530–3PubMedCrossRef
11.
go back to reference Van Belle V et al (2009) Lymph node ratio better predicts disease-free survival in node-positive breast cancer than the number of positive lymph nodes. J Clin Oncol 27(7):1062–8CrossRef Van Belle V et al (2009) Lymph node ratio better predicts disease-free survival in node-positive breast cancer than the number of positive lymph nodes. J Clin Oncol 27(7):1062–8CrossRef
12.
go back to reference Yu JX, Li Y (2007) The staging system of metastatic lymph node ratio in gastric cancer. Clin Oncol (R Coll Radiol) 19(4):269–70CrossRef Yu JX, Li Y (2007) The staging system of metastatic lymph node ratio in gastric cancer. Clin Oncol (R Coll Radiol) 19(4):269–70CrossRef
13.
go back to reference Kim JS et al (2009) Oncologic outcomes after radical surgery following preoperative chemoradiotherapy for locally advanced lower rectal cancer: abdominoperineal resection versus sphincter-preserving procedure. Ann Surg Oncol 16(5):1266–73PubMedCrossRef Kim JS et al (2009) Oncologic outcomes after radical surgery following preoperative chemoradiotherapy for locally advanced lower rectal cancer: abdominoperineal resection versus sphincter-preserving procedure. Ann Surg Oncol 16(5):1266–73PubMedCrossRef
14.
go back to reference Ha YH, Jeong SY, Lim SB, Choi HS, Hong YS, Chang HJ, Kim DY, Jung KH, Park JG (2010) Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Ann Surg 252(2):336–40PubMedCrossRef Ha YH, Jeong SY, Lim SB, Choi HS, Hong YS, Chang HJ, Kim DY, Jung KH, Park JG (2010) Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Ann Surg 252(2):336–40PubMedCrossRef
15.
go back to reference Inoue K et al (2002) The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 9(1):27–34PubMedCrossRef Inoue K et al (2002) The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 9(1):27–34PubMedCrossRef
16.
go back to reference Johnson PM 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(22):3570–5PubMedCrossRef Johnson PM 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(22):3570–5PubMedCrossRef
17.
go back to reference Chang GJ et al (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99(6):433–41PubMedCrossRef Chang GJ et al (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99(6):433–41PubMedCrossRef
18.
go back to reference Ceelen W, Van Nieuwenhove Y, Pattyn P (2010) Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol 17(11):2847–55PubMedCrossRef Ceelen W, Van Nieuwenhove Y, Pattyn P (2010) Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol 17(11):2847–55PubMedCrossRef
19.
go back to reference Chen SL, Steele SR, Eberhardt J, Zhu K, Bilchik A, Stojadinovic A (2011) Lymph node ratio as a quality and prognostic indicator in stage III colon cancer. Ann Surg 253(1):82–7PubMedCrossRef Chen SL, Steele SR, Eberhardt J, Zhu K, Bilchik A, Stojadinovic A (2011) Lymph node ratio as a quality and prognostic indicator in stage III colon cancer. Ann Surg 253(1):82–7PubMedCrossRef
20.
go back to reference Moran MR et al (1992) Prognostic value of positive lymph nodes in rectal cancer. Dis Colon Rectum 35(6):579–81PubMedCrossRef Moran MR et al (1992) Prognostic value of positive lymph nodes in rectal cancer. Dis Colon Rectum 35(6):579–81PubMedCrossRef
21.
go back to reference Faus C et al (2010) The role of the pathologist in rectal cancer diagnosis and staging and surgical quality assessment. Clin Transl Oncol 12(5):339–345PubMedCrossRef Faus C et al (2010) The role of the pathologist in rectal cancer diagnosis and staging and surgical quality assessment. Clin Transl Oncol 12(5):339–345PubMedCrossRef
Metadata
Title
Prognostic significance of lymph node ratio in patients undergoing abdominoperineal resection of rectum
Authors
M. Tayyab
A. Sharma
A. W. MacDonald
J. Gunn
J. E. Hartley
J. R. T. Monson
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Langenbeck's Archives of Surgery / Issue 7/2012
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-012-0986-9

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