Lymph-node ratio is an independent prognostic factor in patients with stage III colorectal cancer: a retrospective study
- PDF / 279,793 Bytes
- 7 Pages / 595.28 x 793.7 pts Page_size
- 70 Downloads / 195 Views
WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Lymph-node ratio is an independent prognostic factor in patients with stage III colorectal cancer: a retrospective study from the Middle East Elias Elias1, Deborah Mukherji1, Walid Faraj2, Mohammad Khalife2, Hani Dimassi3, Mohamad Eloubeidi4, Hasan Hattoum5, Ghassan K Abou-Alfa6, Ahmad Saleh1 and Ali Shamseddine1*
Abstract Background: In this retrospective study, we evaluated the prognostic effect of positive lymph-node ratio (pLNR) on patients with stage III colorectal cancer (CRC). Our paper is the first analysis, to our knowledge, to deal with such data from the Middle East. Methods: We analyzed the clinicopathological data of 535 patients diagnosed with colorectal cancer at our institution between 1983 and 2003. The 164 patients diagnosed with stage III disease were divided into two categories based on lymph-node ratio (LNR) being the ratio of positive lymph nodes over total lymph nodes dissected: LNR ≤0.4 and LNR >0.4. We used Kaplan-Meier and Cox proportional hazard models to evaluate the prognostic effect of pLNR. Results: The 10-year survival rate for the patients with stage IIIA, IIIB and IIIC cancers were 76%, 56% and 0% respectively (P = 0.014). Using pLNR of 0.4 as the cutoff point was found to yield clinically and significant results, with a significant difference in the outcomes of patients with pLNR ≤0.4 compared to those with pLNR >0.4 (hazard ratio = 5.25, 95% confidence interval = 1.2 to 22.1, P = 0.02). Conclusion: The ratio-based staging (pLNR) of CRC is a more accurate and clinically useful prognostic method than the number of positive LNs resected or the total number of LNs retrieved for predicting the course of patients with stage III CRC. Keywords: Colorectal cancer, Stage III, Lymph node ratio, Prognosis
Background Colorectal cancer (CRC) is the third most common cancer in both female and male populations [1]. Currently, its progression is staged using the TNM (tumor, node, metastasis) staging system according to tumor size, lymph-node involvement and distant metastases, as recommended by the American Joint Committee on Cancer (AJCC) [2]. However, many investigators have questioned the prognostic power of the TNM system because of the possibility of stage migration, and have proposed alternative prognostic methods.
* Correspondence: [email protected] 1 Division of Hematology and Oncology, Department of Internal Medicine American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon Full list of author information is available at the end of the article
One notable alternative bases a patient’s prognosis upon the total number of LNs resected. This concept has long been debated in the literature. Many studies have shown that a higher number of LNs retrieved leads to more accurate staging and apparently improved survival outcomes [3-8]. Furthermore, a study conducted by the National Cancer Institute (NCI) involving 60,000 patients illustrated a relationship between the number of resected positive LNs and the survival rate in s
Data Loading...
