The Prognostic Significance of Lymph Node Status and Lymph Node Ratio (LNR) on Survival of Right Colon Cancer Patients:
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ORIGINAL RESEARCH
The Prognostic Significance of Lymph Node Status and Lymph Node Ratio (LNR) on Survival of Right Colon Cancer Patients: a Tertiary Center Experience Mosab Shetiwy 1
&
Amr F Elalfy 1 & Osama Eldamshety 1 & Ramy Abbas 2 & Mohamed Abdelkhalek 1
Accepted: 17 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Colon cancer is a major health problem and is one of the most frequent cancers all over the world. In Egypt, the incidence of colon cancer is relatively low, but its mortality rate is high. Lymphatic spread of colon cancer is one of the most important factors affecting the prognosis of patients. Recently, the lymph node ratio (LNR) has been evaluated as a prognostic parameter for survival. This study aimed at evaluation of nodal status of resected specimens and LNR, as well as its impact on the disease-free survival (DFS) and overall survival (OS) after curative resection of right colon cancer. Methods The institutional registry of the Oncology Center Mansoura University (OCMU) was revised for node-positive right colon cancer cases that were operated in the period between January 2010 and January 2015. Fifty-three patients met the inclusion criteria and were followed up till January 2020. Results A total of 766 lymph nodes were excised from the patients. Thirty-two patients (60.4%) had a LN yield of ≥12 LNs with a mean LNR of 0.257 ± 0.27. Multivariate analysis of outcomes showed that LNR was significantly correlated with both DFS (p = 0.015) and OS (p = 0.024). Moreover, the number of resected LNs was also associated with statistically significant relationship with the DFS and OS. Conclusion Our study confirms the validity of LNR as a prognostic tool that correlates with the survival of patients. Moreover, LNR cutoff values may help predict those of high chance of tumor recurrence. Trial Registration MS/20.03.1087 (Institutional IRB), date of registration: March 10, 2020, “retrospectively registered”. Keywords Right colon cancer . Lymph node ratio . Disease-free survival . Overall survival
Introduction The prognosis of colon cancer has been linked to several factors, the most important of which is the lymphatic spread of the disease. According to the 8th edition of the American Joint Committee on Cancer (AJCC) cancer staging system, lymph node (LN)–positive disease classifies the tumor as stage III disease (including micro-metastasis) [1]. Stage III (nonmetastatic) colon cancer requires adjuvant chemotherapy,
* Mosab Shetiwy [email protected] 1
Surgical Oncology Unit, Oncology Center, Department of Surgery, Mansoura University, Mansoura, Egypt
2
Medical Oncology Unit, Oncology Center, Department of Medicine, Mansoura University, Mansoura, Egypt
based solely on the node positive disease. Recently, studies suggested that there is a marked increase in the LN yield and evaluation, yet without improvement of the survival of patients with colon cancer [2]. Complete mesocolic excision (CME) with central vascular ligation (CVL) is still
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