The Prognostic Significance of the Metastatic Lymph Node Ratio versus the Number of Affected Lymph Nodes in Patients with Colorectal Cancer Stage III Undergoing Potentially Curative Surgery | ||
| The Medical Journal of Cairo University | ||
| Article 62, Volume 86, March, March 2018, Pages 491-496 PDF (509.45 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/mjcu.2018.55187 | ||
| Authors | ||
| AHMED S.A. ABDUL-SAMAD, M.Sc.; MOSTAFA A. SOLIMAN, M.D.; MAMDOH H. HAGGAG, M.D.; TAREK O. HEGAZY, M.D. | ||
| The Department of General Surgery, Faculty of Medicine, Cairo University | ||
| Abstract | ||
| Abstract Background: Many investigators have questioned the prognostic power of the TNM system in the prognosis of colorectal cancer because of the possibility of stage migration, and have proposed alternative prognostic methods; one of those is the lymph node ratio. Aim of Work: The objective of this study is to compare the prognostic significance of the LNR with the absolute number of affected lymph nodes for resected colorectal ade-nocarcinoma stage III regarding overall and disease specific survival. Patients and Methods: 55 patients with colorectal cancer stage III who underwent curative surgery were enrolled in a retrospective cohort study reviewing their medical charts from Medical Oncology Department between January 2005 and December 2006, and their five years follow-up period regarding local recurrence, metastasis and survival. Results: The mean follow-up time was 55.1±18 months (range 6-72, median 60 months). During this time period, 12 (21.8%) patients died of disease, 20 (36.4%) patients developed local recurrence or metastasis. Overall Survival (OS) was 90.9%, 85.5%, 78.2% at 1.5, 3, 5 years respectively. Disease Specific Survival (DSS) was 90.9%, 74.5%, 63.6% at 1.5, 3, 5 years respectively. Five year overall survival rates was significantly worse in colorectal cancers with LNR >40% (p-value <0.01, hazard ratio 0.022, 95% CI 0.003-0.17) and also worse 5 year disease specific survival (p-value <0.01, hazard ratio 0.182, 95% CI 0.075-0.44). Total LN £ 11 and positive number of LNs >4 showed significant worsening in the 5 year DSS only (p-value <0.05, hazard ratio 2.8, 95% CI 1.025-7.7) vs. (p-value <0.05, hazard ratio 0.32, 95% CI 0.13-0.8) respectively. Conclusion: LNR was a robust prognostic indicator for node-positive colon cancers undergoing curative surgery. Because this ratio-based staging was demonstrated to reduce stage migration and to aid in identifying high-risk patients, application of the pLNR improved patient stratification in colorectal cancer and may be considered in future staging systems, it could be proposed as a standard tool for colon cancer staging. | ||
| Keywords | ||
| Lymph node ratio – Colorectal cancer | ||
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