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BMC Surg. 2018 Oct 3;18(1):81. doi: 10.1186/s12893-018-0417-0.

Lymph node ratio is inferior to pN-stage in predicting outcome in colon cancer patients with high numbers of analyzed lymph nodes.

Author information

1
Department of Surgery, Spitalzentrum Biel-Bienne AG, Vogelsang 84, CH-2501, Biel, Switzerland.
2
Department of Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
3
Department of Surgery, Spital Limmattal, Schlieren, Switzerland.
4
Department of Surgery, University of Basel, Basel, Switzerland.
5
Department of Surgery, Kantonsspital Olten, Olten, Switzerland.
6
Department of Surgery, Spitalzentrum Biel-Bienne AG, Vogelsang 84, CH-2501, Biel, Switzerland. carsten.viehl@unibas.ch.

Abstract

BACKGROUND:

The lymph node ratio (LNR), i.e. the number of positive lymph nodes (LN) divided by the total number of analyzed LN, has been described as a strong outcome predictor in node-positive colon cancer patients. However, most published analyses are constrained by relatively low numbers of analyzed LN. Therefore, the objective of the present study was to evaluate the prognostic impact of LNR in colon cancer patients with high numbers of analyzed LN.

METHODS:

One hundred sixty-six colon cancer patients underwent open colon resection. All node-positive patients were analyzed for this study. The number of analyzed LN, of positive LN, the disease-free (DFS) and overall survival (OS) time were prospectively recorded. Patients were dichotomously allocated to a high or a low LNR-group, respectively, with the median LNR (0.125) as a cut-off value. Median follow-up was 34.3 months.

RESULTS:

Fifty-eight patients (34.9%) were node-positive. The median number of analyzed LN was 23 (range 8-54). DFS and OS were significantly shorter in pN2 vs pN1 patients (p < 0.001, and p = 0.001, respectively), and in LNR high vs low patients (p = 0.032, and p = 0.034, respectively). pN2 (vs pN1) disease showed hazard ratios (HR) of 6.2 (p < 0.001), and 6.8 (p < 0.005; for DFS and OS, respectively), while LNR high (vs low) showed HR of 3.0 (p =0.041), and 4.5 (p = 0.054).

CONCLUSIONS:

LNR is a reasonable outcome predictor in node-positive colon cancer patients. However, LNR is inferior to pN-stage in predicting survival in patients with high number of harvested lymph nodes.

KEYWORDS:

Colon cancer; Lymph node ratio; Outcome; pN-stage

PMID:
30285691
PMCID:
PMC6171184
DOI:
10.1186/s12893-018-0417-0
[Indexed for MEDLINE]
Free PMC Article

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