Chengwu Jin1, Xiangbing Deng2, Yan Li3, Wanbin He2, Xuyang Yang2, Jian Liu1. 1. Department of Gastrointestinal Surgery, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China. 2. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 3. State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Abstract
OBJECTIVE: With neoadjuvant therapy increasingly used in advanced rectal cancer, the lymph node ratio (LNR) has been strongly considered to indicate cancer-specific survival in recent years, and a comprehensive evaluation of a large number of studies is deficient. The objective of our study is to pool enough eligible studies to assess the relationship between LNR and prognosis of advanced rectal cancer after neoadjuvant therapy. METHODS: A systematic search was done in the PubMed and EmBase databases (through 1 March 2017) that reported LNR in colorectal cancer after neoadjuvant therapy. The first two authors independently conducted the study selection and data extraction. All statistical analyses were conducted using STATA 13.0 (College Station, Texas). RESULTS: Thirteen studies with 4023 participants were included in the meta-analysis, and all were published after 2011. A high LNR was assessed to be a predictor of poor overall survival in rectal cancer after neoadjuvant therapy (HR: 2.94, 95% CI:1.97 to 3.91, P < 0.001). Similarly, a high LNR was related to poor disease-free survival (HR: 2.83, 95% CI: 1.82 to 3.85, P < 0.001). With respect to recurrence, the HRs of 3.25, 1.93, and 2.11 also showed a strong relationship between high LNR and poor local, distant, and total recurrences. CONCLUSIONS: Our present study demonstrates that a high LNR can predict poor survival in advanced rectal cancer. We suggest well-designed clinical trials to prospectively assess LNR as an independent predictor of rectal cancer survival.
OBJECTIVE: With neoadjuvant therapy increasingly used in advanced rectal cancer, the lymph node ratio (LNR) has been strongly considered to indicate cancer-specific survival in recent years, and a comprehensive evaluation of a large number of studies is deficient. The objective of our study is to pool enough eligible studies to assess the relationship between LNR and prognosis of advanced rectal cancer after neoadjuvant therapy. METHODS: A systematic search was done in the PubMed and EmBase databases (through 1 March 2017) that reported LNR in colorectal cancer after neoadjuvant therapy. The first two authors independently conducted the study selection and data extraction. All statistical analyses were conducted using STATA 13.0 (College Station, Texas). RESULTS: Thirteen studies with 4023 participants were included in the meta-analysis, and all were published after 2011. A high LNR was assessed to be a predictor of poor overall survival in rectal cancer after neoadjuvant therapy (HR: 2.94, 95% CI:1.97 to 3.91, P < 0.001). Similarly, a high LNR was related to poor disease-free survival (HR: 2.83, 95% CI: 1.82 to 3.85, P < 0.001). With respect to recurrence, the HRs of 3.25, 1.93, and 2.11 also showed a strong relationship between high LNR and poor local, distant, and total recurrences. CONCLUSIONS: Our present study demonstrates that a high LNR can predict poor survival in advanced rectal cancer. We suggest well-designed clinical trials to prospectively assess LNR as an independent predictor of rectal cancer survival.