Li Chen1, Xuefeng Huang1, Zhangfa Song1. 1. Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China.
Abstract
BACKGROUND: Although the absolute number of postoperative positive lymph nodes has been considered as one of the most important predictors for the survival of rectal cancer patients, many researchers have suggested that the lymph node ratio (LNR) may have a better predictive effect. After chemoradiotherapy for rectal cancer, the number of lymph nodes harvested is often reduced, and the predictive value of the postoperative LNR after chemoradiotherapy is still unclear. We performed a retrospective study to analyze the survival predictive value of the LNR after preoperative chemoradiotherapy for rectal cancer. METHODS: Between January 2012 and December 2014, a total of 133 patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy followed by total mesorectal excision were reviewed. According to the postoperative pathological LNR, patients were divided into 3 groups, i.e., LNR = 0, 0 < LNR ≤ 0.15, and 0.15 < LNR ≤ 1, and patients with lymph node metastasis were divided into 2 groups, and the overall survival (OS) and disease-free survival (DFS) of each group were analyzed and evaluated. RESULTS: The median follow-up time of this study was 40 months, and the 5-year OS and DFS rates were 86.3% and 74.8% for the whole cohort, respectively. According to the postoperative pathological LNR, patients were divided into 3 groups, LNR = 0, 0 < LNR ≤ 0.15, 0.15 < LNR ≤ 1, the respective 5-year OS and DFS rates for the LNR 3 groups were 96.7%, 94.7% and 42.9% (P < 0.001) and 84.9%, 73%, and 30.7% (P < 0.001), respectively. Multivariate analysis revealed that only the LNR was the independent prognostic factor for these patients. For patients with lymph node metastasis, it was also revealed that only the LNR was an independent prognostic factor. Subgroup analysis demonstrated that there was a significant correlation between the LNR and patient survival both in the number of lymph nodes harvested, less than 12 and more than 12 subgroups (P < 0.05). CONCLUSION: The postoperative positive lymph node ratio (LNR) is an independent prognostic factor for patients with locally advanced rectal cancer who undergo preoperative chemoradiotherapy followed by total mesorectal excision. Both in the number of lymph nodes harvested less than 12 and more than 12 subgroups, the LNR is significantly correlated with patient survival. IJCEP
BACKGROUND: Although the absolute number of postoperative positive lymph nodes has been considered as one of the most important predictors for the survival of rectal cancerpatients, many researchers have suggested that the lymph node ratio (LNR) may have a better predictive effect. After chemoradiotherapy for rectal cancer, the number of lymph nodes harvested is often reduced, and the predictive value of the postoperative LNR after chemoradiotherapy is still unclear. We performed a retrospective study to analyze the survival predictive value of the LNR after preoperative chemoradiotherapy for rectal cancer. METHODS: Between January 2012 and December 2014, a total of 133 patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy followed by total mesorectal excision were reviewed. According to the postoperative pathological LNR, patients were divided into 3 groups, i.e., LNR = 0, 0 < LNR ≤ 0.15, and 0.15 < LNR ≤ 1, and patients with lymph node metastasis were divided into 2 groups, and the overall survival (OS) and disease-free survival (DFS) of each group were analyzed and evaluated. RESULTS: The median follow-up time of this study was 40 months, and the 5-year OS and DFS rates were 86.3% and 74.8% for the whole cohort, respectively. According to the postoperative pathological LNR, patients were divided into 3 groups, LNR = 0, 0 < LNR ≤ 0.15, 0.15 < LNR ≤ 1, the respective 5-year OS and DFS rates for the LNR 3 groups were 96.7%, 94.7% and 42.9% (P < 0.001) and 84.9%, 73%, and 30.7% (P < 0.001), respectively. Multivariate analysis revealed that only the LNR was the independent prognostic factor for these patients. For patients with lymph node metastasis, it was also revealed that only the LNR was an independent prognostic factor. Subgroup analysis demonstrated that there was a significant correlation between the LNR and patient survival both in the number of lymph nodes harvested, less than 12 and more than 12 subgroups (P < 0.05). CONCLUSION: The postoperative positive lymph node ratio (LNR) is an independent prognostic factor for patients with locally advanced rectal cancer who undergo preoperative chemoradiotherapy followed by total mesorectal excision. Both in the number of lymph nodes harvested less than 12 and more than 12 subgroups, the LNR is significantly correlated with patient survival. IJCEP
Authors: S D Lee; T H Kim; D Y Kim; J Y Baek; S Y Kim; H J Chang; S C Park; J W Park; J H Oh; K H Jung Journal: Eur J Surg Oncol Date: 2012-03-30 Impact factor: 4.424
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