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. 2017 Jun;6(3):154-161.
doi: 10.21037/hbsn.2016.08.08.

Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer

Ali Ahmad  1 , Jeffrey Reha  1 , Abdul Saied  1   2 , N Joseph Espat  1   2 , Ponnandai Somasundar  1   2 , Steven C Katz  1   2
Affiliations

Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer

Ali Ahmad et al. Hepatobiliary Surg Nutr. 2017 Jun.

Abstract

Background: The primary objective of our study was to assess the association of primary tumor lymph node ratio (LNR) in stage IV colorectal adenocarcinomas (CRC) with overall survival (OS) and the extent of metastatic disease in the liver.

Methods: We analyzed data on 53 stage IV CRC patients who underwent surgical resection of the primary tumor. The median LNR of 0.25 was used to stratify patients into high LNR (H-LNR) and low LNR (L-LNR) groups. Statistical comparison was performed using chi square test and multiple regression models. OS was calculated using the Kaplan-Meier (KM) method while cox regression was used for multivariate analysis.

Results: H-LNR status was associated with the presence of >3 liver metastases (LM) [odds ratio (OR): 2.43, P=0.047] and bilobar LM (OR: 3.94, P=0.039). The OS in H-LNR patients was significantly worse in the entire cohort compared to L-LNR (9% vs. 34% at 3 years, P=0.027). The 5-year OS in patients undergoing liver resection for LM was also significantly worse in the H-LNR group (0% vs. 37%, P=0.013). LNR was independently associated with survival on multivariate analysis [HR: 2.63; 95% confidence intervals (CI), 1.13-6.14; P=0.025].

Conclusions: In stage IV CRC, LNR is associated with the extent of hepatic tumor burden and was an independent predictor of survival in patients undergoing liver resection.

Keywords: Colorectal cancer (CRC); liver metastases (LM); lymph node ratio (LNR); survival.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
ROC analysis of factors associated with LNR. Dotted lines at point of intersection represent sensitivity and specificity of LNR =0.25. ROC, receiver operating characteristic; LNR, lymph node ratio.
Figure 2
Figure 2
Scatter plot of LNR and survival. Each point represents an individual patient. Regression line with correlation coefficient represents association for entire group. LNR, lymph node ratio.
Figure 3
Figure 3
Kaplan-Meier analysis of overall survival in L-LNR and H-LNR groups. LNR, lymph node ratio; L-LNR, low LNR; H-LNR, high LNR.
Figure 4
Figure 4
Kaplan-Meier analysis of overall survival in patients undergoing surgery for liver metastases in L-LNR and H-LNR groups. LNR, lymph node ratio; L-LNR, low LNR; H-LNR, high LNR.
See this image and copyright information in PMC

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