Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 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

Manuel O Jakob  1 , Ulrich Guller  2 , Alex Ochsner  3 , Daniel Oertli  4 , Markus Zuber  5 , Carsten T Viehl  6
Affiliations
Multicenter Study

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

Manuel O Jakob et al. BMC Surg. .

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.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study has been approved by the regional Ethic committees of Basel (#201/00), Bern (#30/2001), and Olten (#EKO-0026). A written consent was signed by every participant.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a DFS according to pN-category (pN1 vs pN2). b OS according to pN- category (pN1 vs pN2)
Fig. 2
Fig. 2
a DFS according to LNR (LNR low vs LNR high). b OS according to LNR (LNR low vs high)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer staging manual. 7. New York: Springer-Verlag; 2010.
    1. Sobin LH, Gospodarowicz MK, Wittekind CH. TNM classification of malignant tumors. 7. New York: Wiley-Blackwell; 2009.
    1. Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, et al. Prognostic factors in colorectal cancer. College of American Pathologists. Consensus statement 1999. Arch Pathol Lab Med. 2000;124(7):979–994. - PubMed
    1. Chen SL, Bilchik AJ. More extensive nodal dissection improves survival for stages I to III of colon cancer: a population based study. Ann Surg. 2006;244(4):602–610. - PMC - PubMed
    1. Lu Yen-Jung, Lin Pei-Ching, Lin Chun-Chi, Wang Huann-Sheng, Yang Shung-Haur, Jiang Jeng-Kai, Lan Yuan-Tzu, Lin Tzu-Chen, Liang Wen-Yi, Chen Wei-Shone, Lin Jen-Kou, Chang Shih-Ching. The Impact of the Lymph Node Ratio is Greater than Traditional Lymph Node Status in Stage III Colorectal Cancer Patients. World Journal of Surgery. 2013;37(8):1927–1933. doi: 10.1007/s00268-013-2051-4. - DOI - PubMed

Publication types

LinkOut - more resources