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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Oncol. | doi: 10.3389/fonc.2018.00628

The prognostic impact of the metastatic lymph nodes ratio in colorectal cancer.

Chi-Hao Zhang1,  Yan-yan Li1, Qing-wei Zhang2,  Alberto Biondi3, Valeria Fico3, Roberto Persiani3, Xiao-Chun Ni4* and Meng Luo1*
  • 1Shanghai Ninth People’s Hospital, Shanghai Jiao-Tong University School of Medicine, China
  • 2Renji Hospital, Shanghai JiaoTong University School of Medicine, China
  • 3Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Italy
  • 4Department of Periodontology, Shanghai Ninth People's Hospital, China

Background: This study was designed to validate the prognostic significance of the ratio of positive to examined lymph nodes (LNR) in patients with colorectal cancer.
Methods: 218,314 patients from the SEER database and 1,811 patients from the three independent multicenter were included in this study. The patients were divided into 5 groups on a basis of previous published LNR: LNR0, patients with no metastatic lymph nodes; LNR1, patients with the LNR between 0.1 and 0.17; LNR2, patients with the LNR between 0.18 and 0.41; LNR3, patients with the LNR between 0.42 and 0.69; LNR4, patients with the LNR greater than 0.7. The 5-year OS and CSS rate were estimated using Kaplan-Meier method and the survival difference was tested using log-rank test. Multivariate Cox analysis was used to further assess the influence of the LNR on patients’ outcome.
Results: The 5-year OS rate of patients within LNR0 to LNR4 group was 71.2%, 55.8%, 39.3%, 22.6% and 14.6%, respectively (p<0.001) in the SEER database. While the 5-year OS rate of those with LNR0 to LNR4 was 75.2%, 66.1%, 48.0%, 34.0% and 17.7%, respectively (p<0.001) in the international multicenter cohort. In the multivariate analysis, LNR was demonstrated to be a strong prognostic factor in patients with <12 and ≥12 metastatic lymph nodes. Furthermore, the LNR had a similar impact on the patients’ prognosis in colon cancer and rectal cancer.
Conclusion: The LNR allowed better prognostic stratification than the positive node (pN) in patients with colorectal cancer and the cut-off values were well validated.

Keywords: colorectal cancer, Lymph node ratio (LNR), prognosis, Overall survival (OS), SEER

Received: 28 Aug 2018; Accepted: 03 Dec 2018.

Edited by:

Sherif Abdel-Misih, Comprehensive Cancer Center, The Ohio State University, United States

Reviewed by:

Yoshiharu Sakai, Kyoto University, Japan
Paul Willemsen, Ziekenhuisnetwerk Antwerpen Middelheim, Belgium
Heather L. Lewis, University of Colorado Hospital, United States  

Copyright: © 2018 Zhang, Li, Zhang, Biondi, Fico, Persiani, Ni and Luo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Dr. Xiao-Chun Ni, Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai, China,
Dr. Meng Luo, Shanghai Ninth People’s Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China,