Lymph node ratio prognosticates overall survival in patients with stage IV colorectal cancer.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-08-23 DOI:10.1007/s10151-024-02984-6

K Naidu, P H Chapuis, L Connell, C Chan, M J F X Rickard, K-S Ng

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Abstract

Background: Lymph node ratio (LNR) is suggested to address the shortcomings of using only lymph node yield (LNY) or status in colorectal cancer (CRC) prognosis. This study explores how LNR affects survival in patients with metastatic colorectal cancer (mCRC), seeking to provide clearer insights into its application.

Methods: This observational cohort study investigated stage IV patients with CRC (1995-2021) who underwent an upfront resection of their primary tumour at Concord Hospital, Sydney. Clinicopathological data were extracted from a prospective database, and LNR was calculated both continuously and dichotomously (LNR of 0 and LNR > 0). The primary endpoint was overall survival (OS). The associations between LNR and various clinicopathological variables were tested using regression analyses. Kaplan-Meier and Cox regression analyses estimated OS in univariate and multivariate survival models.

Results: A total of 464 patients who underwent a primary CRC resection with clear margins (mean age 68.1 years [SD 13.4]; 58.0% M; colon cancer [n = 339,73.1%]) had AJCC stage IV disease. The median LNR was 0.18 (IQR 0.05-0.42) for colon cancer (CC) resections and 0.21 (IQR 0.09-0.47) for rectal cancer (RC) resections. A total of 84 patients had an LNR = 0 (CC = 66 patients; RC = 18 patients). The 5-year OS for the CC cohort was 10.5% (95% CI 8.7-12.3) and 11.5% (95% CI 8.4-14.6) for RC. Increasing LNR demonstrated a decline in OS in both CC (P < 0.001) and RC (P < 0.001). In patients with non-lymphatic dissemination only (LNR = 0 or N0 status), there was better survival compared with those with lymphatic spread (CC aHR1.50 [1.08-2.07;P = 0.02], RC aHR 2.21 [1.16-4.24;P = 0.02]).

Conclusions: LNR is worthy of consideration in patients with mCRC. An LNR of 0 indicates patients have a better prognosis, underscoring the need for adequate lymphadenectomy to facilitate precise mCRC staging.

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淋巴结比率预示着 IV 期结直肠癌患者的总生存期。

背景：淋巴结比值（LNR）被认为可以解决在结直肠癌（CRC）预后中仅使用淋巴结产量（LNY）或状态的缺点。本研究探讨了淋巴结比值如何影响转移性结直肠癌（mCRC）患者的生存，旨在为其应用提供更清晰的见解：这项观察性队列研究调查了在悉尼康科德医院接受原发肿瘤前期切除术的 IV 期 CRC 患者（1995-2021 年）。临床病理数据从前瞻性数据库中提取，LNR采用连续和二分法计算（LNR为0和LNR>0）。主要终点是总生存期（OS）。通过回归分析检验了 LNR 与各种临床病理变量之间的关系。Kaplan-Meier和Cox回归分析在单变量和多变量生存模型中估计了OS：共有 464 名患者（平均年龄为 68.1 岁 [SD 13.4]；58.0% 为男性；结肠癌 [n = 339,73.1%]）接受了边缘清晰的原发性 CRC 切除术，其疾病处于 AJCC IV 期。结肠癌（CC）切除术的 LNR 中位数为 0.18（IQR 0.05-0.42），直肠癌（RC）切除术的 LNR 中位数为 0.21（IQR 0.09-0.47）。共有 84 名患者的 LNR = 0（CC = 66 名患者；RC = 18 名患者）。CC队列的5年OS为10.5%（95% CI 8.7-12.3），RC队列的5年OS为11.5%（95% CI 8.4-14.6）。LNR的增加表明CC和RC的OS均有所下降（P 结论：LNR的增加值得在癌症治疗中加以考虑：LNR值得mCRC患者考虑。LNR 为 0 表明患者的预后较好，这强调了进行充分淋巴结切除以促进 mCRC 精确分期的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.