PROGNOSTIC IMPORTANCE OF THE LYMPH NODE RATIO IN STAGE III COLORECTAL CANCERS

Yıl 2022, Cilt: 29 Sayı: 4, 661 - 670, 27.12.2022

Kübra Erdoğan , Nisbet Yılmaz , Ahmet Erdoğan , Osman Sütçüoğlu , Ozan Yazıcı , Nuriye Yıldırım Özdemir

https://doi.org/10.17343/sdutfd.1193868

Öz

Objective
Colorectal cancers (CRCs) are among the most com-
mon cancers all over the world with a high mortality
rate. Many prognostic factors have been identified for
these cancers, one of which is the lymph node ratio
(LNR). The purpose of this study was to reveal the
prognostic importance of the LNR in stage III CRCs.
Material and Method
The records of stage III colorectal patients who received
adjuvant chemotherapy between January 1998
and May 2014 were examined retrospectively. Similar
to the literature, the patients were divided into three
groups according to their LNRs. Those with a ratio of
0–0.20 were in the 1st group, with 0.21–0.50 were in
the 2nd group, and with 0.51–1 were in the 3rd group.
Demographic characteristics of the patients, number
of positive and total lymph nodes removed, lymph
node positivity rate, presence of free tumor nodules,
and survival were evaluated.
Results
A total of 263 patients were included in the study. While
163 (61.9%) of the patients were male, the median
age was 62 (min: 25–max: 85). The mean number
of lymph nodes removed was 17.46 (±11.55), and
the mean number of positive lymph nodes was 3.48
(±5.13). The mean duration of disease-free survival
(DFS) was 65.2 (±46.07) months (min = 6, max =
223). The mean overall survival time (OS) was 70.9
(±44.4) months (min = 6, max = 223). In univariate
analysis, it was observed that as the LNR increased,
recurrence and mortality increased statistically significantly
(P < 0.001). According to the results of multivariate
analysis, the relationship of DFS and OS with
the LNR groups was statistically significant (P = 0.030
and P = 0.019, respectively).
Conclusion
The LNR in operated stage III CRC is an effective
prognostic factor on DFS and OS.

Anahtar Kelimeler

Colorectal cancer, Prognosis, Lymph node ratio, Adjuvant chemotherapy

EVRE III KOLOREKTAL KANSERLERDE LENF NODU POZİTİFLİK ORANININ PROGNOSTİK ÖNEMİ

Öz

Amaç
Kolorektal kanserler, tüm dünyada sık görülen ve mortalitesi
yüksek kanserlerdendir. Bu kanserler ile ilgili
birçok prognostik faktör tanımlanmıştır. Bunlardan bir
tanesi de lenf nodu pozitiflik oranıdır. Bu çalışmanın
amacı, Evre III kolorektal kanserlerde lenf nodu pozitiflik
oranının prognostik önemini ortaya koymaktır.
Gereç ve Yöntem
Ocak 1998 ile Mayıs 2014 tarihleri arasında kolorektal
kanser tanısı ile opere edilip adjuvan kemoterapi
alan, evre III hastaların kayıtları retrospektif olarak incelendi.
Hastalar literatüre benzer şekilde lenf nodu
pozitiflik oranına göre 0-0,20 arası olanlar 1. grup,
0,21-0,50 arası olanlar 2. grup ve 0,51-1 arası olanlar
3. grup şeklinde üç gruba ayrıldı. Hastaların demografik
özellikleri, çıkarılan pozitif ve toplam lenf nodu
sayısı, lenf nodu pozitiflik oranı, serbest tümör nodülü
varlığı ve sağ kalım verileri incelendi.
Bulgular
Çalışmaya 263 hasta dâhil edildi. Hastaların 163’ü
(%61,9) erkek iken, yaş ortanca değeri 62 (min:
25-max:85) idi. Ortalama çıkarılan lenf nodu sayısı
17.46 (±11.55) ve ortalama pozitif lenf nodu sayısı
3.48 (±5.13) idi. Hastalıksız sağkalım süresi ortalama
65,2(±46,07) ay (min=6, max=223) idi. Genel sağkalım
süresi ortalama 70,9 (±44,4) ay (min=6, max=223)
idi. Hastalıksız sağkalım ve genel sağkalım ile lenf
nodu grupları arasındaki ilişki tek değişkenli analizde
incelendiğinde; lenf nodu pozitiflik oranını arttıkça
nüksün ve mortalitenin istatistiksel olarak anlamlı şekilde
arttığı gözlendi (p<0,001). Çok değişkenli analiz
sonuçlarına göre de hastalıksız sağkalım ve genel
sağkalım ile lenf nodu pozitiflik oranını grupları arasındaki
ilişki [sırasıyla (p=0,030), (p=0,019)] istatistiksel
olarak anlamlı bulundu.
Sonuç
Opere evre III kolorektal kanserlerde lenf nodu pozitiflik
oranın hastalıksız sağ kalım ve genel sağ kalım
üzerine, etkili bir prognostik faktördür.

Anahtar Kelimeler

Kolorektal kanser, Prognoz, Lenf nodu oranı, Adjuvan kemoterapi

Kaynakça

• 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71(3):209-49.
• 2. Ladabaum U, Dominitz JA, Kahi C, Schoen RE. Strategies for Colorectal Cancer Screening. Gastroenterology 2020;158(2):418-32.
• 3. Li Y, Wu G, Zhang Y, Han B, Yang W, Wang X, et al. Log odds of positive lymph nodes as a novel prognostic predictor for colorectal cancer: a systematic review and meta-analysis. BMC Cancer 2022;18;22(1):290.
• 4. Bilimoria KY, Palis B, Stewart AK, Bentrem DJ, Freel AC, Sigurdson ER, et al. Impact of tumor location on nodal evaluation for colon cancer. Dis Colon Rectum 2008; 51(2):154-61.
• 5. Ceelen W, Nieuwenhove YV, Pattyn P. Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol 2010;17(11):2847-55.
• 6. Siegel RC, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69(1):7-34.
• 7. 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):979-94.
• 8. Baidoun F,Elshiwy K, Elkeraie Y, Merjaneh Z, Khoudari G, Sarmini MT, et al. Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes. Curr Drug Targets 2021;22(9):998-1009.
• 9. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007;21;99(6):433-41.
• 10. Moon JY, Lee MR, Ha GW. Prognostic value of tumor deposits for long-term oncologic outcomes in patients with stage III colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2022;37(1):141-51.
• 11. Ramos-Esquivel A, Juárez M, González I, Porras J, Rodriguez L. Prognosis impact of the lymph node ratio in patients with colon adenocarcinoma: a single-centre experience. J Gastrointest Cancer 2014;45(2):133-36.
• 12. Sabbagh C, Mauvais F, Cosse C, Rebibo L, Joly JP, Dromer D, et al. A lymph node ratio of 10% is predictive of survival in stage III colon cancer: a French regional study. Int Surg 2014;99(4):344-53.
• 13. Sugimoto K, Sakamoto K, Tomiki Y, Goto M, Kotake K, Sugihara K. Proposal of new classification for stage III colon cancer based on the lymph node ratio: analysis of 4,172 patients from multi-institutional database in Japan. Ann Surg Oncol 2015;22(2):528-34.
• 14. Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K, et al. Outcome of ratio of lymph node metastasis in gastric carcinoma Ann Surg Oncol 2002;9(8):775-84.
• 15. Woodward WA, Vinh-Hung V, Ueno NT, Cheng YC, Royce M, Georges Vlastos PT, et al. Prognostic value of nodal ratios in node-positive breast cancer. J Clin Oncol 2006;20;24(18):2910-16.
• 16. Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005;1;23(34):8706-12.
• 17. Klos CL, Bordeianou LG, Sylla P, Chang Y, Berger DL. The prognostic value of lymph node ratio after neoadjuvant chemoradiation and rectal cancer surgery. Dis Colon Rectum 2011;54(2):171-75.
• 18. Garcia B, Guzman C, Johnson C, Hellenthal NJ, Monie D, Monzon JR. Trends in lymph node excision and impact of positive lymph node ratio in patients with colectomy for primary colon adenocarcinoma: Population based study 1988 to 2011. Surg Oncol 2016;25(3):158-63.
• 19. Leonard D, Remue C, Orabi NA, Maanen A, Danse E, Dragean A, et al. Lymph node ratio and surgical quality are strong prognostic factors of rectal cancer: results from a single referral centre. Colorectal Dis 2016;18(6):O175-84.
• 20. Shen SS, Haupt BX, Ro JY, Zhu J, Bailey HR, Schwartz MR. Number of lymph nodes examined and associated clinicopathologic factors in colorectal carcinoma. Arch Pathol Lab Med 2009;133(5):781-86.
• 21. Gonsalves WI, Kanuri S, Tashi T, Aldoss I, Sama A, Al-Howaidi I, et al. Clinicopathologic factors associated with lymph node retrieval in resectable colon cancer: a Veterans' Affairs Central Cancer Registry (VACCR) database analysis. J Surg Oncol 2011;104(6):667-71.