Prognostic Value of the Lymph Node Ratio in Stage III Colorectal Cancer: A Systematic Review
- 18 June 2010
- journal article
- review article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 17 (11), 2847-2855
- https://doi.org/10.1245/s10434-010-1158-1
Abstract
Background. Although nodal invasion represents one of the most powerful prognostic indicators in colorectal cancer, marked heterogeneity exists within stage III patients. Recently, the lymph node ratio (LNR), defined as the ratio of the number of positive nodes over the total number of examined nodes, was proposed to stratify outcome in stage III patients. Methods. A systematic search was performed for studies examining the prognostic significance of the LNR in colon or rectal cancer. Individual studies were assessed for methodological quality and summary data extracted. Hazard ratios from multivariate analyses were entered in a fixed-effects meta-analysis model. Results. In total, 16 studies were identified including 33,984 patients with stage III colon or rectal cancer. In all identified studies, the LNR was identified as an independent prognostic factor in patients with stage Ill cancer of the colon or rectum. The prognostic separation obtained by the LNR was superior to that of the number of positive nodes (N stage). The pooled hazard ratios for overall and disease-free survival were 2.36 (95% confidence interval, 2.14-2.61) and 3.71 (95% confidence interval, 2.56-5.38), respectively. Conclusions. The LNR allows superior prognostic stratification in stage Ill colorectal cancer and should be validated in prospective studiesKeywords
This publication has 47 references indexed in Scilit:
- Lymph node ratio predicts disease‐specific survival in melanoma patientsCancer, 2009
- Should Total Number of Lymph Nodes be Used as a Quality of Care Measure for Stage III Colon Cancer?Annals of Surgery, 2009
- Lymph Node Evaluation and Survival After Curative Resection of Colon Cancer: Systematic ReviewJNCI Journal of the National Cancer Institute, 2007
- Razão entre linfonodos positivos e dissecados como fator prognóstico em câncer de cólonRevista da Associação Médica Brasileira, 2007
- Prognostic value of the lymph node ratio in node positive colon cancerGut, 2006
- Increasing Negative Lymph Node Count Is Independently Associated With Improved Long-Term Survival in Stage IIIB and IIIC Colon CancerJournal of Clinical Oncology, 2006
- Prognostic Value of Nodal Ratios in Node-Positive Breast CancerJournal of Clinical Oncology, 2006
- New Tumor-Node-Metastasis Staging Strategy for Node-Positive (stage III) Rectal Cancer: An AnalysisJournal of Clinical Oncology, 2004
- A New TNM Staging Strategy for Node-Positive (Stage III) Colon CancerAnnals of Surgery, 2002
- The prognostic inhomogeneity of colorectal carcinomas Stage IIICancer, 2001