Nodal stage of stage III colon cancer: the impact of metastatic lymph node ratio.
OBJECTIVE
We assessed which classification of lymph node metastasis better predicted outcomes in patients with colorectal carcinoma.


METHODS
We identified 318 patients (176 men) with stage III colon cancer who underwent curative resection. The number of LNs dissected, LNR, and disease-free survival time, were analyzed. Lymph node disease was stratified by the American Joint Committee on Cancer staging and LNR, with the latter categorized into groups with LNR <0.059 (n = 67), 0.059-0.23 (n = 171), and >0.23 (n = 80). Median follow-up time was 37 (range, 1-122) months.


RESULTS
LNR significantly increased with the number of metastatic LNs (P < 0.0001). Three-year disease-free survival (DFS) rates differed significantly in the three LNR groups. Within each TNM stage, 3-year DFS rates differed according to LNR, but, within each LNR subgroup, 3-year DFS did not differ according to TNM stage. When both TNM stage and LNR subgroup were considered, 3-year DFS was stratified into four groups, which differed significantly (P < 0.0001). Considering number of retrieved lymph nodes, this stratification was not found when <12 lymph nodes retrieved.


CONCLUSIONS
Re-stratified lymph node staging, reflecting both LNR and TNM stage, can predict survival in patients with LN-positive colon cancer, especially when more than 12 lymph nodes harvested.
Park
In Ja
IJ
Department of Surgery, Vievis Namuh Hospitla, Seoul, South Korea.
Choi
Gyu-Seog
GS
Jun
Soo Han
SH