title: Prognostic significance of lymph node ratio in patients undergoing abdominoperineal resection of rectum.
abstract: BACKGROUND
  Lymph node ratio (LNR) has been shown to be an independent prognostic factor in stage III colorectal cancer. Abdominoperineal resection (APR) of rectum is historically associated with poorer oncological outcomes compared to other colorectal resections, and significance of LNR in this group of patients has not been studied.
  
  
  OBJECTIVE
  Our aim was to determine impact of LNR on oncological outcomes in a series of patients with rectal cancers undergoing APR.
  
  
  METHODS
  A series of patients who had undergone APR and had lymph node metastasis were identified from a prospectively maintained clinical, histopathological and radiological database. LNR was calculated, and Cox regression was used to determine the impact of factors affecting local recurrence, distal metastases and overall survival.
  
  
  RESULTS
  Fifty-eight (42 males) patients were identified to have rectal cancer with lymph node involvement. LNR was an independent predictor of distal metastasis and overall survival at cutoff levels of 0.17, 0.41 and 0.69.
  
  
  CONCLUSIONS
  Lymph node ratio is an independent predictor of survival outcomes in patients with stage III tumours undergoing APR. LNR may help improve stratification of this group of patients.
authors.affiliation: Academic Surgical Unit, University of Hull, Cottingham, HU16 5JQ, UK.
authors.forename: M
authors.initials: M
authors.lastname: Tayyab
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.forename: A W
authors.initials: AW
authors.lastname: Macdonald
authors.forename: J
authors.initials: J
authors.lastname: Gunn
authors.forename: J E
authors.initials: JE
authors.lastname: Hartley
authors.forename: J R T
authors.initials: JR
authors.lastname: Monson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome