title: Metastatic lymphs nodes and lymph node ratio as predictive factors of survival in perforated and non-perforated T4 colorectal tumors.
abstract: OBJECTIVE
  Recently it has been hypothesized that perforation of colorectal cancer (CRC) itself is not a predictor of poor prognosis. The aim of this study was to analyze the prognostic impact, of the spontaneous perforation of the tumour, metastatic lymph nodes and lymph node ratio (LNR) after potentially curative surgery.
  
  
  METHODS
  Retrospective analysis of oncologic outcomes of patients with T4a CRC grouped by perforated and non-perforated tumours. Between 2001 and 2010, 100 patients were included. Oncologic outcomes, disease-free survival and global survival were analyzed.
  
  
  RESULTS
  Forty-nine patients had a non-perforated cancer and 51 presented a perforated neoplasm. Perforated cancers had a lower mean number of lymph nodes (1.16 vs. 4.14, P < 0.001), lower LNR (0.13 vs. 0.33, P = 0.001), better TNM-stage (P < 0.001), and lower metastases during follows-up (P = 0.02). The perforated-group had higher survival (P = 0.017) and higher metastasis-free time (P = 0.03). LNR cutoffs (<0.05, 0.05-0.4, and >0.4) had significant differences in overall survival (log-rank < 0.001). The predictive value of LNR and metastatic lymph nodes in mortality was similar.
  
  
  CONCLUSIONS
  In our experience, perforated cancers had higher survival rates and metastasis-free interval that non-perforated cancers, probably by a lower number of metastatic lymph nodes, smaller LNR and better TNM stage. Moreover the predictive value, in mortality rate, of metastatic lymph nodes and LNR was similar.
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Rodríguez-González
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez-Riera
authors.forename: Luciano
authors.initials: L
authors.lastname: Delgado-Plasencia
authors.forename: Alberto
authors.initials: A
authors.lastname: Bravo-Gutiérrez
authors.forename: Hugo
authors.initials: H
authors.lastname: Alvarez-Argüelles
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salido
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Fernández-Peralta
authors.forename: Juan J
authors.initials: JJ
authors.lastname: González-Aguilera
authors.forename: Antonio
authors.initials: A
authors.lastname: Alarcó-Hernández
authors.forename: Vicente
authors.initials: V
authors.lastname: Medina-Arana
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000401:mortality*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate
keywords: free-time metastases; lymph node ratio; metastatic lymphs nodes; overall survival; perforated colorectal cancer