title: Lymph node ratio improves TNM and Astler-Coller's assessment of colorectal cancer prognosis: an analysis of 761 node positive cases.
abstract: BACKGROUND
  Prognosis assessment of node-positive colorectal cancer patients by Astler-Coller (AC) and TNM classifications is suboptimal. Recently, several versions of lymph node ratio (LNR; ratio metastatic/examined nodes) have been proposed but are still mostly unused.
  
  
  METHODS
  The prognostic value of several criteria, including LNR (two classes-LNR1 and LNR2-identified by a 15% cut-off) was studied in 761 consecutive patients, from 2000 through 2010. The relationships between total examined nodes, N, T and LNR were also analysed. LNR1 and LNR2 patients' survival was analysed within AC and TNM subgroups, and then coupled with them.
  
  
  RESULTS
  Age, tumour location and LNR are independent factors predicting survival. The relationships between LNR, N stage and T stage with examined nodes suggest confusing factors. LNR allows for identification of subgroups with different survival within AC and TNM classifications (p < 0.0001). Patients with LNR class discordant from AC stage (LNR1-C2 and LNR2-C1) have a similar 5-year survival (54 and 57%, respectively). LNR2 and TNM stage IIIC define a poor 5-year prognosis (33%).
  
  
  CONCLUSIONS
  LNR is a powerful prognosis predictor, easily integrated with TNM and AC classifications to improve prognosis assessment and facilitate clinical use. Possible confusing factors should be considered in future studies.
authors.affiliation: Sezione di Chirurgia Generale e Terapia Chirurgica, Dipartimento di Scienze Chirurgiche, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy, renatocosti@hotmail.com.
authors.forename: Renato
authors.initials: R
authors.lastname: Costi
authors.forename: Filippo
authors.initials: F
authors.lastname: Beggi
authors.forename: Valeria
authors.initials: V
authors.lastname: Reggiani
authors.forename: Matteo
authors.initials: M
authors.lastname: Riccò
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Crafa
authors.forename: Melissa
authors.initials: M
authors.lastname: Bersanelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Tartamella
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Violi
authors.forename: Luigi
authors.initials: L
authors.lastname: Roncoroni
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Sarli
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary*; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
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