title: Prognostic influences of lymph node ratio in major cancers of Taiwan: a longitudinal study from a single cancer center.
abstract: BACKGROUND
  The utility of lymph node ratio (LNR) in predicting outcomes has been reported previously. In current study, we further subgroup by LNR in subjects with lymph nodes metastasis of colorectal cancer, breast cancer, and head and neck cancer.
  
  
  METHODS
  Cancers with pathological lymph node metastasis (pN+) at time of diagnosis between 2004 and 2012 were identified from the cancer registry database of the Dalin Tzu Chi General Hospital. The Kaplan-Meier method with log-rank test and the Cox proportional hazards model were used to compare the disease-specific survival (DSS) rates for different LNR after adjusting for possible confounding risk factors.
  
  
  RESULTS
  A total of 431 cancer patients with pN+ were eligible in the current study: 149 patients with colorectal cancer; 141 patients with breast cancer; and 141 patients with head and neck cancer. High LNR was associated with poor DSS rates with the mean 24-45 months of follow-up period. In the multivariate analysis, high LNR was an independent poor prognostic factor in colorectal cancer (LNR ≥ 0.5; HR 4.10; p < 0.001), breast cancer (LNR ≥ 0.8; HR 5.75; p = 0.002), and head and neck cancer (LNR ≥ 0.4; HR 2.56; p = 0.005).
  
  
  CONCLUSIONS
  High LNR exerts a significant role as a negative prognostic factor when comparing the traditional American Joint Committee on Cancer (AJCC) lymph nodes classification for major cancers. Therefore, LNR could be considered as an alternative and superior to, at least partially, traditional AJCC lymph nodes classification for cancer patients.
authors.affiliation: Department of Pathology, School of Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Wang
authors.forename: Chin-Chia
authors.initials: CC
authors.lastname: Wu
authors.forename: Moon-Sing
authors.initials: MS
authors.lastname: Lee
authors.forename: Shih-Kai
authors.initials: SK
authors.lastname: Hung
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Chen
authors.forename: Chih-Yao
authors.initials: CY
authors.lastname: Hsu
authors.forename: Chia-Wen
authors.initials: CW
authors.lastname: Hsu
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Su
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D013624:Taiwan