title: Novel lymph node ratio predicts prognosis of colorectal cancer patients after radical surgery when tumor deposits are counted as positive lymph nodes: a retrospective multicenter study.
abstract: The lymph node ratio (LNR), defined as the relation of tumor-infiltrated to resected lymph nodes, has been identified as an independent prognostic factor for colorectal cancer (CRC) after radical surgery. Recently, new guidelines propose counting tumor deposits (TDs) as positive lymph nodes (pLNs). The aim of this study was to investigate whether a novel LNR (nLNR) that considers TDs as pLNs can be used to accurately predict the long-term outcome of CRC patients. In this multicenter retrospective study, clinicopathological and outcome data from 2,051 stage III CRC patients who underwent R0 resection were collected between January 2004 and December 2011. Disease-free survival (DFS) and overall survival (OS) according to the nLNR category were analyzed using Kaplan-Meier survival curves. Univariate and multivariate analyses were performed to determine significant prognostic factors, and ROC curves were computed to measure the predictive capacity of the nLNR category. The 5-year DFS rates of nLNR1-4 were 68.3%, 48.4%, 33.3% and 16.5%, respectively (P<0.0001), and the 5-year OS rate of nLNR1-4 were 71.8%, 60.1%, 42.7% and 21.8%, respectively (P<0.0001). The area of under curve (AUC) of the nLNR was 0.686 (95% CI 0.663-0.710) and 0.672 (95% CI 0.648-0.697) for predicting DFS and OS. Our results demonstrate that the nLNR predicted long-term outcomes better than the LNR, npN and pN, using the cutoff points 0.250, 0.500 and 0.750.
authors.affiliation: Central Lab, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Central Lab, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China.
authors.forename: Shasha
authors.initials: S
authors.lastname: Xing
authors.affiliation: General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China.|Department of General Surgery, Zhongshan Hospital, Fudan University Colorectal Cancer Research Center, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: General Surgery Department, Sichuan Cancer Hospital, Chengdu, China.
authors.forename: Shengke
authors.initials: S
authors.lastname: Yang
authors.affiliation: Gastrointestinal Tumor Surgery Department, Hubei Cancer Hospital, Wuhan, China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Hu
authors.affiliation: General Surgery Department, 2nd Affiliated Hospital of Jilin University, Changchun, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Internal Medicine-Oncology, Cancer Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Du
authors.affiliation: General Surgery Department, Xuzhou Central Hospital, Xuzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yin
authors.affiliation: Surgical Department of Gastrointestinal Diseases, Youan Hospital of Capital Medical University, Beijing, China.
authors.forename: Sai
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Pathology, Clinical Medical College of Chengdu University, Chengdu, China.
authors.forename: Ci
authors.initials: C
authors.lastname: Li
authors.affiliation: General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China.
authors.forename: Jiatian
authors.initials: J
authors.lastname: Yuan
authors.affiliation: General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Lv
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: colorectal cancer; lymph node ratio; prognosis; tumor deposits