Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis.
The lymph node ratio (LNR) (i.e. the number of metastatic lymph nodes divided by the number of totally resected lymph nodes) has recently emerged as an important prognostic factor in colorectal cancer (CRC). However, the tumor node metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a meta-analysis to evaluate the prognostic role of the LNR in node positive CRC. A systematic search was performed in PubMed, Embase and the Cochrane Library for relevant studies up to November 2015. As a result, a total of 75,838 node positive patients in 33 studies were included in this meta-analysis. Higher LNR was significantly associated with shorter overall survival (OS) (HR = 1.91; 95% CI 1.71-2.14; P = 0.0000) and disease free survival (DFS) (HR = 2.75; 95% CI: 2.14-3.53; P = 0.0000). Subgroup analysis showed similar results. Based on these results, LNR was an independent predictor of survival in colorectal cancer patients and should be considered as a parameter in future oncologic staging systems.
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Ming-Ran
MR
Zhang
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
Tian-Hang
TH
Xie
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Jun-Lin
JL
Chi
Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Yuan
Y
Li
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
Lie
L
Yang
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
Yong-Yang
YY
Yu
Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|Department of Oncology, Department of Clinical and Experiment Medicine, Linköping University, Linköping, Sweden.
Xiao-Feng
XF
Sun
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Zong-Guang
ZG
Zhou
D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017594:Publication Bias; D016019:Survival Analysis
colorectal cancer; lymph node; lymph node ratio; meta-analysis; prognostic role
Chin J Cancer. 2012 May;31(5):241-7
22313594
J Surg Oncol. 2012 Sep 1;106(3):238-42
22886537
Int J Colorectal Dis. 2009 Nov;24(11):1297-302
19479270
Colorectal Dis. 2011 Oct;13(10):1116-22
20874800
Med Sci Monit. 2014 Aug 04;20:1369-75
25087904
Dis Colon Rectum. 2009 Jul;52(7):1244-50
19571700
Oncotarget. 2016 May 17;7(20):29420-8
27105541
World J Gastrointest Surg. 2010 Mar 27;2(3):70-7
21160853
Surg Oncol. 2015 Jun;24(2):84-8
25912951
Minerva Chir. 2014 Jun;69(3):147-53
24970303
Rev Col Bras Cir. 2013 Nov-Dec;40(6):463-70
24573624
J Surg Oncol. 2012 Feb;105(2):125-9
21837680
Ann Surg Oncol. 2011 Sep;18(9):2453-60
21455596
Can J Surg. 2015 Aug;58(4):237-44
26022151
Colorectal Dis. 2014 Nov;16(11):O386-92
24980876
World J Surg. 2009 Dec;33(12):2704-13
19760316
CA Cancer J Clin. 2014 Mar-Apr;64(2):104-17
24639052
J Am Coll Surg. 2008 Dec;207(6):882-7
19183535
Ann Surg Oncol. 2010 Oct;17(10):2640-6
20300967
Int J Colorectal Dis. 2011 Jul;26(7):891-6
21399947
Ann Surg. 2011 Jan;253(1):82-7
21135690
J Surg Oncol. 2011 Apr;103(5):406-10
21400524
Int J Radiat Oncol Biol Phys. 2009 Jul 1;74(3):796-802
19289261
Int J Colorectal Dis. 2014 May;29(5):599-604
24648033
Int J Colorectal Dis. 2012 Mar;27(3):309-17
22065110
Br J Cancer. 2009 May 19;100(10):1530-3
19401684
World J Surg. 2013 Aug;37(8):1927-33
23609344
Colorectal Dis. 2013 May;15(5):559-65
23061638
Ann Surg Oncol. 2008 Nov;15(11):3118-23
18769971
Dis Colon Rectum. 2004 Jan;47(1):66-9
14719153
Nan Fang Yi Ke Da Xue Xue Bao. 2012 Nov;32(11):1663-6
23174600
Nan Fang Yi Ke Da Xue Xue Bao. 2014 Apr;34(4):458-62
24752087
Zhonghua Wei Chang Wai Ke Za Zhi. 2011 Apr;14(4):249-53
21538264
Ann Surg Oncol. 2007 May;14(5):1712-7
17253102
Surg Today. 2011 Oct;41(10):1370-9
21922359
Eur J Surg Oncol. 2008 Jul;34(7):771-5
18079086
Zhonghua Zhong Liu Za Zhi. 2012 Jul;34(7):506-9
22967468
PLoS One. 2012;7(4):e35021
22529970
Tech Coloproctol. 2011 Sep;15(3):273-9
21695442
Br J Cancer. 2015 Jul 14;113(2):212-9
26079302
Ann Surg Oncol. 2010 Nov;17(11):2847-55
20559741
Ann Surg Oncol. 2008 Jun;15(6):1600-8
18327530
Oncotarget. 2015 Oct 20;6(32):33912-8
26393881
World J Surg. 2013 May;37(5):1094-102
23385643
Ann Oncol. 2016 May;27(5):955-6
26802150
Ann Oncol. 2016 Jan;27(1):42-8
26483050
Br J Cancer. 2006 Oct 9;95(7):841-7
16969342
Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Oct;15(10):1057-61
23099906