Abstract
Background
The aim of this study was to assess the prognostic value of metastatic lymph node
(LN) ratio (MLNR) in stage III rectal cancer and whether this prognostic value remains
significant when <12 LNs are retrieved.
Methods
This prospective study included 115 patients with stage III rectal cancer from 2006
to 2010. All patients underwent neoadjuvant long-course chemoradiation, curative resection,
and postoperative adjuvant therapy (5-fluorouracil and leucovorin). Data collected
included demographics, tumor pathology, tumor-node-metastasis staging, number of LNs
retrieved, MLNR, recurrence, and mortality.
Results
The mean number of examined LNs was 12.1, and the mean number of metastatic LNs was
3.5 (range, 1 to 19). The mean MLNR was .37 (range, 0 to 1.00). The mean duration
of follow-up was 37 months (range, 24 to 63). Forty patients died during the follow-up
period (overall mortality, 34.8%), only 31 because of cancer (cancer-specific mortality,
27%). Univariate analysis revealed that ypN stage, lymphovascular invasion, and follow-up
duration were significantly associated with increased recurrence and decreased survival.
Number of positive nodes and ypT stage significantly affected recurrence, with no
effect on overall survival. Multivariate analysis proved that MLNR was the only independent
risk factor for both mortality and recurrence. Prognostic capability was not affected
by having <12 nodes retrieved. The best sensitivity and specificity of MLNR as a prognostic
factor for both tumor recurrence and overall survival were achieved at a cutoff value
of .375.
Conclusions
MLNR is an independent prognostic factor for recurrence and survival after the resection
of stage III rectal cancer, with high sensitivity and specificity in patients who
received neoadjuvant chemoradiation and postoperative chemotherapy. The total number
of LN retrieved did not affect the prognostic value of MLNR even if <12.
Keywords
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Article info
Publication history
Published online: October 10, 2013
Received in revised form:
July 17,
2013
Received:
May 1,
2013
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
