Prognostic Value of Lymph Node Ratio in Patients with Resected Synchronous Colorectal Liver Metastases and Less Than 12 Examined Lymph Nodes,Journal of Gastrointestinal Surgery

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Prognostic Value of Lymph Node Ratio in Patients with Resected Synchronous Colorectal Liver Metastases and Less Than 12 Examined Lymph Nodes
Journal of Gastrointestinal Surgery ( IF 3.2 ) Pub Date : 2021-07-13 , DOI: 10.1007/s11605-021-05079-x
Sorin Tiberiu Alexandrescu _{1,

2} , Florin M Selaru ₃ , Andrei S Diaconescu _{1,

2} , Cristian A Zlate ₁ , Diana Blanita ₁ , Razvan T Grigorie ₁ , Narcis O Zarnescu ₂ , Vlad Herlea _{4,

5} , Irinel Popescu _{1,

5}

Affiliation

Background

Recent studies suggest that lymph node ratio (LNR) has significantly better prognostic power than N-status in patients with colorectal cancer, in particular when the number of evaluated lymph nodes (LNs) was insufficient. The aim of this study was to assess the prognostic value of LNR in patients with resected synchronous colorectal liver metastases (SCLMs) and less than 12 examined LNs.

Methods

A prospectively maintained database of patients with resected SCLMs was queried for patients with less than 12 LNs evaluated at the time of surgery. X-tile software was used to determine the LNR cutoff value able to divide the patients in two subgroups with distinct prognosis. Overall survival (OS) and disease-free survival (DFS) rates were compared by log-rank test. A multivariate Cox regression analysis identified independent prognostic factors.

Results

A cutoff LNR value of 0.22 divided patients into Low-LNR group (35 patients) and High-LNR group (36 patients). Both OS and DFS rates were significantly higher in Low-LNR group than those in High-LNR group. Independent predictors of poor OS were High-LNR (HR: 2.841, 95% CI: 1.480–5.453, p value = 0.002), bilobar SCLMs (HR: 2.253, 95% CI: 1.144–4.437, p value = 0.019) and lack of adjuvant chemotherapy (HR: 2.702, 95% CI: 1.448–5.043, p value = 0.002), while the only independent predictor of poor DFS was High-LNR (HR: 2.531, 95% CI: 1.259–5.090, p value = 0.009).

Conclusions

LNR > 0.22 was independently associated with poor OS and DFS in patients with resected SCLMs and less than 12 evaluated LNs.

中文翻译：

淋巴结比率在切除同步结直肠肝转移且检查淋巴结少于 12 个的患者中的预后价值

背景

最近的研究表明，在结直肠癌患者中，淋巴结比率 (LNR) 比 N 状态具有显着更好的预后能力，特别是当评估的淋巴结 (LNs) 数量不足时。本研究的目的是评估 LNR 在切除同步结直肠肝转移 (SCLM) 且检查的 LN 少于 12 个的患者中的预后价值。

方法

对手术时评估的 LN 少于 12 个的患者进行了前瞻性维护的 SCLM 切除患者数据库的查询。X-tile 软件用于确定能够将患者分为预后不同的两个亚组的 LNR 截止值。通过对数秩检验比较总生存率（OS）和无病生存率（DFS）。多变量 Cox 回归分析确定了独立的预后因素。

结果

截止 LNR 值为 0.22，将患者分为低 LNR 组（35 名患者）和高 LNR 组（36 名患者）。Low-LNR组的OS和DFS率均显着高于High-LNR组。不良 OS 的独立预测因子是高 LNR（HR：2.841，95% CI：1.480–5.453，p 值 = 0.002），双叶 SCLM（HR：2.253，95% CI：1.144–4.437，p 值 = 0.019）和缺乏辅助化疗（HR：2.702，95% CI：1.448-5.043，p 值 = 0.002），而 DFS 差的唯一独立预测因子是高 LNR（HR：2.531，95% CI：1.259-5.090，p 值 = 0.009)。