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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

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

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Authors and Affiliations

  1. Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania

    Sorin Tiberiu Alexandrescu MD, PhD, Andrei S. Diaconescu, Cristian A. Zlate, Diana Blanita, Razvan T. Grigorie & Irinel Popescu

  2. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Sorin Tiberiu Alexandrescu MD, PhD, Andrei S. Diaconescu & Narcis O. Zarnescu

  3. Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Florin M. Selaru

  4. Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania

    Vlad Herlea

  5. Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania

    Vlad Herlea & Irinel Popescu

Authors
  1. Sorin Tiberiu Alexandrescu MD, PhD
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  2. Florin M. Selaru
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  4. Cristian A. Zlate
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  9. Irinel Popescu
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Contributions

STA and FMS conception and design of the study, drafting the manuscript; ASD, CAZ, DB, and RTG data acquisition, drafting the manuscript; NOZ statistical analysis, drafting the manuscript; VH and IP analysis and interpretation of data and revising manuscript critically for important intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Sorin Tiberiu Alexandrescu MD, PhD.

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Ethics Approval

The performance of this retrospective study was approved by the Ethics Committee of Fundeni Clinical Institute, Bucharest, under the number 30769/11.06.2020.

Conflict of Interest

The authors declare no competing interests.

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Alexandrescu, S.T., Selaru, F.M., Diaconescu, A.S. et al. Prognostic Value of Lymph Node Ratio in Patients with Resected Synchronous Colorectal Liver Metastases and Less Than 12 Examined Lymph Nodes. J Gastrointest Surg 26, 141–149 (2022). https://doi.org/10.1007/s11605-021-05079-x

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  • DOI: https://doi.org/10.1007/s11605-021-05079-x

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