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Alexandrescu ST, Selaru FM, Diaconescu AS, Zlate CA, Blanita D, Grigorie RT, Zarnescu NO, Herlea V, Popescu I. Prognostic Value of Lymph Node Ratio in Patients with Resected Synchronous Colorectal Liver Metastases and Less Than 12 Examined Lymph Nodes. J Gastrointest Surg 2022; 26:141-149. [PMID: 34258674 DOI: 10.1007/s11605-021-05079-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/19/2021] [Indexed: 01/31/2023]
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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Affiliation(s)
- Sorin Tiberiu Alexandrescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania.
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Florin M Selaru
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrei S Diaconescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian A Zlate
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
| | - Diana Blanita
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
| | - Razvan T Grigorie
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
| | - Narcis O Zarnescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vlad Herlea
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Irinel Popescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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