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Background: Many investigators have questioned the prognostic power of the TNM system in the prognosis of colorectal cancer because of the possibility of stage migration, and have proposed alternative prognostic methods; one of those is the lymph node ratio. Aim of Work: The objective of this study is to compare the prognostic significance of the LNR with the absolute number of affected lymph nodes for resected colorectal adenocarcinoma stage III regarding overall and disease specific survival. Patients and Methods: 55 patients with colorectal cancer stage III who underwent curative surgery were enrolled in a retrospective cohort study reviewing their medical charts from Medical Oncology Department between January 2005 and December 2006, and their five years follow-up period regarding local recurrence, metastasis and survival. Results: The mean follow-up time was 55.1 ± 18 months (range 6-72, median 60 months). During this time period, 12 (21.8%) patients died of disease, 20 (36.4%) patients developed local recurrence or metastasis. Overall Survival (OS) was 90.9%, 85.5%, 78.2% at 1.5, 3, 5 years respectively. Disease Specific Survival (DSS) was 90.9%, 74.5%, 63.6% at 1.5, 3, 5 years respectively. Five year overall survival rates was significantly worse in colorectal cancers with LNR >40% (p-value <0.01, hazard ratio 0.022, 95% CI 0.003-0.17) and also worse 5 year disease specific survival (p-value <0.01, hazard ratio 0.182, 95% CI 0.075-0.44). Total LN ≤ 11 and positive number of LNs >4 showed significant worsening in the 5 year DSS only (p-value <0.05, hazard ratio 2.8, 95% CI 1.025-7.7) vs. (p-value <0.05, hazard ratio 0.32, 95% CI 0.13-0.8) respectively. Conclusion: LNR was a robust prognostic indicator for node-positive colon cancers undergoing curative surgery. Because this ratio-based staging was demonstrated to reduce stage migration and to aid in identifying high-risk patients, Correspondence to: Dr. Ahmed S.A. Abdul-Samad, The Department of General Surgery, Faculty of Medicine, Cairo University application of the pLNR improved patient stratification in colorectal cancer and may be considered in future staging systems, it could be proposed as a standard tool for colon cancer staging.

the medical journal of cairo university/the medical journal of cairo university

The Prognostic Significance of the Metastatic Lymph Node Ratio versus the Number of Affected Lymph Nodes in Patients with Colorectal Cancer Stage III Undergoing Potentially Curative Surgery