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Lymph node ratio is a powerful prognostic index in patients with stage III distal rectal cancer: a Japanese multicenter study |
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| Authors: | Kobayashi Hirotoshi Mochizuki Hidetaka Kato Tomoyuki Mori Takeo Kameoka Shingo Shirouzu Kazuo Saito Yukio Watanabe Masahiko Morita Takayuki Hida Jin-Ichi Ueno Masashi Ono Masato Yasuno Masamichi Sugihara Kenichi;Study Group for Rectal Cancer Surgery of the Japanese Society for Cancer of the Colon and Rectum |
| Institution: | 1. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113?C8519, Japan 2. Department of Surgery, National Defense Medical College, Saitama, Japan 3. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan 4. Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan 5. Second Department of Surgery, Tokyo Women??s Medical University, Tokyo, Japan 6. Department of Surgery, School of Medicine, Kurume University, Fukuoka, Japan 7. Department of Surgery, International Medical Center of Japan, Tokyo, Japan 8. Department of Surgery, Kitasato University Hospital, Kanagawa, Japan 9. Depatment of Surgery II, Hirosaki University School of Medicine, Aomori, Japan 10. Department of Surgery, Kinki University School of Medicine, Osaka, Japan 11. Department of Surgery, Cancer Institute Hospital, Tokyo, Japan 12. Department of Surgery, National Cancer Center Hospital East, Kashiwa, Japan |
| Abstract: | PurposeThe present study aims to define the prognostic impact of the lymph node ratio (LNR) in patients with stage III distal rectal cancer.MethodsWe analyzed data from 501 patients who underwent curative resection (total mesorectal excision, TME) for stage III distal rectal cancer at 12 institutions between 1991 and 1998. Patients were divided into four groups according to quartiles based on LNR.ResultsAmong the 501 patients, 381 underwent TME with pelvic sidewall dissection (PSD). The median numbers of lymph nodes retrieved with and without PSD were 45 and 17, respectively (P?<?0.0001). Forty-nine patients with lymph node retrieved less than 12 were excluded from further analyses. Among various clinicopathological parameters, univariate analysis identified age (P?=?0.0059), histological grade (P?<?0.0001), depth of tumor invasion (P?=?0.0003), and number of positive nodes (P?<?0.0001) and LNR (P?<?0.0001) as prognostic factors. The Cox proportional hazards model revealed that age (P?=?0.014), histological grade (P?<?0.0001), depth of tumor invasion (P?=?0.0002), and LNR (group 3, P?=?0.0012; group 4, P?<?0.0001) were independent prognostic factors. When the American Joint Committee on Cancer (AJCC) seventh staging system was added as a covariate, both AJCC stage (P?<?0.0001) and LNR (P?<?0.0001) were independent prognostic factors.ConclusionsAdding the LNR concept to the AJCC cancer staging system will improve accuracy in evaluating the nodal status of distal rectal cancer. |
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