Gut Liver.  2012 Apr;6(2):203-209.

Prognostic Significance of the Lymph Node Ratio Regarding Recurrence and Survival in Rectal Cancer Patients Treated with Postoperative Chemoradiotherapy

• Kim JY
• Chung SM
• Choi BO
• Lee IK
• An CH
• Won JM
• Ryu MR

Abstract

BACKGROUND/AIMS
To evaluate the prognostic impact of the lymph node ratio (LNR: the ratio of positive lymph nodes to the total number of lymph nodes examined) on disease recurrence and survival among rectal cancer patients who received curative surgery and postoperative chemoradiotherapy (CRT).
METHODS
Between 1995 and 2008, 124 patients with pathologic T3-4 or node-positive rectal cancer underwent curative surgery and postoperative CRT. Postoperative radiotherapy was delivered at a median dose of 50.4 Gy (range, 45 to 59.4 Gy) for 6 weeks. Chemotherapy consisted of a bolus injection of 5-fluorouracil and leucovorin in the first and last week of radiotherapy (91.9%) or daily capecitabine during radiotherapy (8.1%). Further adjuvant chemotherapy was administered after chemoradiation.
RESULTS
The median follow-up was 5.1 years. In the multivariate analysis, pathologic N (pN) stage and lymphovascular invasion were significantly associated with disease-free survival and disease-specific survival (p<0.05). However, when the LNR with a cutoff value of 0.2 was included as a covariate in the model, the LNR was highly significant (p<0.001), and the pN stage lost its significance (p>0.05).
CONCLUSIONS
The LNR predicts recurrence and survival more accurately than pN stage. The pN stage and the LNR should be considered together when estimating the risk of disease recurrence among rectal cancer patients.

Keyword

Rectal neoplasms; Lymph nodes; Combined modality therapy

MeSH Terms

Chemoradiotherapy
Chemotherapy, Adjuvant
Combined Modality Therapy
Deoxycytidine
Disease-Free Survival
Fluorouracil
Follow-Up Studies
Humans
Leucovorin
Lymph Nodes
Multivariate Analysis
Rectal Neoplasms
Recurrence
Capecitabine
Deoxycytidine
Fluorouracil
Leucovorin