Prognostic implication of metastatic lymph node ratio in node-positive rectal cancer

Sang-Min Lee,Jong-Seok Shin,Hong-Jo Choi,Ki-Jae Park,Young-Hoon Roh,Hyuk-Chan Kwon,Mee-Sook Roh,Hyung-Sik Lee,Choongrak Kim 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.4

Purpose: The aim of this study was to evaluate the prognostic significance of the ratio between metastatic and examined lymph nodes (LNs) in patients with stage Ⅲ rectal cancer. Methods: A review was made of 175 (male, 98) patients with stage Ⅲ rectal cancer of R0 resection. LN disease was stratified both by the American Joint Committee on Cancer/International Union Against Cancer nodal classification (pN) and by quartiles of the lymph node ratio (LNR). Disease-free survivals (DFS) were made using Kaplan-Meier curves and assessed by the log rank test and multivariate analysis was performed using the Cox proportional hazards model. Results: Patients ranged in age from 29 to 83 (median, 60) years with median follow-up of 47 months (range, 13 to 181 months). months. There was a significant correlation between the number of metastatic LNs and the LNR (r = 0.8681, P < 0.0001). Cut-off points of LNR quartiles best to separate patients with regard to 5-year DFS were between quartile 2 and 3, and between 3 and 4 (LNR1, 2, and 3); the 5-year DFS according to such stratification was 89.6%, 55.8%, and 18.2% in LNR1, 2, and 3, respectively (P < 0.0001). Cox model identified the LNR as the most significant independent prognostic covariate; LNR2 showed 3.6 times (95% confidence interval [CI], 1.682 to 7.584; P = 0.0009) and LNR3, 18.7 times (95% CI, 6.872 to 50.664; P < 0.0001) more risky than LNR1. Conclusion: This study suggests that ratio-based LN staging, which reflects the number of LNs examined and the quality of LN dissection, is a simple and reliable system for prognostic LN stratification in patients with stage Ⅲ rectal cancer.

Clinical Significance of Lymph Node Ratio in Stage III Colorectal Cancer

박요한,이재임,박종경,조항주,강원경,안창혁 대한대장항문학회 2011 Annals of Coloproctolgy Vol.27 No.5

Purpose: Recent literature has shown that lymph node ratio is superior to the absolute number of metastatic lymph nodes in predicting the prognosis in several malignances other than colorectal cancer. The aim of this study was to evaluate the prognostic significance of the lymph node ratio (LNR) in patients with stage III colorectal cancer. Methods: We included 186 stage III colorectal cancer patients who underwent a curative resection over a 10-year period in one hospital. The cutoff point of LNR was chosen as 0.07 because there was significant survival difference at that LNR. The Kaplan-Meier and the Cox proportional hazard models were used to evaluate the prognostic effect according to LNR. Results: There was statistically significant longer overall survival in the group of LNR > 0.07 than in the group of LNR ≤ 7(P = 0.008). Especially, there was a survival difference for the N1 patients group (LN < 4) according to LNR (5-year survival of N1 patients was lower in the group of LNR > 0.07, P = 0.025), but there was no survival difference for the N2 group (4≥ LN) according to LNR. The multivariate analysis showed that the LNR is an independent prognostic factor. Conclusions: LNR can be considered as a more accurate and potent modality for prognostic stratifications in patients with stage III colorectal cancer.

Prognostic Role of Metastatic Lymph Node Ratio in Papillary Thyroid Carcinoma

표정수,손진희,장경식 대한병리학회 2018 Journal of Pathology and Translational Medicine Vol.52 No.5

Background: The aim of this study is to elucidate the clinicopathological significances, including the prognostic role, of metastatic lymph node ratio (mLNR) and tumor deposit diameter in papillary thyroid carcinoma (PTC) through a retrospective review and meta-analysis. Methods: We categorized the cases into high (≥ 0.44) and low mLNR (< 0.44) and investigated the correlations with clinicopathological parameters in 64 PTCs with neck level VI lymph node (LN) metastasis. In addition, meta-analysis of seven eligible studies was used to investigate the correlation between mLNR and survival. Results: Among 64 PTCs with neck level VI LN metastasis, high mLNR was found in 34 PTCs (53.1%). High mLNR was significantly correlated with macrometastasis (tumor deposit diameter ≥ 0.2 cm), extracapsular spread, and number of metastatic LNs. Based on linear regression test, mLNR was significantly increased by the largest LN size but not the largest metastatic LN (mLN) size. High mLNR was not correlated with nuclear factor κB or cyclin D1 immunohistochemical expression, Ki-67 labeling index, or other pathological parameters of primary tumor. Based on meta-analysis, high mLNR significantly correlated with worse disease-free survival at the 5-year and 10-year follow-up (hazard ratio [HR], 4.866; 95% confidence interval [CI], 3.527 to 6.714 and HR, 5.769; 95% CI, 2.951 to 11.275, respectively). Conclusions: Our data showed that high mLNR significantly correlated with worse survival, macrometastasis, and extracapsular spread of mLNs. Further cumulative studies for more detailed criteria of mLNR are needed before application in daily practice.

The Prognostic Value of Central Lymph Node Yield and Ratio in Papillary Thyroid Carcinoma Patients Who Underwent Thyroidectomy with Prophylactic Central Compartment Neck Dissection

권오준,이소희,배자성 대한갑상선학회 2019 International Journal of Thyroidology Vol.12 No.1

Background and Objectives: The impacts of prophylactic central compartment neck dissection (pCCND) on the prognosis of papillary thyroid cancer (PTC) are controversial. The aim of this study is to evaluate the relationship between nodal factors of pCCND and the prognosis of PTC patients. Materials and Methods: A total of 1754 patients who underwent thyroidectomy with pCCND were retrospectively reviewed. Nodal factor was defined as the number of metastatic lymph node (MLN), lymph node yield (LNY) and lymph node ratio (LNR). In regarding the cutoff of nodal factors, patients were categorized as low/high MLN, LNR and LNY group. The correlation of clinicopathologic characteristics including nodal factors and recurrence free survival (RFS) were anlalyzed. Results: Of these, 1195 patients underwent thyroidectomy with unilateral pCCND and 559 patients underwent total thyroidectomy with bilateral pCCND. During follow-up, 45 (2.57%) patients showed recurrent disease. Of these, 19 patients underwent bilateral pCCND and 26 cases were unilateral pCCND. Gross extrathyroidal extension (ETE), high MLN and LNR showed statistically significant on RFS in univariate analysis in unilateral pCCND. In multivariate analysis, gross ETE and high LNR were independent risk factor of recurrence in unilateral pCCND. In bilateral pCCND, larger tumor size, minimal ETE, high MLN and LNR were significant correlation with RFS in univariate analysis. However, in multivariate analysis, multiple larger tumor and high LNR showed significant correlation with RFS. LNY was not statistically significant in both unilateral and bilateral pCCND. Conclusion: In regarding nodal factors, high LNR was only independent risk factor to worse RFS in both unilateral and bilateral pCCND in cN0 PTC patients.

갑상선유두암에서 p53과 Cyclin D1의 발현이 가지는 예후인자로서의 의미

류정원(Jung Won Ryu),이영돈(Young Don Lee),정유승(Yoo Seung Chung),정동해(Dong Hae Chung),석재연(Jae Yeon Seok) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.2

Purpose: P53 and cyclin D1 have been evaluated as a prognostic marker in papillary thyroid carcinoma (PTC). However, the relationship between p53/cyclin D1 and PTC prognosis has not yet been confirmed. Therefore, we investigated the relationship between p53/cyclin D1 and PTC prognostic factors. Methods: 919 patients with PTC were enrolled. Immunohistochemistry slides were reviewed for p53 and cyclin D1 immunoreactivity. Patients were classified into two groups according to the p53 and cyclin D1 grade: negative for ≤5% and positive for >5%. Medical records were reviewed to evaluate the prognostic factors, lymph node metastatic ratio (LNMR), and MACIS score. We analyzed patients based on p53/cyclin D1(−/−), p53/cyclin D1(−/+), p53/cyclin D1(+/−), p53/cyclin D1(+/+) separately for evaluation of independent effect of p53 and cyclin D1. Results: Mean age of the patients was 49.73 years (range 15∼87), and tumor size was 1.19 cm (range 0.1∼5.0). P53 was positive in 809 (88.0%) and cyclin D1 was positive in 748 (81.4%). Positivity of p53 and cyclin D1 were correlated (r=0.448). There was no statistical significance in MACIS score. Positivity of p53 and cyclin D1 were related with larger tumor size, older age, early T stage, more tumor capsulation, and female. LNMR was higher in p53/cyclin D1(+/−) than p53/cyclin D1(−/−) (P=0.036), p53/cyclin D1(−/+) than p53/cyclin D1(−/−) (P=0.034), and p53/cyclin D1(+/+) than p53/cyclin D1(−/−) (P=0.007). Conclusion: There was no consistent relationship between p53/cyclin D1 and worse prognostic factors of PTC. However, LNMR was higher in p53(+) and cyclin D1(+) cases independently, much more in p53/cyclin D1(+/+) than p53/cyclin D1(−/−).

pT2 위암 생존율에 있어서 전이 림프절 비율의 의의

박종익(Jong Ik Park),신동규(Dong Gue Shin),조익행(Ik Haeng Cho),양대현(Dae Hyun Yang),이해완(Hae Wan Lee),김일명(Il Myung Kim) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.70 No.6

장막침윤 위암의 예후인자

김종한(Jong-Han Kim),부윤정(Yoon-Jung Boo),박성수(Sung-Soo Park),김진(Jin Kim),김승주(Seung-Joo Kim),목영재(Young-Jae Mok),김종석(Chong-Suk Kim) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.70 No.4