Study on the prognostic value of positive lymph node ratio and log odds of positive lymph nodes in colorectal cancer

doi:10.3877/cma.j.issn.1674-0793.2024.03.006

Abstract

Abstract:

Objective

To investigate the value of positive lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in the prognosis of colorectal cancer patients.

Methods

A total of 206 patients who underwent radical surgery for colorectal cancer in Wujin Hospital Affiliated to Jiangsu University from January 2017 to December 2018 were retrospectively analyzed and followed up after surgery. The relationship between LNR and LODDS and clinicopathological variables was analyzed. The accuracy of positive lymph node number (pN), LNR, and LODDS stage was used in evaluating the recurrence and survival of colorectal cancer using the receiver operating characteristic (ROC) curve.

Results

The overall survival rate of colorectal cancer patients was significantly correlated with age, tumor location, degree of tumor differentiation, tumor invasion degree, tumor size, postoperative adjuvant therapy, the number of lymph node metastases (N), distant metastases (M), tumor TNM stage, length of hospital stay, LNR and LODDS stage (P<0.05). The independent factors affecting the survival of colorectal cancer after surgery were degree of tumor differentiation, lymph node metastasis, distant metastasis, TNM stage, LNR stage and LODDS stage (all P<0.01). The results of ROC curve showed that the area under the curve of pN, LNR and LODDS stages on recurrence (tumor free survival) were 0.748, 0.739 and 0.733, respectively, and the area under the curve for the effect on overall survival were 0.739, 0.725 and 0.720, respectively (P<0.001).

Conclusions

LNR and LODDS significantly affect the overall survival rate of colorectal cancer patients, and they are independent factors affecting the survival of colorectal cancer after surgery. Therefore, they can be used as effective supplements when pN stage is insufficient, and LNR is better than LODDS.

Key words: Colorectal neoplasms, Lymph node ratio, Positive lymph node ratio, Log odds of positive lymph nodes, Positive lymph node number, Prognosis, Survival analysis

Yaocheng Sun, Jianjun Tang, Weiyuan Zhang, Chuanlei Liu. Study on the prognostic value of positive lymph node ratio and log odds of positive lymph nodes in colorectal cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(03): 204-208.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2024.03.006

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2024/V18/I03/204

Figures/Tables 8

References 18

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA, 2021, 71(3): 209-249.
[2]	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging[J]. CA Cancer J Clin, 2017, 67(2): 93-99.
[3]	Li BW, Ma XY, Lai S, et al. Development and validation of a prognostic nomogram for colorectal cancer after surgery[J]. World J Clin Cases, 2021, 9(21): 5860-5872.
[4]	In Ja P, Sik YC, Seok-Byung L, et al. Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy[J]. World J Gastroenterol, 2015, 21(11): 3274-3281.
[5]	Lykke J, Jess P, Roikjaer O, et al. The prognostic value of lymph node ratio in a national cohort of rectal cancer patients[J]. Eur J Surg Oncol, 2016, 42(4): 504-512.
[6]	Otmani IE, Effared B, Agy FE, et al. Lymph nodes with germinal centers are not associated with tumor response after neoadjuvant treatment in locally advanced rectal cancer[J]. Clin Pathol, 2022, 15: 1-12.
[7]	Guan X, Jiao S, Wen R, et al. Optimal examined lymph node number for accurate staging and long-term survival in rectal cancer: A population-based study[J]. Int J Surg, 2023, 109(8): 2241-2248.
[8]	Arslan NC, Sokmen S, Canda AE, et al. The prognostic impact of the log odds of positive lymph nodes in colon cancer[J]. Color Dis, 2014, 16(11): 386-392.
[9]	Persiani R, Cananzi FC, Biondi A, et al. Log odds of positive lymph nodes in colon cancer: A meaningful ratio-based lymph node classification system[J]. World J Surg, 2012, 36(3): 667-674.
[10]	Cai H, Xu T, Zhuang Z, et al. Value of the log odds of positive lymph nodes for prognostic assessment of colon mucinous adenocarcinoma: analysis and external validation[J]. Cancer Med, 2021, 10(23): 8542-8557.
[11]	Tsai HL, Lu CY, Hsieh JS, et al. The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer[J]. J Gastrointest Surg, 2007, 11(5): 660-665.
[12]	Qiao Y, Zhu J, Han T, et al. Finding the minimum number of retrieved lymph nodes in node-negative colorectal cancer using Real-world Data and the SEER database[J]. Int J Surg, 2023, 109(12): 4173-4184.
[13]	Zhang QW, Zhang CH, Pan YB, et al. Prognosis of colorectal cancer patients is associated with the novel log odds of positive lymph nodes scheme: derivation and external validation[J]. J Cancer, 2020, 11(7): 1702-1711.
[14]	Junginger T, Goenner U, Lollert A, et al. The prognostic value of lymph node ratio and updated TNM classification in rectal cancer patients with adequate versus inadequate lymph node dissection[J]. Tech Coloproctol, 2014, 18(9): 805-811.
[15]	Wang Y, Zhuo C, Shi D, et al. Unfavorable effect of small tumor size oncause - specific survival in stage Ⅱa colon cancer, a SEER - based study[J]. Int J Colorectal Dis, 2015, 30(1): 131-137.
[16]	Yadav A, Singh S, Sarin N, et al. Expression of epidermal growth factor receptor (EGFR) and β-catenin in colorectal carcinoma and its correlation with tumor grade and stage[J]. Indian J Surg Oncol, 2023, 14(4): 758-764.
[17]	Baqar AR, Wilkins S, Wang W, et al. Log odds of positive lymph nodes is prognostically equivalent to lymph node ratio in non-metastatic colon cancer[J]. BMC Cancer, 2020, 20(1): 762-771.
[18]	Scarinci A, Di Cesare T, Cavaniglia D, et al. The impact of log odds of positive lymph nodes (LODDS) in colon and rectal cancer patient stratification: A single-center analysis of 323 patients[J]. Updates Surg, 2018, 70(1): 23-31.

变量	例(%)	3年总生存率(%)	5年总生存率(%)	P值
性别				0.664
男	121(58.7)	81.0	66.9
女	85(41.3)	75.3	64.7
年龄(岁)				0.029
≤66	105(51.0)	81.9	73.0
>66	101(49.0)	75.2	58.4
肿瘤部位				0.050
直肠	168(81.6)	85.4	69.0
结肠	38(18.4)	71.1	52.6
肿瘤直径(cm)				0.018
<5	111(53.7)	82.5	76.3
≥5	95(46.3)	69.4	57.6
术后辅助治疗				<0.001
是	155(75.2)	66.3	49.7
否	51(24.8)	93.5	87.6
分化程度				<0.001
高	11(5.3)	90.9	72.7
中	132(64.1)	85.6	75.8
低	63(30.6)	61.9	44.4
浸润深度(T)				0.002
T1	8(3.9)	100.0	100.0
T2	25(12.1)	100.0	88.0
T3	30(14.6)	93.3	76.7
T4	143(69.4)	70.6	58.0
pN分期				<0.001
N0	101(49.0)	92.1	84.2
N1	57(27.7)	78.9	61.4
N2	48(23.3)	50.0	33.3
远处转移(M)				<0.001
M0	199(96.6)	80.6	67.3
M1	7(3.4)	14.3	14.3
TNM分期				<0.001
Ⅰ	28(13.6)	100.0	96.0
Ⅱ	72(35.0)	88.9	79.2
Ⅲ	99(48.1)	69.7	51.5
Ⅳ	7(3.4)	14.3	14.3
住院时间(d)				<0.001
≤19	134(65.0)	88.1	78.4
>19	72(35.0)	61.1	43.1
LNR分期				<0.001
LNR0	106(51.5)	92.5	84.0
LNR1	41(19.9)	73.2	56.1
LNR2	59(28.6)	57.6	40.7
LODDS分期				<0.001
LODDS0	103(50.0)	92.2	83.5
LODDS1	46(22.3)	73.9	58.7
LODDS2	57(27.7)	57.9	40.4

变量	例(%)	3年总生存率(%)	5年总生存率(%)	P值
性别				0.664
男	121(58.7)	81.0	66.9
女	85(41.3)	75.3	64.7
年龄(岁)				0.029
≤66	105(51.0)	81.9	73.0
>66	101(49.0)	75.2	58.4
肿瘤部位				0.050
直肠	168(81.6)	85.4	69.0
结肠	38(18.4)	71.1	52.6
肿瘤直径(cm)				0.018
<5	111(53.7)	82.5	76.3
≥5	95(46.3)	69.4	57.6
术后辅助治疗				<0.001
是	155(75.2)	66.3	49.7
否	51(24.8)	93.5	87.6
分化程度				<0.001
高	11(5.3)	90.9	72.7
中	132(64.1)	85.6	75.8
低	63(30.6)	61.9	44.4
浸润深度(T)				0.002
T1	8(3.9)	100.0	100.0
T2	25(12.1)	100.0	88.0
T3	30(14.6)	93.3	76.7
T4	143(69.4)	70.6	58.0
pN分期				<0.001
N0	101(49.0)	92.1	84.2
N1	57(27.7)	78.9	61.4
N2	48(23.3)	50.0	33.3
远处转移(M)				<0.001
M0	199(96.6)	80.6	67.3
M1	7(3.4)	14.3	14.3
TNM分期				<0.001
Ⅰ	28(13.6)	100.0	96.0
Ⅱ	72(35.0)	88.9	79.2
Ⅲ	99(48.1)	69.7	51.5
Ⅳ	7(3.4)	14.3	14.3
住院时间(d)				<0.001
≤19	134(65.0)	88.1	78.4
>19	72(35.0)	61.1	43.1
LNR分期				<0.001
LNR0	106(51.5)	92.5	84.0
LNR1	41(19.9)	73.2	56.1
LNR2	59(28.6)	57.6	40.7
LODDS分期				<0.001
LODDS0	103(50.0)	92.2	83.5
LODDS1	46(22.3)	73.9	58.7
LODDS2	57(27.7)	57.9	40.4

变量	Exp(B)	95% CI	P值
肿瘤分化程度	1.757	1.027~3.004	0.040
远处转移	2.082	1.284~3.377	0.003
淋巴结转移	2.025	1.182~3.469	0.010
TNM分期	2.646	1.396~5.015	0.003
LNR分期	2.043	1.210~3.347	0.009
LODDS分期	1.904	1.152~3.125	0.020

变量	Exp(B)	95% CI	P值
肿瘤分化程度	1.757	1.027~3.004	0.040
远处转移	2.082	1.284~3.377	0.003
淋巴结转移	2.025	1.182~3.469	0.010
TNM分期	2.646	1.396~5.015	0.003
LNR分期	2.043	1.210~3.347	0.009
LODDS分期	1.904	1.152~3.125	0.020

变量	Exp(B)	95% CI	P值
肿瘤分化程度	2.012	1.232~3.287	0.005
远处转移	1.993	1.198~3.346	0.005
淋巴结转移	2.171	1.253~3.764	0.006
TNM分期	2.385	1.241~4.584	0.009
LNR分期	1.973	1.218~3.152	0.004
LODDS分期	2.036	1.254~3.291	0.005

Please choose a citation manager

Content to export