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Background and purpose: Currently, for patients with mid-to-low locally advanced rectal cancer and potentially resectable T4bM0 colon cancer, guidelines recommend neoadjuvant therapy strategies to enhance the response rate and increase the likelihood of conversion surgery. Among these patients, ypⅢ stage colorectal cancer (CRC) is assessed using the Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) TNM staging system for postoperative pathological features. However, neoadjuvant therapy can lead to lymph node regression in the surgical area, resulting in an insufficient number of detected lymph nodes (less than 12), preventing classification according to conventional TNM staging. Thus, TNM staging often fails to predict the prognosis of ypⅢ patients who have undergone neoadjuvant therapy. This study aimed to evaluate the prognostic value of the positive lymph node ratio (LNR) in ypⅢ stage CRC patients treated with neoadjuvant therapy. Methods: Retrospective data was collected from ypⅢ stage CRC patients who received neoadjuvant therapy and underwent radical surgery at Fudan University Shanghai Cancer Center between 2008 and 2018. Collect clinical pathological characteristics such as age, gender, primary tumor location, tumor differentiation grade, pathological staging, and whether the patient has relapsed or died during follow-up at the time of surgery. Inclusion criteria: CRC patients who have received neoadjuvant therapy and surgery and have been confirmed to be stage Ⅲ by postoperative pathological examination. Exclusion criteria: ① Preoperative imaging examination or intraoperative exploration reveals distant organ metastasis; ② History of malignant tumors in the past; ③ Multiple primary CRC. This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center (ethics number: 050432-4-2108*). The R software survminer package (surv_cutpoint algorithm) was used to calculate the optimal cutoff value for LNR relative to disease-free survival (DFS), and patients were divided into low and high LNR groups accordingly. Clinical pathological characteristics and DFS were compared between the two groups. COX proportional hazards regression models were employed to identify adverse pathological features, and survival plots along with prediction models for DFS were generated using the survival and rms packages. Results: A total of 489 patients were included, comprising 289 males and 200 females, with a median age of 56 years (23-80 years) and a median follow-up time of 1 062 d. During the follow-up period, 164 patients (33.5%) died. In the entire cohort, 204 (41.7%) patients had fewer than 12 lymph nodes detected. The optimal cutoff value for LNR was 0.29, classifying 317 patients into the low LNR group (LNR≤0.29) and 172 patients into the high LNR group (LNR>0.29). The high LNR group exhibited shorter DFS compared to the low LNR group [hazard ratio (HR)=2.103, 95% CI: 1.582-2.796, P

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Abstract Background Adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Lymph node metastasis is an important clinical issue in AEG patients. This study investigated the usefulness of a positive lymph node ratio (PLNR) to stratify prognosis and evaluate stage migration. Methods We retrospectively analysed 117 consecutive AEG patients (Siewert type I or II) who received a lymphadenectomy between 2000 and 2016. Results A PLNR cut-off value of 0.1 most effectively stratified patient prognosis into two groups (P

Background: Adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Lymph node metastasis is an important clinical issue in AEG patients. This study investigated the usefulness of a positive lymph node ratio (PLNR) to stratify prognosis and evaluate stage migration. Methods: We retrospectively analysed 117 consecutive AEG patients (Siewert type I or II) who received a lymphadenectomy between 2000 and 2016. Results: A PLNR cut-off value of 0.1 most effectively stratified patient prognosis into two groups (P < 0.001). Also, prognosis could be clearly stratified into four groups: PLNR = 0, 0 < PLNR < 0.1, 0.1 ≤ PLNR < 0.2, and 0.2 ≤ PLNR (P < 0.001, 5-year survival rates (88.6%, 61.1%, 34.3%, 10.7%)). A PLNR ≥ 0.1 significantly correlated with tumour diameter ≥ 4 cm (P < 0.001), tumour depth (P < 0.001), greater pathological N-status (P < 0.001), greater pathological Stage (P < 0.001), and oesophageal invasion length ≥ 2 cm (P = 0.002). A PLNR ≥ 0.1 was a poor independent prognostic factor (hazard ratio 6.47, P < 0.001). The PLNR could stratify prognosis if at least 11 lymph nodes were retrieved. A 0.2 PLNR cut-off value discriminated a stage migration effect in pN3 and pStage IV (P = 0.041, P = 0.015) patients; PLNR ≥ 0.2 might potentially diagnose a worse prognosis and need meticulous follow-up post-surgery. Conclusion: Using PLNR, we can evaluate the prognosis and detect higher malignant cases who need meticulous treatments and follow-up in the same pStage. [ABSTRACT FROM AUTHOR]

Objective To study the impact of regional positive lymph node ratio ( LNR) on prognosis of patients with gallbladder carcinoma. Methods The clinicopathological and survival data of 53 patients with gallbladder carcinoma who underwent radical resection with regional lymph node metastasis in Ningbo University Affiliated Lihuili Hospital from May 2012 to December 2020 were collected, and receiver operating characteristic curve (ROC) was used to determine the optimal cut-off value of LNR for predicting postoperative survival status in patients with gallbladder carcinoma. According to the critical value, the patients were divided into low LNR group and high LNR group. The clinicopathological features and prognosis of the two groups were compared. Log rank test was used for univariate analysis of prognostic factors in patients with gallbladder carcinoma, and Cox proportional hazards model was used for multivariate analysis. Results A total of 417 regional lymph nodes were dissected in 53 patients, of which 144 lymph nodes were positive, with a positive rate of 34.5%. The optimal cut-off value of LNR for predicting postoperative survival status of patients with gallbladder carcinoma was 0.33. According to this cut-off value, patients were divided into low LNR group (LNR≤0.33, 28 cases) and high LNR group (LNR>0.33, 25 cases). The recurrence rates were 64.3% (18 / 28) and 88.0 % (22 / 25) in low LNR group and high LNR group, respectively. The median recurrence-free survival (RFS) was 8 and 7 months, respectively (P = 0. 032). In the low LNR group, the 1-, 3-, and 5-year survival rates were 56.2%, 38.4%, and 32.0%, respectively, and the median overall survival (OS) was 16 months. In the high LNR group, the 1-, 3-, and 5-year survival rates were 37.9%, 5.4%, and 0, respectively, and the median OS was 9 months. The postoperative survival rate of patients in the low LNR group was better than that in the high LNR group (P = 0.008). Univariate analysis showed that LNR was even associated with RFS and OS in patients with gallbladder carcinoma (P<0.05). Multivariate analysis showed that LNR> 0.33 was an independent risk factor for postoperative RFS (HR = 1.977, 95% CI: 1.045-3.740), but not for OS (HR= 1.561, 95% CI: 0.685-3.553). Conclusion On the basis of clearing a sufficient number of regional lymph nodes, patients with gallbladder carcinoma with regional LNR>0.33 are more likely to relapse after operation, but the predictive value of LNR>0.33 OS is insufficient. [ABSTRACT FROM AUTHOR]

Objective To explore the prognostic value of positive lymph node ratio in patients with lung adenocarcinoma, and to investigate the predictive value of the predictive model including positive lymph node ratio on the overall survival rate of patients with lung adenocarcinoma. Methods A total of 36 335 patients with lung adenocarcinoma in the SEER database from 2010 to 2016 were selected and randomly assigned to the training set and SEER verification set according to the ratio of 7∶3.X-tile software was used to determine the best cut-off point of positive lymph node ratio. The independent prognostic factors were selected by LASSO Cox regression, and a predicting model was constructed. In addition, a total of 90 patients with lung adenocarcinoma from Hubei Provincial Hospital of Integrated Chinese and Western Medicine were included as the external validation set. Results No lymph node metastasis was found in 75.1% of the patients in the SEER training set,75.0% in the SEER validation set and 44.4% in the external validation. X-tile results showed the greatest survival difference among the three groups when the positive lymph node ratio was 0.2.LASSO Cox regression analysis revealed that positive lymph node ratio, gender, age, tumor grade, tumor size, M stage and TNM stage were independent prognostic factors of lung adenocarcinoma. The nomogram containing positive lymph node ratios had a high predictive value for the overall survival rate of patients with lung adenocarcinoma in the SEER training set(AUC of three-year survival rate:0.714;AUC of five-year survival rate:0.700; AUC of ten-year survival rate: 0.718), SEER validation set(AUC of three-year survival rate: 0.710; AUC of five-year survival rate:0.709; AUC of ten-year survival rate:0.704), and external validation set(AUC of three year survival rate:0.703;AUC of five-year survival rate: 0.798; AUC of ten-year survival rate: 0.769).Conclusion The positive lymph node ratio fully considers the number of lymph node metastasis and the total number of lymph node dissections on the survival of patients with lung adenocarcinoma, which exhibited good prognostic value. The positive lymph node ratio greater than 0.2 is an independent risk factor for poor overall survival of patients with lung adenocarcinoma. The nomogram containing a positive lymph node ratio has a high predictive value for the prognosis of patients with lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

BackgroundAlthough lymph node dissection (LND) has been commonly used for patients with bronchopulmonary carcinoids (PCs), the prognostic values of the positive lymph node ratio (PLNR) and the number of removed nodes (NRN) remain unclear.MethodsPatients with resected PCs were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015). The optimal cut-off values of the PLNR and NRN were determined by X-tile. The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare the overall survival (OS) and cancer-specific survival (CSS) of patients in different PLNR and NRN groups.ResultsThe study included 1622 patients. The optimal cut-off values of the PLNR and NRN for survival were 13% and 13, respectively. In both Kaplan-Meier analysis and univariable Cox proportional hazards regression analysis before IPTW, a PLNR ≥13% was significantly associated with worse OS (HR = 3.364, P

Background: Although lymph node dissection (LND) has been commonly used for patients with bronchopulmonary carcinoids (PCs), the prognostic values of the positive lymph node ratio (PLNR) and the number of removed nodes (NRN) remain unclear. Methods: Patients with resected PCs were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015). The optimal cut-off values of the PLNR and NRN were determined by X-tile. The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare the overall survival (OS) and cancer-specific survival (CSS) of patients in different PLNR and NRN groups. Results: The study included 1622 patients. The optimal cut-off values of the PLNR and NRN for survival were 13% and 13, respectively. In both Kaplan-Meier analysis and univariable Cox proportional hazards regression analysis before IPTW, a PLNR ≥13% was significantly associated with worse OS (HR = 3.364, P<0.001) and worse CSS (HR = 7.874, P<0.001). These findings were corroborated by the IPTW-adjusted Cox analysis OS (HR = 2.358, P = 0.0275) and CSS (HR = 8.190, P<0.001) results. An NRN ≥13 was not significantly associated with worse OS in either the Kaplan-Meier or Cox analysis before or after IPTW adjustment. In the Cox proportional hazards analysis before and after IPTW adjustment, an NRN ≥13 was significantly associated with worse CSS (non-IPTW: HR = 2.216, P=0.013; IPTW-adjusted: HR = 2.162, P=0.024). Conclusion: A PLNR ≥13% could predict worse OS and CSS in patients with PCs and might be an important complement to the present PC staging system. Extensive LND with an NRN ≥13 might have no therapeutic value for OS and may even have an adverse influence on CSS. Its application should be considered on an individual basis. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer. However, it is still controversial to perform laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer. We performed the present study to compare the long-term outcomes of patients after laparoscopic or open gastrectomy plus D2 lymphadenectomy. Methods: The clinicopathological data of 182 gastric cancer patients receiving gastrectomy plus D2 lymphadenectomy between January 2011 and December 2015 at Shenzhen Traditional Chinese Medicine Hospital were retrospectively retrieved. The overall survival (OS) and disease-free survival (DFS) of these 182 patients were compared. Then, the prognostic significance of positive lymph node ratio (LNR) was assessed. Results: As a whole, OS (P = 0.789) and DFS (P = 0.672) of patients receiving laparoscopic gastrectomy plus D2 lymphadenectomy were not significantly different from those of patients receiving open surgery. For stage I patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.573) and DFS (P = 0.157). Similarly, for stage II patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.567) and DFS (P = 0.830). For stage III patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.773) and DFS (P = 0.404). Laparoscopic or open gastrectomy plus D2 lymphadenectomy was not proven by Cox regression analysis to be an independent prognostic factor for OS and DFS. High LNR was significantly associated with worse OS (P < 0.001) and DFS (P < 0.001). Surgical type did not significantly affect prognosis of patients with low LNR or survival of patients with high LNR. Conclusions: For patients with gastric cancer, laparoscopic gastrectomy plus D2 lymphadenectomy was not inferior to open surgery in terms of long-term outcomes. LNR is a useful prognostic marker for GC patients. [ABSTRACT FROM AUTHOR]

To investigate whether the positive lymph node number (PLNN) and positive lymph node ratio (PLNR) could predict the prognosis of patients with major salivary gland cancer (MSGC) and to identify the optimal cutoff points for these variables that stratify patients according to their risk of survival. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify all patients with MSGC between 1988 and 2014. A logistic regression analysis was carried out to evaluate the risk factors for lymph node metastasis (LNM) in MSGC. The X-tile program was used to identify the cutoff values for the PLNN and PLNR in MSGC patients with LNM. Cox proportional hazards regression models were performed to identify the predictors of cancer-specific survival (CSS). In the SEER database, 8668 eligible patients were identified and 3046 of them had LNM. The logistic regression analysis indicated that older age, male sex, larger tumor size, higher grade, tumor extension and high-risk pathology were associated with LNM. The X-tile program showed that a PLNN>4 and a PLNR>0.15 were prognostic indicators of CSS. A multivariable analysis indicated that, after the factors that might potentially affect the prognosis were adjusted for, the PLNN and PLNR were still associated with CSS. Our Results demonstrated that the PLNN and PLNR were independent prognostic indicators for MSGC patients with lymph node metastasis. [ABSTRACT FROM AUTHOR]

Aims To detect the best cut-off value of the positive lymph node ratio (PLNR) for stratifying the prognosis and analyzing its value with regard to stage migration effect using PLNR in gastric cancer. Methods We retrospectively analyzed 1069 consecutive gastric cancer patients, who underwent curative gastrectomy with radical lymphadenectomy from 1997 through 2009. Results 1) The mean number of dissected lymph nodes was 42.6 in pStage I, 32.4 in pStage II and 37.1 in pStage III. The PLNR of 0.2 was proved to be the best cut-off value to stratify the prognosis of patients into two groups ( P < 0.0001; PLNR <0.2 vs. PLNR ≥0.2), and patients were correctly classified into four groups: PLNR 0, PLNR 0–<0.2, PLNR 0.2–<0.4 and PLNR ≥0.4 by the Kaplan–Meier method. 2) Compared patients with the PLNR <0.2, those with the PLNR ≥0.2 had a significantly higher incidence of pT3 or greater, pN2 or greater, lymphatic invasion, vascular invasion and undifferentiated cancer. Multivariate analysis showed that the PLNR ≥0.2 was an independent prognostic factor [ P < 0.0001, HR 2.77 (95% CI: 1.87–4.09)]. 2) The PLNR cut-off value of 0.2 could discriminate a stage migration effect in pN2–N3 and pStage II–III, which patients with PLNR ≥0.2 might be potentially diagnosed as a lower stage after gastrectomy. Conclusion The PLNR contributes to evaluating prognosis and stage migration effect even in a single institute and enable to identify those who need meticulous treatments and follow-up in patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Nodal metastasis is an important clinical issue in gastric cancer patients. This study was designed to investigate the clinical usefulness of the positive lymph node ratio (PLNR), which reflects both metastatic and retrieved lymph node numbers, in patients with pN3 gastric cancer.Methods: We retrospectively analyzed the records of 138 consecutive pN3 patients who underwent curative gastrectomy with lymphadenectomy from 2000 to 2012.Results: A PLNR of 0.4 was proved to be the best cutoff value to stratify the prognosis of patients with pN3 gastric cancer (P < 0.001). Univariate and multivariate analyses revealed that older age, larger tumor size (≥10 cm), and PLNR ≥ 0.4 [P < 0.001, HR 3.1 (95 % CI 1.7-5.4)] were independent prognostic factors in pN3 gastric cancer. Regarding the recurrence, patients with PLNR <0.4 had a significantly lower rate of lymph node recurrence than those with PLNR ≥0.4 (P = 0.020). There was no significant difference in the lymph node recurrence rate between N3a and N3b patients in the PLNR <0.4 group [P = 0.546, 11.6 % (7/60) vs. 12.5 (1/8)], indicating a better local control regardless of pN3 subgroups.Conclusions: PLNR is useful to stratify the prognosis and evaluate the extent of local tumor clearance in pN3 gastric cancer. [ABSTRACT FROM AUTHOR]

Background In gastric cancer, although at least 16 lymph nodes of retrieved lymph nodes (RLNs) are recommended for nodal staging in Japanese Classification of Gastric Carcinoma and TNM classifications, we wished to clarify their appropriateness. Study Design A total of 1289 consecutive gastric cancer patients, who underwent gastrectomy between 1997 and 2011, were analyzed retrospectively. Results (i) The patients were divided into two groups using a cut-off RLN number of 16 (RLN < 16 or RLN ≥ 16). There were significant differences in the survival rates of patients in pStage II ( P < 0.0001) and III ( P = 0.0009), but not those of patients in pStage I ( P = 0.0627) and IV ( P = 0.1553). (ii) In 498 consecutive patients in pStage II and III, compared with patients in the RLN ≥ 16 group, those in the RLN < 16 group had a significantly higher incidence of older age ( P = 0.0004) and positive lymph node ratio (PLNR) ( P < 0.0001). Univariate and multivariate analyses showed that an RLN number of less than 16 was an independent poor prognostic factor ( P < 0.0001, HR 2.48 [95% CI: 1.60-3.70]). (iii) A cut-off RLN number of 16 could cause the stage migration effect in pStage II or III patients. A cut-off RLN number of 25 or more could eliminate the prognostic effect. Conclusion The RLN number may potentially affect the prognosis and the stage migration in pStage II or III gastric cancer patients. An RLN number of 25 or more could be sufficient for nodal staging. [ABSTRACT FROM AUTHOR]

Alternative lymph node (LN) parameters have been proposed to improve staging in colorectal cancer. This study compared these alternative parameters with conventional TNM staging in predicting long-term survival in patients undergoing curative resection. A total of 295 consecutive patients (mean age 70 years; range 39-95; s.d. 10.4) underwent resection for colorectal cancer from 2001 to 2004. Age, sex, primary tumour site, TNM stage and chemotherapy/radiotherapy were recorded. Patients with colon and rectal cancers were analysed separately for LN parameters: LN total; adequate LN retrieval (> or =12) and inadequate (<12); total number of negative LN; total number of positive LN and the ratio of positive LN to total LN (pLNR). Univariate and multivariate survival analysis was performed. The median number of LN retrieved was 10 (1-57) with adequate LN retrieval in 147 cases (49.8%). For each T and N stage, inadequate LN retrieval did not adversely affect long-term survival (P>0.05). On multivariate analysis, only pLNR was an independent predictor of overall survival in both colon and rectal cancers (HR 11.65, 95% CI 5.00-27.15, P<0.001 and HR 13.40, 95% CI 3.64-49.10, P<0.001, respectively). Application of pLNR subdivided patients into four prognostic groups. Application of the pLNR improved patient stratification in colorectal cancer and should be considered in future staging systems. [ABSTRACT FROM AUTHOR]