PMID- 25341906
OWN - NLM
STAT- MEDLINE
DCOM- 20150604
LR  - 20181202
IS  - 1671-0274 (Print)
IS  - 1671-0274 (Linking)
VI  - 17
IP  - 10
DP  - 2014 Oct
TI  - [Prognostic value of lymph node ratio staging system in stage III( rectal cancer 
      following 30 Gy/10 f preoperative radiotherapy].
PG  - 990-6
AB  - OBJECTIVE: To evaluate the prognostic value of the lymph node ratio(LNR) staging 
      system for rectal cancer following 30 Gy/10 f preoperative radiotherapy. METHODS: 
      Clinical data of 282 patients with mid-lower locally advanced rectal cancer who 
      received preoperative radiotherapy and curative surgery in the Peking University 
      Cancer Hospital from August 2003 to August 2009 were retrospectively reviewed. 
      The radiotherapy regimen was recommended by CACA. Total dose of 30 Gy was divided 
      into 10 fragments (30 Gy/10 f), the biologically equivalent dose (BED) was 36 Gy, 
      and 3D conformal radiotherapy(3D-CRT) was used. Surgery was performed 2-4 weeks 
      after radiation. The prognostic effect of the lymph node ratio(LNR) staging 
      system in addition to the 7th AJCC staging system were retrospectively analyzed 
      and compared in stage III( cases with positive lymph node(s). Patients were 
      divided into four groups by LNR quantiles: LNR1(<0.070), LNR2(0.070-0.142), 
      LNR3(0.143-0.307) and LNR4(>0.307). RESULTS: A total of 108 eligible cases were 
      included in the study. The 3-year disease-free survival (3-yr DFS) was 61.1%. On 
      univariate analysis, circumferential resection margin involvement(P=0.034), tumor 
      differentiation (P=0.002), N stage (P=0.001), TNM stage(P=0.000) and LNR(P=0.003) 
      were significantly associated with 3-yr DFS. On multivariate analysis, 
      abdominoperineal resection (P=0.006, HR=2.611, 95%CI:1.323-5.153), G3-4 
      differentiation (P=0.015, HR=2.208, 95%CI:1.163-4.192), ypN2a/N2b stage(as 
      covariate: P=0.024, HR=2.568, 95%CI:1.135-5.810; P=0.001, HR=3.759, 
      95%CI:1.776-7.958) were independent risk factors for decreased 3-yr DFS. Other 
      factors including LNR were excluded in Cox regression model. The 3-yr DFS was 
      statistically different among subcategories of ypN stage. There was no 
      statistical difference of 3-yr DFS in pair-wise comparison of LNR1 and LNR2, LNR2 
      and LNR3 and LNR3 and LNR4. Additional use of LNR over AJCC staging system did 
      not improve the prediction of prognosis for III(B/C stages and for each stratum 
      of ypN stages, despite the prognostic separation by LNR in III(A stage. 
      CONCLUSION: The LNR staging system in addition to the 7th AJCC staging system 
      does not provide further detailed stratification of the prognosis for stage III( 
      rectal cancer following 30 Gy/10 f preoperative radiotherapy. Lymph node ratio is 
      premature as a prognostic factor in clinical practice.
FAU - Wang, Lin
AU  - Wang L
AD  - Department of Colorectal Surgery, Key Laboratory of Carcinogenesis and 
      Translational Research (Ministry of Education), Peking University Cancer Hospital 
      and Institute, Beijing Cancer Hospital, Beijing 100142, China. zlgujin@126.com.
FAU - Li, Zhongwu
AU  - Li Z
FAU - Li, Ming
AU  - Li M
FAU - Peng, Yifan
AU  - Peng Y
FAU - Gu, Jin
AU  - Gu J
LA  - chi
PT  - Journal Article
PL  - China
TA  - Zhonghua Wei Chang Wai Ke Za Zhi
JT  - Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
JID - 101177990
SB  - IM
MH  - Disease-Free Survival
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Multivariate Analysis
MH  - Neoplasm Staging
MH  - Prognosis
MH  - Rectal Neoplasms/*pathology/radiotherapy/surgery
MH  - Retrospective Studies
EDAT- 2014/10/25 06:00
MHDA- 2015/06/05 06:00
CRDT- 2014/10/25 06:00
PHST- 2014/10/25 06:00 [entrez]
PHST- 2014/10/25 06:00 [pubmed]
PHST- 2015/06/05 06:00 [medline]
AID - 100001882012 [pii]
PST - ppublish
SO  - Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Oct;17(10):990-6.