NEW YORK (Reuters Health) Jun 16 - Lymph node ratio independently predicts survival in patients with stage III rectal cancer treated with total mesorectal excision followed by chemoradiotherapy, according to a report in the July International Journal of Radiation Oncology, Biology, Physics.
Lymph node ratio -- the ratio of positive lymph nodes to examined lymph nodes -- is an important prognostic factor in pancreatic, breast, colorectal, and other cancers, the authors explain, but relatively little is known about the relationship between lymph node ratio and survival in patients with node-positive rectal carcinoma.
Dr. Young Seok Kim and colleagues from University of Ulsan, Seoul, Korea investigated whether lymph node ratio has prognostic value for survival in patients with stage III rectal cancer using data from two prospective studies conducted at their institution.
Overall survival decreased significantly as the lymph node ratio increased from 0.1 or less (89%) to 0.2 or less (67%), 0.4 or less (64%), to greater than 0.4 (50%), the authors report.
Five-year disease-free survival (local and distant) followed the same significant trend, declining from 75% for those with a lymph node ratio of 0.1 or less, to 33% for those with a lymph node ratio above 0.4.
The prognostic value of the lymph node ratio for survival and disease-free survival remained after adjustment for other variables with prognostic significance, the investigators say.
"Lymph node ratio is an important prognostic factor in patients with stage III rectal cancer who underwent total mesorectal excision followed by chemoradiation and should be considered a stratification factor in future randomized controlled trials," the researchers conclude.
"More intensive or further chemotherapy is indicated for patients with higher lymph node ratios," they add, "because most treatment failures were distant metastases."
Int J Radiat Oncol Biol Phys 2009;74:796-802.
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