Cargando…

The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems

BACKGROUND: pN stage in the TNM classification has been the “gold standard” for lymph node staging of colorectal carcinomas, but this system recommends collecting at least 12 lymph nodes for the staging to be reliable. However, new prognostic staging systems have been devised, such as the ganglion q...

Descripción completa

Detalles Bibliográficos
Autores principales: Fortea-Sanchis, Carlos, Martínez-Ramos, David, Escrig-Sos, Javier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280498/
https://www.ncbi.nlm.nih.gov/pubmed/30514228
http://dx.doi.org/10.1186/s12885-018-5048-4
_version_ 1783378690465333248
author Fortea-Sanchis, Carlos
Martínez-Ramos, David
Escrig-Sos, Javier
author_facet Fortea-Sanchis, Carlos
Martínez-Ramos, David
Escrig-Sos, Javier
author_sort Fortea-Sanchis, Carlos
collection PubMed
description BACKGROUND: pN stage in the TNM classification has been the “gold standard” for lymph node staging of colorectal carcinomas, but this system recommends collecting at least 12 lymph nodes for the staging to be reliable. However, new prognostic staging systems have been devised, such as the ganglion quotients or lymph node ratios and natural logarithms of the lymph node odds methods. The aim of this study was to establish and validate the predictive and prognostic ability of the lymph node ratios and natural logarithms of the lymph node odds staging systems and to compare them to the pN nodal classification of the TNM system in a population sample of patients with colon cancer. METHODS: A multicentric population study between January 2004 and December 2007. The inclusion criteria were that the patients were: diagnosed with colon cancer, undergoing surgery with curative intent, and had a complete anatomopathological report. We excluded patients with cancer of the rectum or caecal appendix with metastases at diagnosis. Survival analysis was performed using the Kaplan–Meier actuarial method and the Log-Rank test was implemented to estimate the differences between groups in terms of overall survival and disease-free survival. Multivariate survival analysis was performed using Cox regression. RESULTS: We analysed 548 patients. For the overall survival, the lymph node ratios and natural logarithms of the lymph node odds curves were easier to discriminate because their separation was clearer and more balanced. For disease-free survival, the discrimination between the pN0 and pN1 groups was poor, but this phenomenon was adequately corrected for the lymph node ratios and natural logarithms of the lymph node odds curves which could be sufficiently discriminated to be able to estimate the survival prognosis. CONCLUSIONS: Lymph node ratios and natural logarithms of the lymph node odds techniques can more precisely differentiate risk subgroups from within the pN groups. Of the three methods tested in this study, the natural logarithms of the lymph node odds was the most accurate for staging non-metastatic colon cancer. Thus helping to more precisely adjust and individualise the indication for adjuvant treatments in these patients.
format Online
Article
Text
id pubmed-6280498
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-62804982018-12-10 The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems Fortea-Sanchis, Carlos Martínez-Ramos, David Escrig-Sos, Javier BMC Cancer Research Article BACKGROUND: pN stage in the TNM classification has been the “gold standard” for lymph node staging of colorectal carcinomas, but this system recommends collecting at least 12 lymph nodes for the staging to be reliable. However, new prognostic staging systems have been devised, such as the ganglion quotients or lymph node ratios and natural logarithms of the lymph node odds methods. The aim of this study was to establish and validate the predictive and prognostic ability of the lymph node ratios and natural logarithms of the lymph node odds staging systems and to compare them to the pN nodal classification of the TNM system in a population sample of patients with colon cancer. METHODS: A multicentric population study between January 2004 and December 2007. The inclusion criteria were that the patients were: diagnosed with colon cancer, undergoing surgery with curative intent, and had a complete anatomopathological report. We excluded patients with cancer of the rectum or caecal appendix with metastases at diagnosis. Survival analysis was performed using the Kaplan–Meier actuarial method and the Log-Rank test was implemented to estimate the differences between groups in terms of overall survival and disease-free survival. Multivariate survival analysis was performed using Cox regression. RESULTS: We analysed 548 patients. For the overall survival, the lymph node ratios and natural logarithms of the lymph node odds curves were easier to discriminate because their separation was clearer and more balanced. For disease-free survival, the discrimination between the pN0 and pN1 groups was poor, but this phenomenon was adequately corrected for the lymph node ratios and natural logarithms of the lymph node odds curves which could be sufficiently discriminated to be able to estimate the survival prognosis. CONCLUSIONS: Lymph node ratios and natural logarithms of the lymph node odds techniques can more precisely differentiate risk subgroups from within the pN groups. Of the three methods tested in this study, the natural logarithms of the lymph node odds was the most accurate for staging non-metastatic colon cancer. Thus helping to more precisely adjust and individualise the indication for adjuvant treatments in these patients. BioMed Central 2018-12-04 /pmc/articles/PMC6280498/ /pubmed/30514228 http://dx.doi.org/10.1186/s12885-018-5048-4 Text en © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Fortea-Sanchis, Carlos
Martínez-Ramos, David
Escrig-Sos, Javier
The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems
title The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems
title_full The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems
title_fullStr The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems
title_full_unstemmed The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems
title_short The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems
title_sort lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (lodds) versus the pn-tnm classification and ganglion ratio systems
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280498/
https://www.ncbi.nlm.nih.gov/pubmed/30514228
http://dx.doi.org/10.1186/s12885-018-5048-4
work_keys_str_mv AT forteasanchiscarlos thelymphnodestatusasaprognosticfactorincoloncancercomparativepopulationstudyofclassificationsusingthelogarithmoftheratiobetweenmetastaticandnonmetastaticnodesloddsversusthepntnmclassificationandganglionratiosystems
AT martinezramosdavid thelymphnodestatusasaprognosticfactorincoloncancercomparativepopulationstudyofclassificationsusingthelogarithmoftheratiobetweenmetastaticandnonmetastaticnodesloddsversusthepntnmclassificationandganglionratiosystems
AT escrigsosjavier thelymphnodestatusasaprognosticfactorincoloncancercomparativepopulationstudyofclassificationsusingthelogarithmoftheratiobetweenmetastaticandnonmetastaticnodesloddsversusthepntnmclassificationandganglionratiosystems
AT forteasanchiscarlos lymphnodestatusasaprognosticfactorincoloncancercomparativepopulationstudyofclassificationsusingthelogarithmoftheratiobetweenmetastaticandnonmetastaticnodesloddsversusthepntnmclassificationandganglionratiosystems
AT martinezramosdavid lymphnodestatusasaprognosticfactorincoloncancercomparativepopulationstudyofclassificationsusingthelogarithmoftheratiobetweenmetastaticandnonmetastaticnodesloddsversusthepntnmclassificationandganglionratiosystems
AT escrigsosjavier lymphnodestatusasaprognosticfactorincoloncancercomparativepopulationstudyofclassificationsusingthelogarithmoftheratiobetweenmetastaticandnonmetastaticnodesloddsversusthepntnmclassificationandganglionratiosystems