Lymph node ratio and liver metachronous metastases in colorectal cancer.

Abstract:

AIM:The authors seek to assess whether the lymph node ratio (the ratio of positive nodes divided by the total number of retrieved nodes) could predict the risk of metachronous liver metastases. MATERIAL AND METHODS:A homogeneous group of 280 patients, followed-up for at least 5 years, was evaluated. In order to highlight the groups with the highest risk of metachronous liver metastases, patients were divided into four quartiles groups in relation to the LNR. RESULTS:The number of lymph nodes sampled in group "stage I" was significantly lower. Even if statistical significance between the global LNR and the development of liver metastases has not been reached, the subdivision into quartiles has made it possible to highlight that in the more advanced ratio groups, a higher incidence of metachronous liver metastases (p <0.028) was registered and was a different distribution of patients with or without liver metastasis in function of quartiles (P =0.01). DISCUSSION:The LNR has enabled us to prognosticate patients who are at greater risk of developing metachronous liver metastases. The lower lymph node sampling in the patients with less advanced staging (I) and in patients with nodenegative cancer (I+II) who developed liver metastases, leads us to believe that some patients have been understaged. CONCLUSION:We believe that the LNR, especially in cases of adequate lymph node sampling, is a useful gauge to better sub-stratify "node-positive" patients. KEY WORDS:Colorectal cancer, Liver metastases, Lymph node ratio. OBIETTIVO:L’obiettivo di campionare almeno 12 linfonodi per una corretta stadiazione di una neoplasia colorettale non sempre è raggiunto e ciò è legato sia a variabili modificabili come il chirurgo o il patologo, sia a variabili immodificabili legate al paziente o alla malattia neoplastica. La ratio linfonodale (LNR), cioè il rapporto tra il numero dei linfonodi metastatici ed il numero totale dei linfonodi, permetterebbe una migliore selezione prognostica dei pazienti. Gli autori hanno voluto valutare se la suddivisione dei pazienti in base alla LNR possa predire il rischio di sviluppare metastasi epatiche metacrone da cancro colorettale. MATERIALI E METODI:È stato valutato retrospettivamente un gruppo omogeneo di 280 pazienti seguiti in follow- up per almeno 5 anni. Allo scopo di evidenziare i gruppi a maggior rischio di metastasi epatiche metacrone i soggetti sono stati suddivisi in 4 quartili in relazione alla LNR. RISULTATI: il numero dei linfonodi campionati nel gruppo allo stadio I è stato inferiore in modo statisticamente significativo rispetto ai gruppi II (p=0.011) e III (p<0.007), mentre non abbiamo registrato differenze statisticamente significative tra i gruppi II e III. Per quanto non sia stata raggiunta la significatività statistica tra la LNR globale e lo sviluppo di metastasi epatiche, la suddivisione in quartili ha permesso di evidenziare che in quelli più avanzati (LNR3 + LNR4) veniva registrata una maggiore incidenza di metastasi epatiche metacrone (70% vs 30%; p<0.028) e che esiste una differente distribuzione dei pazienti con o senza metastasi epatiche in funzione dei quartili (P< 0.01). DISCUSSIONE:Alla luce dei dati riportati la LNR permette di prognosticare i pazienti a maggior rischio di sviluppare metastasi epatiche metacrone. Il minor campionamento linfonodale, registrato nei pazienti con stadiazione meno avanzata (BI) e nei pazienti nodes-negative (BI+BII) che hanno sviluppato metastasi epatiche, ci induce a ritenere che alcuni pazienti agli stadi meno avanzati siano stati verosimilmente sottostadiati. CONCLUSIONE:Riteniamo che la LNR, soprattutto in caso di adeguato campionamento linfonodale, possa essere utile per meglio sub-stratificare i pazienti in senso prognostico in generale ed in relazione allo sviluppo di metastasi epatiche metacrone in senso più specifico. Riteniamo che ulteriori studi siano necessari allo scopo di poter stabilire quale sia quel cut-off della LNR che permetta di meglio discriminare sul rischio di ripresa di malattia.

journal_name

Ann Ital Chir

authors

Li Destri G,La Greca G,Pesce A,Conti E,Puleo S,Portale TR,Scilletta R,Piazza M

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

275-280

eissn

0003-469X

issn

2239-253X

pii

S0003469X19030227

journal_volume

90

pub_type

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