• lymph node density
• lymph node metastasis level
• oral cancer
• survival rate
• tumor thickness

• Appendix cancer
• Lymph node metastasis
• Misclassification
• Regional lymph nodes
• Staging

• Humans
• Lymph Node Excision
• Appendix/pathology
• Neoplasm Staging
• Lymph Nodes/pathology
• Adenocarcinoma/surgery
• Prognosis
• Appendiceal Neoplasms/pathology
• Lymphatic Metastasis/pathology
• Retrospective Studies

• Colorectal cancer
• lymph node yield
• pathological staging

• Humans
• Male
• Middle Aged
• Female
• Lymph Node Excision/methods
• Neoplasm Staging
• Lymphatic Metastasis/pathology
• Lymph Nodes/surgery
• Lymph Nodes/pathology
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/pathology
• Retrospective Studies

The prognosis of patients with appendiceal neuroendocrine tumors (ANETs) is related to lymph node (LN) metastasis and other factors. However, it is unclear how the number of examined LNs (ELNs) impact on survival.

To determine the factors affecting the cancer-specific survival (CSS) of patients with ANET and to evaluate the impact of the number of ELNs on survival.

A total of 4583 ANET patients were analyzed in the Surveillance, Epidemiology, and End Results database. Univariate survival analysis was used to identify factors related to survival and the optimal number of ELNs and lymph node ratio (LNR) were determined by the Kaplan–Meier method. The survival difference was determined by CSS.

Except for sex, the other factors, such as age, year, race, grade, histological type, stage, tumor size, ELNs, LNR, and surgery type, were associated with prognosis. The 3-, 5-, and 10-year CSS rates of ANET patients were 91.2%, 87.5, and 81.7%, respectively (median follow-up period of 31 mo and range of 0-499 mo). There was no survival difference between the two surgery types, namely, local resection and colectomy or greater, in both stratifications of tumor size ≥ 2 cm (P = 0.523) and < 2 cm (P = 0.068). In contrast to patients with a tumor size < 2 cm, those with a tumor size ≥ 2 cm were more likely to have LN metastasis (χ² = 378.16, P < 0.001). The optimal number of ELNs was more than 11, 7, and 18 for all patients, node-negative patients, and node-positive patients, respectively. CSS rates of patients with a larger number of ELNs were significantly improved (≤ 10 vs ≥ 11, χ² = 20.303, P < 0.001; ≤ 6 vs ≥ 7, χ² = 11.569, P < 0.001; ≤ 17 vs ≥ 18, χ² = 21.990, P < 0.001; respectively). ANET patients with an LNR value ≤ 0.16 were more likely to have better survival than those with values of 0.17-0.48 (χ² = 48.243, P < 0.001) and 0.49-1 (χ² = 168.485, P < 0.001).

ANET ≥ 2 cm are more likely to develop LN metastasis. At least 11 ELNs are required to better evaluate the prognosis. For patients with positive LN metastasis, 18 or more LNs need to be detected and lower LNR values (LNR ≤ 0.16) indicate a better survival prognosis.

• Appendiceal neoplasm
• Neuroendocrine tumors
• Carcinoid tumor
• Lymph node dissection
• Lymph node ratio
• Survival analysis

• adjuvant chemotherapy
• colon cancer
• minimally invasive surgery
• neoadjuvant therapy
• rectal cancer
• screening

Despite concerns regarding oncologic safety, laparoscopic surgery for colon cancer has been proven in several trials in the lasts decades to be superior to open surgery. In addition, the benefits of laparoscopic surgery can be offered to other patients with malignant disease. The aim of the present study was to compare the quality of oncologic resection for non-metastatic, resectable colon cancer between laparoscopic and open surgery in terms of specimen margins and retrieved lymph nodes in a medium volume center in Romania. A total of 219 patients underwent surgery for non-metastatic colon cancer between January 2017 and December 2020. Of these, 52 underwent laparoscopic resection, while 167 had open surgery. None of the patients in the laparoscopic group had positive circumferential margins (P=0.035) while 12 (7.19%) patients in the open group (OG) had positive margins. A total of three patients in the laparoscopic group (5.77%) and seven patients (4.19%) in the OG had invaded axial margins. While the number of retrieved lymph nodes was not correlated with the type of procedure [laparoscopic group 16.12 (14±6.56), OG 17.31 (15±8.42), P=0.448], the lymph node ratio was significantly higher in the OG (P=0.003). Given the results of the present study, it is safe to conclude that laparoscopic surgery is not inferior to open surgery for non-metastatic colon cancer in a medium volume center.

In Uganda, similar to other countries in East Africa, the incidence of colorectal cancer (CRC) has been steadily increasing. This increase in incidence is accompanied by a poor prognosis. There is limited knowledge on factors responsible for the poor outcome of patients with CRC in Uganda. Cancer survival analysis is one way of determining some of these prognostic factors. The aim of this study was to determine prognostic factors associated with CRC survival in Ugandan patients.

This was a retroprospective cohort study involving patients with linked data in the Kampala cancer registry and medical records from hospitals in Uganda. Participants with a diagnosis of colorectal adenocarcinoma between 1st January 2008 and 31st December 2018 were included. Variables included patients’ demographic data, grade, stage and location of CRC, data on whether a patient was operated on, type of operation, treatment modalities and date of diagnosis. Our outcome variable was time to death after diagnosis. We computed and compared survival using the Log rank test and used Cox proportional hazards regression to determine factors associated with survival.

A total of 247 patients were included in the study with a mean (SD) age of 53.3 (15.7) years and a female: male ratio of 1.14:1. The proportions of patients surviving at 1, 2 and 3 years were 65.2% (95% CI: 58.8–70.9), 42.0% (95% CI:35.6–48.3) and 33.3% (95% CI:27.3–39.4) respectively. In multivariate analysis, factors associated with increased mortality included clinical stage II (aHR = 2.44, 95% CI: 1.10–5.41, p=0.028), stage III (aHR=2.65, 95% CI: 1.31–5.39, p=0.007) and stage IV (aHR=5.47, 95% CI: 2.40–12.48, p<0.001). Curative surgery alone (aHR=0.63, 95% CI: 0.39–1.01, p=0.057) and curative surgery with chemotherapy (aHR=0.53, 95% CI: 0.32–0.88, p=0.015) were associated with a better survival.

The survival rate among CRC patients in Uganda is low. Advanced stage CRC accelerates mortality, while surgery alone or in combination with chemotherapy improves survival. Implementation of national screening programmes for early diagnosis of CRC and increasing surgery and oncology infrastructure is recommended to improve the CRC survival rate in the Ugandan population.

• no specific funding

To evaluate the impact of the log odds of positive lymph nodes (LODDS) on cancer‐specific survival (CSS) in colon mucinous adenocarcinoma (MAC) patients, compared with pN stage and the lymph nodes ratio (LNR).

A total of 10,182 colon MAC patients from the Surveillance, Epidemiology, and End Results database were divided into the training group. The external validation group included 153 patients from Fujian Medical University Union Hospital. The Cox regression method was used to identify prognostic risk factors. Nomograms were evaluated by Harrell's concordance index (C‐index) and calibration curves. Recursive partitioning analysis (RPA) was used to develop a novel staging system.

Time‐dependent receiver operating characteristic curves (ROC) to predict CSS showed the areas under the ROC curve of LODDS were always higher than pN stage and LNR. LNR and LODDS classifications can well distinguish the prognosis of patients with the same pN stage. Cox analyses indicated that age, tumor size, pT stage, pN stage, LNR, and LODDS were independent predictors of CSS (p < 0.05). Based on three lymph nodes classifications, we constructed three prognostic nomograms models for CSS. The C‐index of the pN, LNR, and LODDS classification nomograms were 0.746 (95% confidence interval [95% CI]: 0.736–0.756), 0.750 (95% CI: 0.740–0.760), and 0.758 (95% CI: 0.748–0.768), respectively. In external validation, we observed the C‐index of LODDS classification nomograms was 0.787 (95% CI: 0.648–0.926). RPA stage, including four stages, was constructed successfully based on pT stage and LNR or LODDS, respectively. The 3‐, 5‐, and 8‐year areas under the ROC curve of LNR‐RPA stage and LODDS‐RPA stage were superior to tumor‐node‐metastasis stage.

LODDS to be a better prognostic factor of CSS for colon MAC patients than pN stage and LNR. A nomogram and RPA stage base on LODDS can provide accurate information for personalized cancer treatment.

• LODDS
• RPA stage
• colon mucinous adenocarcinoma
• nomograms
• prognosis

• Colorectal cancer
• lymph node
• prognosis
• ratio
• survival

• aged patients
• clinical frailty scale
• colon cancer
• postoperative outcome
• surgery

• colorectal cancer
• lymph node ratio
• pN category
• prognosis
• treatment

• HPV-related cancer
• human papillomavirus
• lymph node ratio
• nodal staging
• oropharyngeal cancer

Background: The proportion of the number of involved lymph nodes (LNs) to the number of examined LNs—defined as metastatic LN ratio (mLNR)—has been considered as a prognostic parameter. This study aims to elucidate the prognostic implication of the mLNR in colorectal cancer (CRC) according to the tumor location. Methods: We evaluated the correlation between prognoses and the involved and examined LNs as well as mLNR according to the tumor location in 266 surgically resected human CRCs. Besides, to evaluate the optimal cutoff for high and low mLNRs, we investigated the correlation between mLNR and survival according to the various cutoffs. Results: LN metastasis was found in 146 cases (54.9%), and colon and rectal cancers were found in 116 (79.5%) and 30 (20.5%) of the cases, respectively. The mean mLNRs were significantly higher in rectal cancer than in colon cancer (0.38 ± 0.28 vs. 0.21 ± 0.24, P = 0.003). Besides this, the number of involved LNs in rectal cancer was significantly high compared to colon cancer (11.83 ± 10.92 vs. 6.37 ± 7.78, P = 0.014). However, there was no significant difference in the examined LNs between the rectal and colon cancers (31.90 ± 12.28 vs. 36.60 ± 18.11, P = 0.181). In colon cancer, a high mLNR was significantly correlated with worse survival for all cutoffs (0.1, 0.2, 0.3, and 0.4). However, rectal cancer only showed a significant correlation between high mLNR and worse survival in the subgroup with a cutoff of 0.2. Conclusions: Our results showed that high mLNR was significantly correlated with worse survival. The number of involved LNs and mLNRs were significantly higher in rectal cancer than in colon cancer. The cutoff of 0.2 can be useful for the differentiation of prognostic groups, regardless of tumor location.

• LN metastasis
• colorectal cancer
• metastatic lymph node ratio
• survival

• colorectal cancer
• meta-analysis
• metastatic lymph node ratio
• prognostic factor

• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/physiopathology
• Disease-Free Survival
• Humans
• Lymph Node Ratio/methods
• Lymph Node Ratio/standards
• Lymph Nodes/abnormalities
• Lymphatic Metastasis/physiopathology
• Prognosis

• NRF-2017R1C1B5018063 National Research Foundation of Korea (NRF)

• Lymph node ratio
• Sidedness
• Stage III colon cancer
• The number of lymph nodes

• Colorectal cancer
• SEER database
• lymph node ratio
• overall survival
• prognosis

The aim of this study is to elucidate the clinicopathological significances, including the prognostic role, of metastatic lymph node ratio (mLNR) and tumor deposit diameter in papillary thyroid carcinoma (PTC) through a retrospective review and meta-analysis.

We categorized the cases into high (≥ 0.44) and low mLNR (< 0.44) and investigated the correlations with clinicopathological parameters in 64 PTCs with neck level VI lymph node (LN) metastasis. In addition, meta-analysis of seven eligible studies was used to investigate the correlation between mLNR and survival.

Among 64 PTCs with neck level VI LN metastasis, high mLNR was found in 34 PTCs (53.1%). High mLNR was significantly correlated with macrometastasis (tumor deposit diameter ≥ 0.2 cm), extracapsular spread, and number of metastatic LNs. Based on linear regression test, mLNR was significantly increased by the largest LN size but not the largest metastatic LN (mLN) size. High mLNR was not correlated with nuclear factor κB or cyclin D1 immunohistochemical expression, Ki-67 labeling index, or other pathological parameters of primary tumor. Based on meta-analysis, high mLNR significantly correlated with worse disease-free survival at the 5-year and 10-year follow-up (hazard ratio [HR], 4.866; 95% confidence interval [CI], 3.527 to 6.714 and HR, 5.769; 95% CI, 2.951 to 11.275, respectively).

Our data showed that high mLNR significantly correlated with worse survival, macrometastasis, and extracapsular spread of mLNs. Further cumulative studies for more detailed criteria of mLNR are needed before application in daily practice.

• Lymph node metastasis
• Meta-analysis
• Metastatic lymph node ratio
• Papillary thyroid carcinoma
• Prognosis

• colorectal neoplasms
• colorectal surgery
• laparoscopy
• lymph node excision
• neoadjuvant therapy

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Laparoscopy/methods
• Lymph Node Excision/methods
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local/pathology
• Operative Time
• Pelvis
• Pilot Projects
• Rectal Neoplasms/drug therapy
• Rectal Neoplasms/surgery
• Rectum/surgery
• Treatment Outcome

• cancer specific survival
• inflammation
• lymph node count
• lymph node ratio
• lymphocyte monocyte ratio
• modified glasgow prognostic score
• neutrophil lymphocyte ratio
• overall survival
• platelet lymphocyte ratio

• Aged
• Biomarkers
• Blood Platelets
• C-Reactive Protein/analysis
• Colonic Neoplasms/blood
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Female
• Humans
• Inflammation Mediators
• Leukocyte Count
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Lymphocytes
• Male
• Middle Aged
• Monocytes
• Neoplasm Staging
• Neutrophils
• Prognosis
• Time-to-Treatment

The lymph node ratio (LNR) (i.e. the number of metastatic lymph nodes divided by the number of totally resected lymph nodes) has recently emerged as an important prognostic factor in colorectal cancer (CRC). However, the tumor node metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a meta-analysis to evaluate the prognostic role of the LNR in node positive CRC. A systematic search was performed in PubMed, Embase and the Cochrane Library for relevant studies up to November 2015. As a result, a total of 75,838 node positive patients in 33 studies were included in this meta-analysis. Higher LNR was significantly associated with shorter overall survival (OS) (HR = 1.91; 95% CI 1.71–2.14; P = 0.0000) and disease free survival (DFS) (HR = 2.75; 95% CI: 2.14–3.53; P = 0.0000). Subgroup analysis showed similar results. Based on these results, LNR was an independent predictor of survival in colorectal cancer patients and should be considered as a parameter in future oncologic staging systems.

• colorectal cancer
• lymph node
• lymph node ratio
• meta-analysis
• prognostic role

• colorectal neoplasms
• lymph nodes
• neoplasm staging
• survival analysis

• Chemoradiotherapy
• Lymph node
• Rectal cancer
• Tattooing

• Colorectal cancer (CRC)
• liver metastases (LM)
• lymph node ratio (LNR)
• survival

• Lymph node ratio
• nodal count
• nodal status

• Cancer
• Colorectal
• Pathology
• Quality
• Radicality
• Surgery

• Adult
• Aged
• Aged, 80 and over
• Clinical Protocols
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Emergency Treatment
• Female
• Humans
• Laparoscopy
• Male
• Middle Aged
• Morbidity
• Prospective Studies
• Rectal Neoplasms/epidemiology
• Registries
• Switzerland/epidemiology
• Young Adult

AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer.

METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio (NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ² tests where appropriate.

RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9 (P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio (≥ 0.25, P = 0.044).

CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.

• Systemic inflammatory response
• Lymph node yield
• Lymph node count
• Colon cancer
• Colonic cancer
• Neutrophil-lymphocyte ratio
• Neutrophil to lymphocyte ratio
• Lymph node ratio

• Advanced cancer stage
• Colorectal cancer
• Complete mesocolic resection
• Hyperthermic intraperitoneal chemotherapy, HIPEC
• Resection
• Surgical treatment

• Colon cancer
• Lymph node ratio
• Surgery
• Survival

• Adenocarcinoma/drug therapy
• Adenocarcinoma/mortality
• Adenocarcinoma/pathology
• Adenocarcinoma, Mucinous/drug therapy
• Adenocarcinoma, Mucinous/mortality
• Adenocarcinoma, Mucinous/pathology
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Colonic Neoplasms/drug therapy
• Colonic Neoplasms/mortality
• Colonic Neoplasms/pathology
• Female
• Follow-Up Studies
• Humans
• Lymph Nodes/pathology
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Survival Rate

• colonic neoplasms
• lymph nodes
• prognosis

• Age Factors
• Biomarkers, Tumor
• Colonic Neoplasms/diagnosis
• Colonic Neoplasms/physiopathology
• Disease-Free Survival
• Female
• Humans
• Lymphatic Metastasis/pathology
• Male
• Multivariate Analysis
• Neoplasm Invasiveness/pathology
• Prognosis
• Retrospective Studies

• adjuvant chemoradiotherapy
• adjuvant radiotherapy
• head and neck cancer
• larynx cancer
• oral cavity cancer
• otolaryngology

• Adult
• Aged
• Aged, 80 and over
• Colorectal Neoplasms/pathology
• Disease-Free Survival
• Female
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis
• Retrospective Studies

• Aged
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Female
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Staging

Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach, whether the same oncologic clearance, specifically an adequate TME can be obtained is of concern. The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes. The data from 8 RCTs, 3 meta-analyses, and 2 Cochrane Database of Systematic Reviews was reviewed. Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss, earlier return of bowel function, and shorter hospital length of stay. Concerns that laparoscopic rectal cancer surgery compromises short-term oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature. Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.

• Rectal cancer
• Laparoscopy
• Total mesorectal excision
• Anterior resection
• Abdominoperineal resection

• Adult
• Aged
• Aged, 80 and over
• Colonic Neoplasms/mortality
• Colonic Neoplasms/pathology
• Female
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis
• SEER Program