The emerging issue of ratio of metastatic to resected lymph nodes in gastrointestinal cancers: An overview of literature

European Journal of Surgical Oncology

Volumn 37, Issue 10, 2011, Pages 836-847

  Petrelli, F ^a   Borgonovo, K ^a   Barni, S ^a  

^a Azienda Ospedaliera Treviglio Caravaggio Treviglio (BG)   (Italy)

Author keywords

Gastrointestinal carcinomas; Lymph nodes; Pathologist; Prognosis; Ratio; Surgeon

Indexed keywords

ADJUVANT CHEMOTHERAPY; CANCER STAGING; CANCER SURVIVAL; CHEMORADIOTHERAPY; COLON CANCER; COLORECTAL CARCINOMA; ESOPHAGUS CANCER; LYMPH NODE; LYMPH NODE METASTASIS; LYMPH NODE RATIO; LYMPHADENECTOMY; PANCREAS CANCER; PRIORITY JOURNAL; RECTUM CANCER; REVIEW; STOMACH CANCER;

BIOPSY, NEEDLE; DISEASE-FREE SURVIVAL; FEMALE; GASTROINTESTINAL NEOPLASMS; HUMANS; LYMPH NODE EXCISION; LYMPH NODES; LYMPHATIC METASTASIS; MALE; NEOPLASM RECURRENCE, LOCAL; NEOPLASM STAGING; PREDICTIVE VALUE OF TESTS; PROGNOSIS; SURVIVAL ANALYSIS;

EID: 80052963124     PISSN: 07487983     EISSN: 15322157     Source Type: Journal    
DOI: 10.1016/j.ejso.2011.07.008     Document Type: Review

References (126)

1. F. Kamangar, G.M. Dores, and W.F. Anderson Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world J Clin Oncol 24 14 2006 2137 2150 (Pubitemid 46655601)
2. Japanese Research Society for Gastric Cancer The general rules for the gastric cancer study in surgery and pathology 12th ed. 1993 Kanahara Shuppan Tokyo
3. J.D. Roder, K. Bottcher, R. Busch German Gastric Cancer Study Group Classification of regional lymph node metastasis from gastric carcinoma Cancer 82 1998 621 631 (Pubitemid 28090271)
4. F.L. Greene, D.L. Page, and I.D. Fleming AJCC cancer staging manual 6th ed. 2002 Springer-Verlag New York
5. I. Chau, A.R. Norman, and D. Cunningham Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer-pooled analysis from three multicenter, randomized, controlled trials using individual patient data J Clin Oncol 22 2004 2395 2403 (Pubitemid 41121931)
6. T.J. Howard, J.E. Krug, and J. Yu A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon's contribution to long term survival in pancreatic cancer J Gastrointest Surg 10 10 2006 1338 1345
7. T.A. Sohn, C.J. Yeo, and J.L. Cameron Resected adenocarcinoma of the pancreas - 616 patients: results, outcomes, and prognostic indicators J Gastrointest Surg 4 6 2000 567 579
8. D.C. Allison, S. Piantadosi, and L.H. Hruban DNA content and other factors associated with ten-year survival after resection of pancreatic carcinoma J Surg Oncol 67 3 1998 Mar 151 159 (Pubitemid 28134402)
9. N. Wolmark, H. Rockette, and B. Fisher The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03 J Clin Oncol 11 1993 1879 1887 (Pubitemid 23304611)
10. C.G. Moertel, T.R. Fleming, and J.S. Macdonald Fluorouracil plus levamisole as effective adjuvant therapy after resection of Stage III colon carcinoma: a final report Ann Intern Med 122 1995 321 326
11. F.L. Greene, D.L. Page, and I.D. Fleming American Joint Committee on cancer staging manual 6th ed. 2002 Springer Philadelphia
12. E.A. Miller, J. Woosley, C.F. Martin, and R.S. Sandler Hospital-to-hospital variation in lymph node detection after colorectal resection Cancer 101 2004 1065 1071 (Pubitemid 39100442)
13. N.N. Baxter, D.J. Virnig, D.A. Rothenberger, A.M. Morris, J. Jessurun, and B.A. Virnig Lymph node evaluation in colorectal cancer patients: a population-based study J Natl Cancer Inst 97 2005 219 225 (Pubitemid 40277372)
14. K.W.M. Scott, and R.H. Grace Detection of lymph node metastases in colorectal carcinoma before and after fat clearance Br J Surg 78 1989 1165 1167 (Pubitemid 19284443)
15. N.E. Joseph, E.R. Sigurdson, and A.L. Hanlon Accuracy of determining nodal negativity in colorectal cancer based on the number of nodes retrieved on resection Ann Surg Oncol 10 2003 213 218 (Pubitemid 40486952)
16. M. Prandi, R. Lionetto, and A. Bini Prognostic evaluation of stage B colon cancer patients is improved by adequate lymphadenectomy Ann Surg 235 2002 458 463
17. E. Bollschweiler, S.E. Baldus, and W. Schrȯder Staging of esophageal carcinoma: length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors? J Surg Oncol 94 2006 355 363 (Pubitemid 44465337)
18. A.J. Greenstein, V.R. Litle, and S.J. Swanson Prognostic significance of the number of lymph node metastases in esophageal cancer J Am Coll Surg 206 2008 239 246
19. Y.J. Chen, T.E. Schultheiss, J.Y. Wong, and K.H. Kernstine Impact of the number of resected and involved lymph nodes on esophageal cancer survival J Surg Oncol 100 2 2009 Aug 1 127 132
20. M. Wilson, E.L. Rosato, and K.A. Chojnacki Prognostic significance of lymph node metastases and ratio in esophageal cancer J Surg Res 146 1 2008 May 1 11 15 (Pubitemid 351442944)
21. C. Mariette, G. Piessen, N. Briez, and J.P. Triboulet The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent Ann Surg 247 2 2008 Feb 365 371 (Pubitemid 351156783)
22. R.E. Schwarz, and D.D. Smith Clinical impact of lymphadenectomy extent in resectable esophageal cancer J Gastrointest Surg 11 11 2007 Nov 1384 1393 discussion 1393-1394
23. J.A. Hagen, S.R. DeMeester, J.H. Peters, P. Chandrasoma, and T.R. DeMeester Curative resection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies Ann Surg 234 4 2001 Oct 520 530 discussion 530-531
24. J.W. van Sandick, J.J. van Lanschot, F.J. ten Kate, J.G. Tijssen, and H. Obertop Indicators of prognosis after transhiatal esophageal resection without thoracotomy for cancer J Am Coll Surg 194 1 2002 Jan 28 36 (Pubitemid 34044871)
25. B.P. Wijnhoven, K.T. Tran, A. Esterman, D.I. Watson, and H.W. Tilanus An evaluation of prognostic factors and tumor staging of resected carcinoma of the esophagus Ann Surg 245 5 2007 May 717 725 (Pubitemid 46684101)
26. M.A. Eloubeidi, R. Desmond, M.R. Arguedas, C.E. Reed, and C.M. Wilcox Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status Cancer 95 7 2002 Oct 1 1434 1443
27. J.D. Roder, R. Busch, H.J. Stein, U. Fink, and J.R. Siewert Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the oesophagus Br J Surg 81 3 1994 Mar 410 413 (Pubitemid 24124822)
28. N. Rizk, E. Venkatraman, and B. Park The prognostic importance of the number of involved lymph nodes in esophageal cancer; implications for revisions for the American Joint Committee on cancer staging system J Thorac Cardiovasc Surg 132 2006 1374 1381
29. M. Tachibana, D.K. Dhar, and S. Kinugasa Esophageal cancer with distant lymph node metastasis J Clin Gastroenterol 31 2000 318 322
30. W.H. Hsu, P.K. Hsu, C.C. Hsieh, C.S. Huang, and Y.C. Wu The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer J Gastrointest Surg 2009 Aug 12
31. X.B. D'Journo, J.P. Avaro, and P. Michelet Extracapsular lymph node involvement is a negative prognostic factor after neoadjuvant chemoradiotherapy in locally advanced esophageal cancer J Thorac Oncol 4 4 2009 534 539
32. N.G. Coburn, C.J. Swallow, and A. Kiss Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer Cancer 107 2006 2143 2151 (Pubitemid 44665647)
33. D.D. Smith, R.R. Schwarz, and R.E. Schwarz Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database J Clin Oncol 23 2005 7114 7124
34. A.M. Bouvier, O. Haas, and F. Piard How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study Cancer 94 2002 2862 2866 (Pubitemid 34547684)
35. N.C. Estes, J.S. MacDonald, and K. Touijer Inadequate documentation and resection for gastric cancer in the United States: a preliminary report Am Surg 64 1998 680 685 (Pubitemid 28294697)
36. J.P. Kim, J.H. Lee, S.J. Kim, H.J. Yu, and H.K. Yang Clinicopathologic characteristics and prognostic factors in 10,783 patients with gastric cancer Gastric Cancer 1 2 1998 Mar 125 133
37. J.R. Siewert, K. Böttcher, H.J. Stein, and J.D. Roder Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study Ann Surg 228 4 1998 Oct 449 461 (Pubitemid 30194389)
38. A. Takagane, M. Terashima, and K. Abe Evaluation of the ratio of lymph node metastasis as a prognostic factor in patients with gastric cancer Gastric Cancer 2 2 1999 Aug 122 128
39. K. Inoue, Y. Nakane, and H. Iiyama The superiority of ratio-based lymph node staging in gastric carcinoma Ann Surg Oncol 9 1 2002 Jan-Feb 27 34 (Pubitemid 34262894)
40. W.J. Hyung, S.H. Noh, and C.H. Yoo Prognostic significance of metastatic lymph node ratio in T3 gastric cancer World J Surg 26 3 2002 Mar 323 329 (Pubitemid 36920410)
41. E. Bando, Y. Yonemura, K. Taniguchi, S. Fushida, T. Fujimura, and K. Miwa Outcome of ratio of lymph node metastasis in gastric carcinoma Ann Surg Oncol 9 8 2002 Oct 775 784
42. D. Nitti, A. Marchet, and M. Olivieri Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience Ann Surg Oncol 10 9 2003 Nov 1077 1085 (Pubitemid 40486832)
43. C. Kunisaki, H. Shimada, and M. Nomura Clinical impact of metastatic lymph node ratio in advanced gastric cancer Anticancer Res 25 2B 2005 Mar-Apr 1369 1375 (Pubitemid 40546817)
44. J.M. Rodríguez Santiago, E. Muñoz, M. Martí, S. Quintana, E. Veloso, and C. Marco Metastatic lymph node ratio as a prognostic factor in gastric cancer Eur J Surg Oncol 31 1 2005 Feb 59 66 (Pubitemid 40103926)
45. J.H. Cheong, W.J. Hyung, and J.G. Shen The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer Ann Surg Oncol 13 3 2006 Mar 377 385
46. A. Marchet, S. Mocellin, A. Ambrosi Italian Research Group for Gastric Cancer (IRGGC) The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients Ann Surg 245 4 2007 Apr 543 552 (Pubitemid 46555657)
47. J. Kulig, M. Sierzega, P. Kolodziejczyk, T. Popiela Polish Gastric Cancer Study Group Ratio of metastatic to resected lymph nodes for prediction of survival in patients with inadequately staged gastric cancer Br J Surg 96 8 2009 Aug 910 918
48. R. Persiani, S. Rausei, and V. Antonacci Metastatic lymph node ratio: a new staging system for gastric cancer World J Surg 2009 Jul 28
49. C.Y. Kim, and D.H. Yang Adjustment of N stages of gastric cancer by the ratio between the metastatic and examined lymph nodes Ann Surg Oncol 16 7 2009 Jul 1868 1874
50. Z. Sun, G.L. Zhu, and C. Lu The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients Ann Oncol 20 5 2009 May 897 905
51. O. Asoglu, H. Karanlik, and M. Parlak Metastatic lymph node ratio is an independent prognostic factor in gastric cancer Hepatogastroenterology 56 91-92 2009 May-Jun 908 913
52. X. Wang, F. Wan, J. Pan, G.Z. Yu, Y. Chen, and J.J. Wang Prognostic value of the ratio of metastatic lymph nodes in gastric cancer: an analysis based on a Chinese population J Surg Oncol 99 6 2009 May 1 329 334
53. D.Z. Xu, Q.R. Geng, and Z.J. Long Positive lymph node ratio is an independent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes Ann Surg Oncol 16 2 2009 Feb 319 326
54. J. Yu, D. Yang, and F. Wei The staging system of metastatic lymph node ratio in gastric cancer Hepatogastroenterology 55 88 2008 Nov-Dec 2287 2290
55. C.M. Huang, B.J. Lin, H.S. Lu, X.F. Zhang, P. Li, and J.W. Xie Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus World J Gastroenterol 14 27 2008 Jul 21 4383 4388
56. J. van der Schoot, R. Van Hee, T. Philipsen, D. De Bock, V. Delvaux, and J. Weyler The prognosis of patients operated on for gastric cancer in relation to the percentage of lymph nodes invaded by tumour Acta Chir Belg 108 3 2008 May-Jun 308 312
57. R. Persiani, S. Rausei, A. Biondi, S. Boccia, F. Cananzi, and D. D'Ugo Ratio of metastatic lymph nodes: impact on staging and survival of gastric cancer Eur J Surg Oncol 34 5 2008 May 519 524 (Pubitemid 351514881)
58. C. Kunisaki, H. Makino, and H. Akiyama Clinical significance of the metastatic lymph-node ratio in early gastric cancer J Gastrointest Surg 12 3 2008 Mar 542 549
59. H. Ozgü, Y. Sönmez, and O. Yerci Metastatic/resected lymph nodes ratio-based classification in gastric cancer Turk J Gastroenterol 19 1 2008 Mar 2 7 (Pubitemid 351677151)
60. A. Marchet, S. Mocellin, A. Ambrosi Italian Research Group for Gastric Cancer Study (GIRCG) The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series Eur J Surg Oncol 34 2 2008 Feb 159 165
61. H. Saito, Y. Fukumoto, and T. Osaki Prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in patients with advanced gastric cancer J Surg Oncol 97 2 2008 Feb 1 132 135 (Pubitemid 351169041)
62. C. Liu, P. Lu, Y. Lu, H. Xu, S. Wang, and J. Chen Clinical implications of metastatic lymph node ratio in gastric cancer BMC Cancer 7 2007 Oct 24 200
63. O. Celen, E. Yildirim, and U. Berberoglu Prognostic impact of positive lymph node ratio in gastric carcinoma J Surg Oncol 96 2 2007 Aug 1 95 101 (Pubitemid 47264811)
64. H.Y. Lee, H.J. Choi, and K.J. Park Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma Ann Surg Oncol 14 5 2007 May 1712 1717
65. H. Saito, Y. Fukumoto, and T. Osaki Prognostic significance of level and number of lymph node metastases in patients with gastric cancer Ann Surg Oncol 14 5 2007 May 1688 1693 (Pubitemid 46791000)
66. S.J. Kwon, and G.S. Kim Prognostic significance of lymph node metastasis in advanced carcinoma of the stomach Br J Surg 83 11 1996 Nov 1600 1603 (Pubitemid 26365090)
67. N. Fukuda, Y. Sugiyama, A. Midorikawa, and H. Mushiake Prognostic significance of the metastatic lymph node ratio in gastric cancer patients World J Surg 2009 Sep 16
68. M. Sianesi, L. Bezer, and P. Del Rio The node ratio as prognostic factor after curative resection for gastric cancer J Gastrointest Surg 2010 Jan 26
69. J. Deng, H. Liang, and D. Wang Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes Ann Surg Oncol 2009 Dec 29
70. A. Bilici, M. Seker, and B.B. Ustaalioglu Determining of metastatic lymph node ratio in patients who underwent D2 dissection for gastric cancer Med Oncol 2009 Nov 3
71. J.S. Tomlinson, S. Jain, and D.J. Bentrem Accuracy of staging node-negative pancreas cancer: a potential quality measure Arch Surg 142 2007 723 767 discussion 773-764
72. A.C. Berger, J.C. Watson, and E.A. Ross The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma Am Surg 70 2004 235 240 discussion 240
73. M. Sierzega, T. Popiela, J. Kulig, and K. Nowak The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer Pancreas 33 3 2006 Oct 240 245 (Pubitemid 44470138)
74. T.M. Pawlik, A.L. Gleisner, and J.L. Cameron Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer Surgery 141 2007 610 618 (Pubitemid 46616937)
75. R.A. Smith, L. Bosonnet, and P. Ghaneh Preoperative CA19-9 levels and lymph node ratio are independent predictors of survival in patients with resected pancreatic ductal adenocarcinoma Dig Surg 25 3 2008 226 232
76. M.B. Slidell, D.C. Chang, and J.L. Cameron Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis Ann Surg Oncol 15 1 2008 Jan 165 174
77. H. Riediger, T. Keck, and U. Wellner The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer J Gastrointest Surg 13 7 2009 Jul 1337 1344
78. G. Sergeant, N. Ectors, S. Fieuws, R. Aerts, and B. Topal Prognostic relevance of extracapsular lymph node involvement in pancreatic ductal adenocarcinoma Ann Surg Oncol 2009 Aug 1
79. P. Massucco, D. Ribero, E. Sgotto, A. Mellano, A. Muratore, and L. Capussotti Prognostic significance of lymph node metastases in pancreatic head cancer treated with extended lymphadenectomy: not just a matter of numbers Ann Surg Oncol 2009 Sep 24
80. I. Bhatti, O. Peacock, A.K. Awan, D. Semeraro, M. Larvin, and R.I. Hall Lymph node ratio versus number of affected lymph nodes as predictors of survival for resected pancreatic adenocarcinoma World J Surg 34 4 2010 Apr 768 775
81. L.J. Mekenkamp, J.H. van Krieken, C.A. Marijnen, C.J. van de Velde, I.D. Nagtegaal For the pathology review Committee and the Co-operative clinical Investigators Lymph node retrieval in rectal cancer is dependent on many factors - the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist Am J Surg Pathol 2009 Aug 3
82. S.S. Kukreja, E. Esteban-Agusti, J.M. Velasco, and T.J. Hieken Increased lymph node evaluation with colorectal cancer resection: does it improve detection of stage III disease? Arch Surg 144 7 2009 Jul 612 617
83. A.C. Berger, E.R. Sigurdson, and T. LeVoyer Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes J Clin Oncol 23 34 2005 Dec 1 8706 8712 (Pubitemid 46211514)
84. P. Schumacher, S. Dineen, C. Barnett Jr., J. Fleming, and T. Anthony The metastatic lymph node ratio predicts survival in colon cancer Am J Surg 194 6 2007 Dec 827 831 discussion 831-2
85. J. Wang, J.M. Hassett, M.T. Dayton, and M.N. Kulaylat Lymph node ratio: role in the staging of node-positive colon cancer Ann Surg Oncol 15 6 2008 Jun 1600 1608
86. K. Derwinger, G. Carlsson, and B. Gustavsson A study of lymph node ratio as a prognostic marker in colon cancer Eur J Surg Oncol 34 7 2008 Jul 771 775
87. J. Peng, Y. Xu, and Z. Guan Prognostic significance of the metastatic lymph node ratio in node-positive rectal cancer Ann Surg Oncol 15 11 2008 Nov 3118 3123
88. R. Rosenberg, J. Friederichs, and T. Schuster Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period Ann Surg 248 6 2008 Dec 968 978
89. F. Peschaud, S. Benoist, and C. Julié The ratio of metastatic to examined lymph nodes is a powerful independent prognostic factor in rectal cancer Ann Surg 248 6 2008 Dec 1067 1073
90. I.J. Park, G.S. Choi, and S.H. Jun Nodal stage of stage III colon cancer: the impact of metastatic lymph node ratio J Surg Oncol 100 3 2009 Mar 27 240 243
91. S.J. Moug, J.D. Saldanha, J.R. McGregor, M. Balsitis, and R.H. Diament Positive lymph node retrieval ratio optimises patient staging in colorectal cancer Br J Cancer 100 10 2009 May 19 1530 1533
92. C.C. Chin, J.Y. Wang, C.Y. Yeh, Y.H. Kuo, W.S. Huang, and C.H. Yeh Metastatic lymph node ratio is a more precise predictor of prognosis than number of lymph node metastases in stage III colon cancer Int J Colorectal Dis 2009 May 29
93. D.G. Priolli, I.A. Cardinalli, J.A. Pereira, C.H. Alfredo, N.F. Margarido, and C.A. Martinez Metastatic lymph node ratio as an independent prognostic variable in colorectal cancer: study of 113 patients Tech Coloproctol 13 2 2009 Jun 113 121
94. Y.S. Kim, J.H. Kim, and S.M. Yoon lymph node ratio as a prognostic factor in patients with stage III rectal cancer treated with total mesorectal excision followed by chemoradiotherapy Int J Radiat Oncol Biol Phys 74 3 2009 Jul 1 796 802
95. C.A. Vaccaro, V. Im, and G.L. Rossi Lymph node ratio as prognosis factor for colon cancer treated by colorectal surgeons Dis Colon Rectum 52 7 2009 Jul 1244 1250
96. M. Ng, S. Roy-Chowdhury, S.S. Lum, J.W. Morgan, and J.H. Wong The impact of the ratio of positive to total lymph nodes examined and outcome in colorectal cancer Am Surg 75 10 2009 Oct 873 876
97. P.D. Ainsworth, and M.A. Johnson The prognostic significance of the metastatic lymph node ratio in Dukes stage C colorectal cancer in a district general hospital Colorectal Dis 2009 Aug 5
98. G. Galizia, M. Orditura, and F. Ferraraccio The lymph node ratio is a powerful prognostic factor of node-positive colon cancers undergoing potentially curative surgery World J Surg 2009
99. R. Rosenberg, J. Engel, and C. Bruns The prognostic value of lymph node ratio in a population-based collective of colorectal cancer patients Ann Surg 251 6 2010 Jun 1070 1078
100. J.W. Huh, Y.J. Kim, and H.R. Kim Ratio of metastatic to resected lymph nodes as a prognostic factor in node-positive colorectal cancer Ann Surg Oncol 2010 Mar 19
101. C. Pedrazzani, A. Sivins, and G. Ancans Ratio between metastatic and examined lymph nodes (N ratio) may have low clinical utility in gastric cancer patients treated by limited lymphadenectomy: results from a single center experience of 526 patients World J Surg 34 1 2010 Jan 85 91
102. A. Sermier, P. Gervaz, and J.F. Egger Lymph node retrieval in abdominoperineal surgical specimen is radiation time-dependent World J Surg Oncol 4 2006 Jun 2 29
103. A. Habr-Gama, R.O. Perez, and I. Proscurshim Absence of lymph nodes in the resected specimen after radical surgery for distal rectal cancer and neoadjuvant chemoradiation therapy: what does it mean? Dis Colon Rectum 51 3 2008 Mar 277 283
104. A. Rullier, C. Laurent, and M. Capdepont Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival Am J Surg Pathol 32 1 2008 Jan 45 50
105. D. Doll, R. Gertler, and M. Maak Reduced lymph node yield in rectal carcinoma specimen after neoadjuvant radiochemotherapy has no prognostic relevance World J Surg 33 2 2009 Feb 340 347
106. T. Sprenger, H. Rothe, and K. Homayounfar Preoperative chemoradiotherapy does not necessarily reduce lymph node retrieval in rectal cancer specimens - results from a prospective evaluation with extensive pathological work-up J Gastrointest Surg 14 1 2010 Jan 96 103 Epub 2009 Oct 15.116
107. W. Ceelen, Y. Van Nieuwenhove, and P. Pattyn Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review Ann Surg Oncol 17 11 2010 Nov 2847 2855
108. M. De Ridder, V. Vinh-Hung, Y. Van Nieuwenhove, A. Hoorens, A. Sermeus, and G. Storme Prognostic value of the lymph node ratio in node positive colon cancer Gut 55 2006 1681 (Pubitemid 44629243)
109. C.J. Kelty, C.W. Kennedy, and G.L. Falk Ratio of metastatic lymph nodes to total number of nodes resected is prognostic for survival in esophageal carcinoma J Thorac Oncol 5 9 2010 Sep 1467 1471
110. J.K. Smit, B.B. Pultrum, H.M. van Dullemen, G.M. Van Dam, H. Groen, and J.T. Plukker Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy Am J Surg 200 4 2010 Oct 446 453
111. W. Wang, D.Z. Xu, and Y.F. Li Tumor-ratio-metastasis staging system as an alternative to the 7th edition UICC TNM system in gastric cancer after D2 resection - results of a single-institution study of 1343 Chinese patients Ann Oncol 2011 Feb 10
112. J.S. Kim, M.A. Kim, and D.Y. Oh Increasing nodal ratio is a poor prognostic factor for survival in stage III-IV (M0) gastric cancer patients who received curative surgery followed by adjuvant chemotherapy: a retrospective study Jpn J Clin Oncol 41 2 2011 Feb 245 252
113. W. Wang, Y.F. Li, and X.W. Sun Prognosis of 980 patients with gastric cancer after surgical resection Chin J Cancer 29 11 2010 Nov 923 930
114. D. Zhao, H. Xu, K. Li, and Z. Sun Prognostic factors for patients after curative resection for proximal gastric cancer J Huazhong Univ Sci Technolog Med Sci 30 4 2010 Aug 530 535
115. C.M. Huang, J.X. Lin, and C.H. Zheng Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy World J Gastroenterol 16 16 2010 Apr 28 2055 2060
116. M. Sianesi, L. Bezer, and P. Del Rio The node ratio as prognostic factor after curative resection for gastric cancer J Gastrointest Surg 14 4 2010 Apr 614 619
117. J. Deng, H. Liang, D. Sun, and Y. Pan The prognostic analysis of lymph node-positive gastric cancer patients following curative resection J Surg Res 161 1 2010 Jun 1 47 53
118. T.N. Showalter, K.A. Winter, and A.C. Berger The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704 Int J Radiat Oncol Biol Phys 2010 Oct 7
119. H.B. Qiu, L.Y. Zhang, Y.F. Li, Z.W. Zhou, R.P. Keshari, and R.H. Xu Ratio of metastatic to resected lymph nodes enhances to predict survival in patients with stage III colorectal cancer Ann Surg Oncol 2011 Jan 5
120. K.P. Wong, J.T. Poon, J.K. Fan, and W.L. Law Prognostic value of lymph node ratio in stage III colorectal cancer Colorectal Dis 2010 Sep 27 10.1111/j.1463-1318.2010.02435.x
121. L. Stocchi, H. Nelson, and D.J. Sargent Impact of surgical and pathologic variables in rectal cancer: a United States Community and Cooperative Group report J Clin Oncol 19 2001 3895 3902 (Pubitemid 32880068)
122. D. Edler, K. Ohrling, M. Hallstrom, M. Karlberg, and P. Ragnhammar The number of analyzed lymph nodes - a prognostic factor in colorectal cancer Acta Oncol 46 2007 975 981 (Pubitemid 47537177)
123. R. Vather, T. Sammour, A. Kahokehr, A.B. Connolly, and A.G. Hill Lymph node evaluation and long-term survival in stage II and stage III colon cancer: a national study Ann Surg Oncol 16 2009 585 593
124. F.J. Coimbra, W.L. Costa Jr., and A.L. Montagnini The interaction between N-category and N-ratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil Eur J Surg Oncol 37 1 2011 Jan 47 54
125. J. Kang, H. Hur, B.S. Min, K.Y. Lee, and N.K. Kim Prognostic impact of the Lymph node ratio in rectal cancer patients who underwent preoperative chemoradiation J Surg Oncol 2011 Mar 17
126. K.D. Hong, S.I. Lee, and H.Y. Moon Lymph node ratio as determined by the 7th edition of the American Joint Committee on cancer staging system predicts survival in stage III colon cancer J Surg Oncol 103 5 2011 Apr 406 410