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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
    The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.

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Original Article

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Prognostic Significance of the Lymph Node Ratio Regarding Recurrence and Survival in Rectal Cancer Patients Treated with Postoperative Chemoradiotherapy

Ji-Yoon Kim*, Su-Mi Chung*, Byung-Ock Choi*, In-Kyu Lee

*Department of Radiation Oncology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Department of General Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to: Mi-Ryeong Ryu. Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, 271 Cheonbo-ro, Uijeongbu 480-717, Korea. Tel: +82-31-820-3517, Fax: +82-31-847-3059, mrryu@catholic.ac.kr

Received: June 23, 2011; Revised: August 10, 2011; Accepted: September 2, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver 2012; 6(2): 203-209

Published online April 29, 2012 https://doi.org/10.5009/gnl.2012.6.2.203

Copyright © Gut and Liver.

Abstract

Background/Aims

To evaluate the prognostic impact of the lymph node ratio (LNR: the ratio of positive lymph nodes to the total number of lymph nodes examined) on disease recurrence and survival among rectal cancer patients who received curative surgery and postoperative chemoradiotherapy (CRT).

Methods

Between 1995 and 2008, 124 patients with pathologic T3-4 or node-positive rectal cancer underwent curative surgery and postoperative CRT. Postoperative radiotherapy was delivered at a median dose of 50.4 Gy (range, 45 to 59.4 Gy) for 6 weeks. Chemotherapy consisted of a bolus injection of 5-fluorouracil and leucovorin in the first and last week of radiotherapy (91.9%) or daily capecitabine during radiotherapy (8.1%). Further adjuvant chemotherapy was administered after chemoradiation.

Results

The median follow-up was 5.1 years. In the multivariate analysis, pathologic N (pN) stage and lymphovascular invasion were significantly associated with disease-free survival and disease-specific survival (p<0.05). However, when the LNR with a cutoff value of 0.2 was included as a covariate in the model, the LNR was highly significant (p<0.001), and the pN stage lost its significance (p>0.05).

Conclusions

The LNR predicts recurrence and survival more accurately than pN stage. The pN stage and the LNR should be considered together when estimating the risk of disease recurrence among rectal cancer patients.

Keywords: Rectal neoplasms, Lymph nodes, Combined modality therapy


Article

Original Article

Gut Liver 2012; 6(2): 203-209

Published online April 29, 2012 https://doi.org/10.5009/gnl.2012.6.2.203

Copyright © Gut and Liver.

Prognostic Significance of the Lymph Node Ratio Regarding Recurrence and Survival in Rectal Cancer Patients Treated with Postoperative Chemoradiotherapy

Ji-Yoon Kim*, Su-Mi Chung*, Byung-Ock Choi*, In-Kyu Lee

*Department of Radiation Oncology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Department of General Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to: Mi-Ryeong Ryu. Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, 271 Cheonbo-ro, Uijeongbu 480-717, Korea. Tel: +82-31-820-3517, Fax: +82-31-847-3059, mrryu@catholic.ac.kr

Received: June 23, 2011; Revised: August 10, 2011; Accepted: September 2, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

To evaluate the prognostic impact of the lymph node ratio (LNR: the ratio of positive lymph nodes to the total number of lymph nodes examined) on disease recurrence and survival among rectal cancer patients who received curative surgery and postoperative chemoradiotherapy (CRT).

Methods

Between 1995 and 2008, 124 patients with pathologic T3-4 or node-positive rectal cancer underwent curative surgery and postoperative CRT. Postoperative radiotherapy was delivered at a median dose of 50.4 Gy (range, 45 to 59.4 Gy) for 6 weeks. Chemotherapy consisted of a bolus injection of 5-fluorouracil and leucovorin in the first and last week of radiotherapy (91.9%) or daily capecitabine during radiotherapy (8.1%). Further adjuvant chemotherapy was administered after chemoradiation.

Results

The median follow-up was 5.1 years. In the multivariate analysis, pathologic N (pN) stage and lymphovascular invasion were significantly associated with disease-free survival and disease-specific survival (p<0.05). However, when the LNR with a cutoff value of 0.2 was included as a covariate in the model, the LNR was highly significant (p<0.001), and the pN stage lost its significance (p>0.05).

Conclusions

The LNR predicts recurrence and survival more accurately than pN stage. The pN stage and the LNR should be considered together when estimating the risk of disease recurrence among rectal cancer patients.

Keywords: Rectal neoplasms, Lymph nodes, Combined modality therapy

Fig 1.

Figure 1.The disease-free survival (DFS) curve according to the groups by lymph node ratio (LNR). The 5-year DFS rates were 89.9±4.3%, 72.5±7.8%, and 33.4±8.0% with increasing LNRs (p=0.0325).
Gut and Liver 2012; 6: 203-209https://doi.org/10.5009/gnl.2012.6.2.203

Fig 2.

Figure 2.The disease-specific survival (DSS) curve according to the groups by lymph node ratio (LNR). The 5-year DSS rates were 87.4±4.8%, 68.1±8.3%, and 35.3±8.1% with increasing LNRs (p<0.001).
Gut and Liver 2012; 6: 203-209https://doi.org/10.5009/gnl.2012.6.2.203

Table 1 Clinical and Pathologic Features of the Patients

LAR, low anterior resection; APR, abdominoperineal resection; LN, lymph node; CEA, carcinoembryonic antigen.

|@|LAR, low anterior resection; APR, abdominoperineal resection; LN, lymph node; CEA, carcinoembryonic antigen.

Table 2 The 5-Year Kaplan-Meier Values for DFS and DSS according to Prognostic Factor

DFS, disease-free survival; SE, standard error; DSS, disease-specific survival; LAR, low anterior resection; APR, abdominoperineal resection; LN, lymph node; LNR, lymph node ratio.

|@|LAR, low anterior resection; APR, abdominoperineal resection; LN, lymph node; CEA, carcinoembryonic antigen.

Table 3 Multivariate Analysis of the Prognostic Factors for DFS and DSS

LNR, lymph node ratio; DFS, disease-free survival; DSS, disease-specific survival; HR, hazard ratio; CI, confidence interval; LVI, lymphovascular invasion; PNI, perineural invasion.

|@|LAR, low anterior resection; APR, abdominoperineal resection; LN, lymph node; CEA, carcinoembryonic antigen.

Table 4 DFS and DSS Rates Indicated by the LNR in Patients with Stage III Cancer

SE, standard error; DFS, disease-free survival; DSS, disease-specific survival; LNR, lymph node ratio; pN, pathologic N stage.

|@|LAR, low anterior resection; APR, abdominoperineal resection; LN, lymph node; CEA, carcinoembryonic antigen.

Table 5 Treatment-Related Acute Toxicity according to the Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring Scheme

|@|LAR, low anterior resection; APR, abdominoperineal resection; LN, lymph node; CEA, carcinoembryonic antigen.
Gut and Liver

Vol.15 No.6
November, 2021

pISSN 1976-2283
eISSN 2005-1212

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