Metastatic to negative lymph node ratio - can it used as a prognostic indicator in squamous cell carcinoma esophagus

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Oesophageal Cancer
Pathology/Molecular Biology
Presenter Girish M. S
Citation Annals of Oncology (2018) 29 (suppl_9): ix46-ix66. 10.1093/annonc/mdy432
Authors G. M. S
  • Surgical Oncologist, KIDWAI Memorial Institute of oncology, 560029 - Bangalore/IN



In an era of conflict of two versus three field lymph node dissection and the number of lymph node yield in squamous cell carcinoma oesophagus, prognostic value of metastatic lymph node ratio (LNR) in addition to pathological node (pN) has been reported in some studies; but there is no report on the prognostic significance of metastatic to negative lymph node ratio (MNLNR) in cancer patients. The aim of this study was to compare the prognostic value of pN, LNR and MNLNR on the survival of patients with oesophageal squamous cell carcinoma (ESCC) after esophagectomy.


The data of 150 patients with ESCC after curative esophagectomy was retrospectively analyzed. The optimal cut-point for LNR and MNLNR were set as LNR 1 (0), LNR 2 (0.001 – 0.49), and LNR 3 (>0.5) and MNLNR 1 (0), MNLNR 2 (0.001 – 0.2), and MNLNR 3 (> 0.2) respectively. Univariate and multivariate analyses were performed to identify prognostic factors for overall survival (OS).


Patients classified as LNR 1, 2 and 3 observed 5-year OS rates as 88.7, 32.5, 0 respectively (P = <0.001). Patients classified as MNLNR 1, 2, 3 observed 5-year OS rates as 87.5, 51.3, 12.8 respectively (P = <0.008). The pN stage, LNR or MNLNR category was confirmed as a significant independent prognostic factor, respectively in both univariate and multivariate analysis models (P = 0.001, P = 0.001 and P = 0.008) respectively.


The MNLNR was recognized as an independent prognostic factor in ESCC patients after curative esophagectomy. So it can be used as an independent prognostic marker with pN and can be used when inadequate lymph node extracted during surgery as a single prognostic factor.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Kidwai Memorial Institute of Oncology.


Has not received any funding.


The author has declared no conflicts of interest.