The Prognostic Significance of Lymph Node Ratio in Carcinoid Tumors
Virginia Flatow1, Richard R P Warner, Jessica Overbey
1From the *Department of Surgery, †Division of Gastroenterology, and ‡Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
Objectives:
Nodal metastases are an important prognostic factor in survival for patients with carcinoid tumors. However, it is unclear if the current American Joint Committee on Cancer's gastrointestinal carcinoid staging guidelines, which look only at presence or absence of regional metastases (N1/N0), are fully utilizing lymph node data. Some research has indicated that lymph node ratios (LNRs) are powerful predictors of survival. In our study, we evaluated LNR in carcinoid tumors.
Methods:
Eleven thousand one hundred eighty-nine carcinoid tumors recorded in the Surveillance, Epidemiology, and End Results database between 1988 and 2011 were evaluated. Receiver operating characteristic curves and the area under the receiver operating characteristic curve (AUC) were used to evaluate the ability of nodal involvement or LNR to predict 10-year survival. All analyses were performed using STATA and SAS version 9.3.
Results:
Receiver operating characteristic curve analysis indicated that LNR and node positivity were both predictive of 10-year survival, AUC = 0.734, P < 0.0001; AUC = 0.7048, P < 0.0001. Lymph node ratio was 88% specific and 50% sensitive in predicting 10-year survival. N1 was 88% specific and 49% sensitive in predicting 10-year survival.
Conclusions:
Our study indicated that LNR is an independent predictor of survival for patients with carcinoid tumors but was no better than N1/N0 for 10-year survival.
