SUMMARY OBJECTIVE: Rectal cancer is an important cause of mortality and morbidity globally. The aim of this study was to investigate whether the log odds of positive nodes system is a better indicator than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis, which is an important cause of mortality and morbidity globally. METHODS: This was a single-center retrospective cross-sectional study. Data were obtained from the medical records of patients with rectum adenocarcinoma followed at Gazi University Hospital. The clinicopathological data of 128 patients with rectum adenocarcinoma who underwent low anterior resection or abdominoperineal resection between January 2010 and December 2018 was retrospectively reviewed. Patients with rectum adenocarcinoma as the first and only primary diagnosis, which was confirmed by histopathological examination, than those who had undergone complete curative resection via low anterior resection or abdominoperineal resection were included. Those with familial adenomatous polyposis or Lynch syndrome, those under 18 years of age, with a synchronous tumor, peritoneal spread, or metastatic disease at the time of diagnosis, and those with <12 lymph nodes dissected from the resection material were excluded from the study. RESULTS: In multivariate analysis, age, perineural invasion, tumor node metastasis stage, lymph node ratio stage, and log odds of positive nodes stage were found to be independent prognostic factors (p<0.05). LODDS2 patients’ mortality rates were 9.495 times higher than LODDS0 patients [hazard ratio=9.495, (95%CI 4.155–21.694), p<0.001] while LNR2 stage patients’ mortality rates were 7.016 times higher than LNR0 stage patients [hazard ratio=7.016, (95%CI 3.123–15.765), p<0.001] and N2 stage patients had a 5.135 times higher risk of mortality than those who were in N0 stage [hazard ratio=5.135 (95%CI 2.451–10.756), p<0.001]. CONCLUSION: Log odds of positive nodes is a more valuable prognostic factor for rectal cancer patients than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis.

Resumen Antecedentes: La incidencia de metástasis en ganglios linfáticos retropancreáticos en pacientes con cáncer gástrico no es despreciable. Objetivo: Determinar los factores de riesgo de metástasis en los ganglios linfáticos (GL) retropancreáticos e investigar su importancia clínica. Método: Se analizaron retrospectivamente los datos clínicos patológicos de 237 pacientes con cáncer gástrico entre junio de 2012 y junio de 2017. Resultados: Hubo 14 pacientes (5.9%) que presentaron metástasis de GL retropancreático. La mediana de supervivencia de los pacientes con y sin metástasis del GL retropancreático fue de 13.1 y 25.7 meses, respectivamente. Según el análisis univariado, se encontró que el tamaño tumoral ≥ 8 cm, Bormann tipo III/IV, tipo indiferenciado, presencia de invasión angiolinfática, profundidad de invasión (pT4), estadio N3 y metástasis GL No. 3, 7, 8, 9 y 12p se asociaba con metástasis de GL retropancreático. Según el análisis multivariante, se encontró que el tamaño tumoral ≥ 8 cm, Bormann tipo III/IV, tipo indiferenciado, pT4, estadio N3, metástasis de GL No. 9 y metástasis de GL No. 12p eran variables pronósticas independientes para la metástasis de GL retropancreático. Conclusiones: La metástasis del GL retropancreático es un factor de mal pronóstico para el cáncer gástrico. El tamaño del tumor ≥ 8 cm, el tipo III/IV de Bormann, el tumor indiferenciado, el estadio pT4, N3 y las metástasis de GL No. 9 y 12p son factores de riesgo de metástasis en los GL retropancreáticos.

Abstract Background: The incidence of retropancreatic lymph node metastasis in gastric cancer patients is not negligible. Objective: The aim of present study was to determine the risk factors for retropancreatic lymph node (LN) metastasis and to investigate its clinical significance. Patients and Methods: Clinical pathologic data of 237 patients with gastric cancer between June 2012 and June 2017 were analyzed retrospectively. Results: 14 patients (5.9%) had retropancreatic LN metastases. The median survival of patients with and without retropancreatic LN metastasis was 13.1 and 25.7 months. According to univariate analysis; tumor size ≥ 8 cm, Bormann type III/IV, undifferentiated type, presence of angiolymphatic invasion, depth of invasion (pT4), N3 stage, No. 3, No. 7, No. 8, No. 9, and No. 12p LN metastasis was found to be associated with retropancreatic LN metastasis. According to multivariate analysis; tumor size ≥ 8 cm, Bormann type III/IV, undifferentiated type, pT4, N3 stage, No. 9 LN metastasis, and No. 12p LN metastasis were found to be independent prognostic variables for retropancreatic LN metastasis. Conclusion: Retropancreatic LN metastasis is a poor prognostic factor for gastric cancer. Tumor size (≥ 8 cm), Bormann type III/IV, undifferentiated tumor, pT4, N3 stage, and No. 9 and No. 12p LN metastasis are risk factors for metastasis to retropancreatic lymph node.