Clinical Significance of the Metastatic Lymph-node Ratio in Early Gastric Cancer

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2007 Sep 14

PMID 17851724

Citations 13

Authors

Chikara Kunisaki

Hirochika Makino

Hirotoshi Akiyama

Yuichi Otsuka

Hidetaka A Ono

Takashi Kosaka

Ryo Takagawa

Yutaka Nagahori

Masazumi Takahashi

Fumihiko Kito

Hiroshi Shimada

Affiliations

Soon will be listed here.

Abstract

The metastatic lymph-node ratio has important prognostic value in gastric cancer; this study focused on its significance in early gastric cancer. In total, 1,472 patients with early gastric cancer underwent curative gastrectomy between 1992 and 2001. Of these, 166 (11.3%) had histologically proven lymph-node metastasis. Prognostic factors were identified by univariate and multivariate analyses. Metastasis was evaluated using the Japanese Classification of Gastric Carcinoma (JGC) and the Union Internationale Contre le Cancer/Tumor, Node, Metastasis (UICC/TNM) Classification. The metastatic lymph-node ratio was calculated using the hazard ratio. The cut-off values for the metastatic lymph-node ratio were set at 0, <0.15, >or=0.15 to <0.30, and >or=0.30. The numbers of dissected and metastatic lymph nodes were correlated, but the number of dissected lymph nodes and the metastatic lymph-node ratio was not related. The JGC and UICC/TNM classification demonstrated stage migration and heterogeneous stratification for disease-specific survival. The metastatic lymph-node ratio showed less stage migration and homogenous stratification. The metastatic lymph-node ratio may be a superior method of classification, which provides also accurate prognostic stratification for early gastric cancer patients.

Citing Articles

Comparative analysis of methodologies for predicting overall survival in patients with non-small cell lung cancer based on the number and rate of resected positive lymph nodes: A study based on the SEER database for 2010 through 2019.

Guo Q, Hu S, Wang S, Su L, Zhang W, Xu J Clin Respir J. 2023; 17(11):1145-1157.

PMID: 37723579 PMC: 10632082. DOI: 10.1111/crj.13699.

Tumor budding as an indicator for lymph node metastasis and prognosis of early gastric cancer.

Yao G, Fang Y, Fu Y, Xu J, Song H, Zhu H J Cancer Res Clin Oncol. 2022; 149(9):5603-5616.

PMID: 36512103 DOI: 10.1007/s00432-022-04522-z.

Lymph node ratio has impact on relapse and outcome in patients with stage III melanoma.

Tas F, Erturk K Int J Clin Oncol. 2019; 24(6):721-726.

PMID: 30788673 DOI: 10.1007/s10147-019-01410-4.

Comparison of the 8th union for international cancer control lymph node staging system for gastric cancer with two other lymph node staging systems.

Cao H, Tang Z, Yu Z, Wang Q, Li Z, Lu Q Oncol Lett. 2019; 17(1):1299-1305.

PMID: 30655898 PMC: 6312982. DOI: 10.3892/ol.2018.9694.

Is retrieval of at least 15 lymph nodes sufficient recommendation in early gastric cancer?.

Kim Y Ann Surg Treat Res. 2014; 87(4):180-4.

PMID: 25317412 PMC: 4196431. DOI: 10.4174/astr.2014.87.4.180.

References

Kim J, Lee J, Kim S, Yu H, Yang H . Clinicopathologic characteristics and prognostic factors in 10 783 patients with gastric cancer. Gastric Cancer. 2002; 1(2):125-133. DOI: 10.1007/s101200050006. View

Inoue K, Nakane Y, Iiyama H, Sato M, Kanbara T, Nakai K . The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol. 2002; 9(1):27-34. DOI: 10.1245/aso.2002.9.1.27. View

Rodriguez Santiago J, Munoz E, Marti M, Quintana S, Veloso E, Marco C . Metastatic lymph node ratio as a prognostic factor in gastric cancer. Eur J Surg Oncol. 2005; 31(1):59-66. DOI: 10.1016/j.ejso.2004.09.013. View

Kwon S, Kim G . Prognostic significance of lymph node metastasis in advanced carcinoma of the stomach. Br J Surg. 1996; 83(11):1600-3. DOI: 10.1002/bjs.1800831136. View

Hyung W, Noh S, Yoo C, Huh J, Shin D, Lah K . Prognostic significance of metastatic lymph node ratio in T3 gastric cancer. World J Surg. 2002; 26(3):323-9. DOI: 10.1007/s00268-001-0227-9. View

Nitti D, Marchet A, Olivieri M, Ambrosi A, Mencarelli R, Belluco C . 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. 2003; 10(9):1077-85. DOI: 10.1245/aso.2003.03.520. View

Yu W, Choi G, Whang I, Suh I . Comparison of five systems for staging lymph node metastasis in gastric cancer. Br J Surg. 1997; 84(9):1305-9. View

Japanese Gastric Cancer Association . Japanese Classification of Gastric Carcinoma - 2nd English Edition -. Gastric Cancer. 2002; 1(1):10-24. DOI: 10.1007/s101209800016. View

Takagane A, Terashima M, Abe K, Araya M, Irinoda T, Yonezawa H . Evaluation of the ratio of lymph node metastasis as a prognostic factor in patients with gastric cancer. Gastric Cancer. 2002; 2(2):122-128. DOI: 10.1007/s101200050034. View

10.

Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K . Lymph node status assessment for gastric carcinoma: is the number of metastatic lymph nodes really practical as a parameter for N categories in the TNM Classification? Tumor Node Metastasis. J Surg Oncol. 1998; 69(1):15-20. DOI: 10.1002/(sici)1096-9098(199809)69:1<15::aid-jso4>3.0.co;2-n. View

11.

Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Ono H . Clinical impact of metastatic lymph node ratio in advanced gastric cancer. Anticancer Res. 2005; 25(2B):1369-75. View

12.

Cheong J, Hyung W, Shen J, Song C, Kim J, Choi S . The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer. Ann Surg Oncol. 2006; 13(3):377-85. DOI: 10.1245/ASO.2006.04.018. View

13.

Gotoda T, Sasako M, Ono H, Katai H, Sano T, Shimoda T . Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg. 2001; 88(3):444-9. DOI: 10.1046/j.1365-2168.2001.01725.x. View

14.

Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H . Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol. 2006; 13(3):363-9. DOI: 10.1245/ASO.2006.03.061. View

15.

Siewert J, Bottcher K, Stein H, Roder J . Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. 1998; 228(4):449-61. PMC: 1191515. DOI: 10.1097/00000658-199810000-00002. View

16.

Ding Y, Chen G, Xia J, Zang X, Yang H, Yang L . Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of patients with surgically-removed gastric carcinoma. World J Gastroenterol. 2004; 10(2):182-5. PMC: 4716999. DOI: 10.3748/wjg.v10.i2.182. View

17.

Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K . Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002; 9(8):775-84. DOI: 10.1007/BF02574500. View

18.

Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H . Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study. Ann Surg Oncol. 2006; 13(5):659-67. DOI: 10.1245/ASO.2006.07.015. View