Prognostic Value of the Lymph Node Ratio in Stage III Gastric Cancer Patients Undergoing Radical Resection

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2014 May 10

PMID 24811256

Citations 15

Authors

Bin Ke

Xi-Na Song

Ning Liu

Ru-Peng Zhang

Chang-Li Wang

Han Liang

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this study was to investigate the prognostic value of metastatic lymph node ratio (LNR) in patients having radical resection for stage III gastric cancer.

Methods: A total of 365 patients with stage III gastric cancer who underwent radical resection between 2002 and 2008 at Tianjin Medical University Cancer Institute and Hospital were analyzed. The cut-point survival analysis was adopted to determine the appropriate cutoffs for LNR. Kaplan-Meier survival curves and log-rank tests were used for the survival analysis.

Results: By cut-point survival analysis, the LNR staging system was generated using 0.25 and 0.50 as the cutoff values. Pearson's correlation test revealed that the LNR was related with metastatic lymph nodes but not related with total harvested lymph nodes. Cox regression analysis showed that depth of invasion and LNR were the independent predictors of survival (p<0.05). There was a significant difference in survival between each pN stages classified by the LNR staging, however no significant difference was found in survival rate between each LNR stages classified by the pN staging.

Conclusions: The LNR is an independent prognostic factor for survival in stage III gastric cancer and is superior to the pN category in TNM staging. It may be considered as a prognostic variable in future staging system.

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References

Nakajima T . Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002; 5(1):1-5. DOI: 10.1007/s101200200000. View

Pedrazzani C, Sivins A, Ancans G, Marrelli D, Corso G, Krumins V . Ratio between metastatic and examined lymph nodes (N ratio) may have low clinical utility in gastric cancer patients treated by limited lymphadenectomy: results from a single-center experience of 526 patients. World J Surg. 2009; 34(1):85-91. DOI: 10.1007/s00268-009-0288-8. View

Ueno S, Tanabe G, Sako K, Hiwaki T, Hokotate H, Fukukura Y . Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program. Hepatology. 2001; 34(3):529-34. DOI: 10.1053/jhep.2001.27219. View

Sun Z, Wang Z, Zhu Z, Xu Y, Xu Y, Huang B . Evaluation of the seventh edition of American Joint Committee on Cancer TNM staging system for gastric cancer: results from a Chinese monoinstitutional study. Ann Surg Oncol. 2012; 19(6):1918-27. DOI: 10.1245/s10434-011-2206-1. View

Lee S, Kim H, Son B, Shin J, Yoo C . Prognostic significance of the metastatic lymph node ratio in patients with gastric cancer. World J Surg. 2012; 36(5):1096-1101. DOI: 10.1007/s00268-012-1520-5. View

Wang J, Dang P, Raut C, Pandalai P, Maduekwe U, Rattner D . Comparison of a lymph node ratio-based staging system with the 7th AJCC system for gastric cancer: analysis of 18,043 patients from the SEER database. Ann Surg. 2012; 255(3):478-85. DOI: 10.1097/SLA.0b013e31824857e2. View

Xu D, Geng Q, Long Z, Zhan Y, Li W, Zhou Z . Positive lymph node ratio is an independent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2008; 16(2):319-26. DOI: 10.1245/s10434-008-0240-4. View

Jemal A, Bray F, Center M, Ferlay J, Ward E, Forman D . Global cancer statistics. CA Cancer J Clin. 2011; 61(2):69-90. DOI: 10.3322/caac.20107. View

Toth D, Torok M, Kincses Z, Damjanovich L . Prospective, comparative study for the evaluation of lymph node involvement in gastric cancer: Maruyama computer program versus sentinel lymph node biopsy. Gastric Cancer. 2012; 16(2):201-7. DOI: 10.1007/s10120-012-0170-5. View

10.

Coburn N, Swallow C, Kiss A, Law C . Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer. 2006; 107(9):2143-51. DOI: 10.1002/cncr.22229. View

11.

Giuliani A, Caporale A, Corona M, Di Bari M, Demoro M, Ricciardulli T . Lymphadenectomy in gastric cancer: influence on prognosis of lymph node count. J Exp Clin Cancer Res. 2004; 23(2):215-24. View

12.

Yu C, He W, Liu P . Relationship between the prognostic accuracy of metastatic lymph node ratio and the number of retrieved nodes. Ann Surg Oncol. 2011; 18 Suppl 3:S216-7. DOI: 10.1245/s10434-010-1525-y. View

13.

Zhou Y, Zhang J, Cao S, Li Y . The evaluation of metastatic lymph node ratio staging system in gastric cancer. Gastric Cancer. 2012; 16(3):309-17. DOI: 10.1007/s10120-012-0190-1. View

14.

Lee S, Hwang I, Park Y, Gardner J, Ro J . Metastatic lymph node ratio in advanced gastric carcinoma: a better prognostic factor than number of metastatic lymph nodes?. Int J Oncol. 2010; 36(6):1461-7. DOI: 10.3892/ijo_00000632. View

15.

Kong S, Lee H, Ahn H, Kim J, Kim W, Lee K . Stage migration effect on survival in gastric cancer surgery with extended lymphadenectomy: the reappraisal of positive lymph node ratio as a proper N-staging. Ann Surg. 2011; 255(1):50-8. DOI: 10.1097/SLA.0b013e31821d4d75. View

16.

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

17.

Liu H, Deng J, Zhang R, Hao X, Jiao X, Liang H . The RML of lymph node metastasis was superior to the LODDS for evaluating the prognosis of gastric cancer. Int J Surg. 2013; 11(5):419-24. DOI: 10.1016/j.ijsu.2013.03.009. View

18.

Lee E, Chae Y, Kim I, Choi J, Yeom B, Leong A . Prognostic relevance of immunohistochemically detected lymph node micrometastasis in patients with gastric carcinoma. Cancer. 2002; 94(11):2867-73. DOI: 10.1002/cncr.10562. View

19.

Lin Y, Ueda J, Kikuchi S, Totsuka Y, Wei W, Qiao Y . Comparative epidemiology of gastric cancer between Japan and China. World J Gastroenterol. 2011; 17(39):4421-8. PMC: 3218157. DOI: 10.3748/wjg.v17.i39.4421. View

20.

Chen S, Zhao B, Li Y, Feng X, Sun X, Li W . The prognostic value of harvested lymph nodes and the metastatic lymph node ratio for gastric cancer patients: results of a study of 1,101 patients. PLoS One. 2012; 7(11):e49424. PMC: 3499537. DOI: 10.1371/journal.pone.0049424. View