Abstract
ObjectiveThe 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.MethodsA 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.ResultsBy 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.ConclusionsThe 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.
Highlights
Gastric cancer is one of the most common forms of cancer worldwide, with approximately one million new cases diagnosed each year [1]
Due to lack of effective screening in China, most gastric cancers are identified at an advanced stage [2], which is reflected by poor overall survival rates
Clinicopathological parameters of patients All of the patients with gastric cancer were in stage III in terms of the UICC TNM classification (7th edition)
Summary
Gastric cancer is one of the most common forms of cancer worldwide, with approximately one million new cases diagnosed each year [1]. More new cases of gastric cancer are diagnosed in China than in any other country around the world. Due to lack of effective screening in China, most gastric cancers are identified at an advanced stage [2], which is reflected by poor overall survival rates. In 2010, the UICC published the 7th edition TNM classification of malignant tumors for gastric cancer [4]. In this edition, the stage III was changed to contain three subdivisions: IIIa, IIIb, IIIc. The T4N+/TanyN3M0 classification which was defined as stage IV in the 6th edition, was classified as the stage III according to the 7th classification system. It is important to identify prognostic factors for these patients and to better tailor treatment decisions
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