Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study

Chairat Supsamutchai,Teerawut Rakchob,Songpol Phosuwan,Chumpon Wilasrusmee,Tanet Chatmongkonwat,Pattawia Choikrua,Tharin Thampongsa,Jakrapan Jirasiritham

doi:10.1016/j.amsu.2020.04.002

Chairat Supsamutchai, Teerawut Rakchob + Show 6 more

Open Access

https://doi.org/10.1016/j.amsu.2020.04.002

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Abstract

IntroductionD2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). Number of lymph nodes (LN) harvested is an important factor for accurate staging. The number of LN retrieved and the metastasis LN status are also important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection.Patients and methodsSingle center retrospective cohort study of GC patients underwent curative resection from January 1995 to December 2016 was conducted. The patients were categorized into 3 groups based on LNR (0.00–0.35, >0.35–0.75, and >0.75–1.00) and 2 groups based on number of LN retrieved (<15 and ≥ 15). Kaplan-Meier method was used to estimate recurrence-free survival. Cox-regression were used to determine the association between LNR/other factors and the disease recurrence.ResultsOne-hundred fifty-three patients were included in analysis. Univariate analysis showed that LNR >0.35, pathologic LN stages (pN) 2–3, higher number of LN metastasis, and TNM stage III were significantly recurrence risk factors. After adjusting for several covariates, LNR >0.35 still was significant predictor (adjusted HR [95%CI], 8.53 [1.97, 36.86]; p = 0.004) while number of LN retrieved or number of metastasis LN were not.ConclusionLNR could be a strong indicator for the recurrence of GC after curative resection while the number of LN retrieved or metastasis did not predict the recurrence. Future studies, such as prospective studies, are needed to confirm and identify the optimum LNR cut-off.

Highlights

D2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC)
This study aims to evaluate the association between the number of LN that retrieved from the curative resection, number of metastatic lymph nodes, and the lymph node ratio (LNR) and the recurrence rate after curative resection of gastric cancer
The patients who underwent curative surgery resection were included in the review and study analysis if the patient was ≥18 years old at the time of surgery, the gastric cancer diagnosis confirmed by histology, did not previously receive neoadjuvant therapy and no distant metastasis at the time of surgery from an imaging study, such as ultrasonography, computer tomography (CT) or magnetic resonance imaging (MRI)

Summary

Introduction

D2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). The number of LN retrieved and the metastasis LN status are important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection. Conclusion: LNR could be a strong indicator for the recurrence of GC after curative resection while the number of LN retrieved or metastasis did not predict the recurrence. Future studies, such as prospective studies, are needed to confirm and identify the optimum LNR cut-off. The number of lymph nodes harvested during the gastric resection is an important factor to determine the accuracy for cancer staging

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