The Lymph Node Metastasis in Gastric Cancer and Ratio of Metastatic Lymph Nodes (RLN)

Abstract

The routine identification and removal of regional lymph nodes (LN) in solid neoplasm is essential. The proportion between metastatic and examined lymph nodes (N-ratio) has been proposed as an independent prognostic factor in patients with gastric cancer. We analysed the postoperative survival of 124 patients with gastric cancer, having 96 intraoperative lymphography with colorant (methyl blue). For lymph nodes status (N, PN), two classifications were assigned: TNM, UICC/AJCC and the JSCA: (NR0: 0%, NR1 ≤20%, NR2 >20%). The impact concerning staging and survival of patients with gastric cancer and R0 resection was compared in the study group. A total of 124 patients with gastric cancer from our institution were studied retrospectively between 1998 and 2007. Results: a significant difference in survival was seen in the patients with NR1 versus NR2. In our multivariate analysis study, only NR with pT and histologicaly G (grading) were found to be independent prognostic factors. With JSCA classification, in the patients with gastric cancer operated between 2000 and 2007, stage migration was present in 43 cases (51%), with the UICC/AJCC TNM classification, in the patients operated between 1998 and 2007, 15 cases (18%) and when NR was applied, stage migration was found only in 14 (11%) of cases. Conclusion: the NR is a simply reproducible staging system, with a very good prognostic significance.