Lymph node ratio as a prognostic factor in gastric cancer patients following D1 resection. Comparison with the current TNM staging system

Abstract Background The prognostic significance of preoperative plasma fibrinogen in patients with operable gastric cancer remains under debate. This study aimed to elucidate the prognostic value of fibrinogen in gastric cancer patients underwent gastrectomy. Methods A total of 4351 patients with gastric cancer collected from three comprehensive medical centers were retrospectively evaluated. Patients were categorized by minimum P value using X-tile, while the baseline confounders for fibrinogen was balanced through propensity score matching (PSM). The relationships between fibrinogen and other clinicopathologic features were evaluated, and nomogram was constructed to assess its prognostic improvement compared with TNM staging system. Results Fibrinogen was significantly correlated with macroscopic type, tumor differentiation, tumor size, and T and N stage. The factors, fibrinogen and T stage as well as N stage, were identified to be independent prognostic factors after PSM. Nomogram based on fibrinogen demonstrated a smaller Akaike information criterion (AIC) and a larger concordance index (C-index) than TNM staging system, illustrating that fibrinogen might be able to improve the prognostic accuracy. Conclusions Preoperative plasma fibrinogen levels in gastric cancer patients were significantly correlated with tumor progression, which could be regarded as a reliable marker for survival prognostic prediction.

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Survival comparison in gastric cancer patients between 7th and 8th edition of the AJCC TNM staging system: The first western single center experience

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2018.12.010 ◽

2019 ◽

Vol 45 (6) ◽

pp. 1105-1108 ◽

Cited By ~ 3

Author(s):

L. Graziosi ◽

E. Marino ◽

A. Donini

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Staging System ◽

Tnm Staging ◽

Single Center ◽

Single Center Experience ◽

Tnm Staging System ◽

Gastric Cancer Patients ◽

8Th Edition

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Metastatic lymph node ratio successfully predicts prognosis in western gastric cancer patients

Surgical Oncology ◽

10.1016/j.suronc.2015.03.001 ◽

2015 ◽

Vol 24 (2) ◽

pp. 84-88 ◽

Cited By ~ 30

Author(s):

Onur C. Kutlu ◽

Mitchell Watchell ◽

Sharmila Dissanaike

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Lymph Node Ratio ◽

Metastatic Lymph Node ◽

Metastatic Lymph ◽

Node Ratio ◽

Gastric Cancer Patients

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Lymph node ratio and survival for gastric cancer: A retrospective analysis of the SEER database

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4561 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4561-4561

Author(s):

R. Shridhar ◽

G. W. Dombi

Keyword(s):

Gastric Cancer ◽

Multivariate Analysis ◽

Lymph Node ◽

Prognostic Factor ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Seer Database ◽

Node Negative ◽

Node Ratio ◽

Gastric Cancer Patients

4561 Purpose: To determine the prognostic significance of the lymph node ratio (ratio of number of positive lymph nodes to number of dissected lymph nodes) in gastric cancer patients. Methods: We retrospectively analyzed 10,176 gastric patients from 1990–2003 who underwent curative gastrectomy from the SEER database. Survival curves were calculated according to the Kaplan-Meier method and analyzed with log-rank test. Multivariate analysis of prognostic factors related to survival was performed by the Cox proportional hazard model. Results: The lymph node ratio (LNR) was a strong predictor of survival. LNR was equally predictive of survival whether the analysis was restricted to patients with <15 lymph nodes dissected or >15 lymph nodes dissected. Survival of patients with a LNR of 0.1–5% was not significantly different than node negative patients; however, survival of patients with a LNR of 5–10% was significantly different than node negative patients. Multivariate analysis showed that LNR, T-stage, tumor size, and number of lymph nodes positive were independent prognostic predictors of death and that LNR was the strongest predictor for death. Multivariate analysis showed that the number of lymph nodes dissected was an independent prognostic factor for survival. Moreover, LNR was an independent prognostic factor for N1 and N2 patients by AJCC staging. LNR trended toward significance in AJCC N3 patients. Conclusions: LNR was the strongest predictor of death in gastric cancer patients when compared to T-stage, number of lymph nodes positive, and tumor size. LNR is equally predictive regardless of the adequacy of the lymph node dissection. No significant financial relationships to disclose.

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Study of Survival in Gastric Cancer with Emphasis on Lymph Node Status as an Independent Prognostic Factor

Journal of Interdisciplinary Medicine ◽

10.2478/jim-2019-0031 ◽

2019 ◽

Vol 4 (4) ◽

pp. 185-189

Author(s):

Nicolae Suciu ◽

Orsolya Bauer ◽

Zalán Benedek ◽

Radu Ghenade ◽

Marius Coroș ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Lymph Nodes ◽

Vascular Invasion ◽

Lymph Node Ratio ◽

Independent Prognostic Factor ◽

Lymph Node Status ◽

Node Ratio ◽

Gastric Cancer Patients

Abstract Background: Lymph node status in gastric cancer is known as an independent prognostic factor that guides the surgical and oncological treatment and independently influences long-term survival. Several studies suggest that the lymph node ratio has a greater importance in survival than the number of metastatic lymph nodes. Aim: The aim of this study was to evaluate the clinical and morphological factors that can influence the survival of gastric cancer patients, with an emphasis on nodal status and the lymph node ratio. Material and methods: We conducted a retrospective study in which 303 patients with gastric cancer admitted to the Department of Surgery of the Mureș County Hospital between 2008 and 2018 were screened for study enrolment. Data were obtained from the records of the department and from the histopathological reports. The examined variables included: age, gender, tumor localization, T stage, histological type, grade of differentiation, surgical procedure, lympho-vascular invasion, excised lymph nodes, metastatic lymph nodes, lymph node ratio. After screening, the study included a total number of 100 patients, for which follow-up data was available. Results: The mean age of the study population was 66.43 ± 10 years, and 71% were males. The average survival period was 21.42 months. Statistical analysis showed that the localization of the tumor (p = 0.021), vascular invasion (p ---lt---0.001), T (p = 0.004) and N (p ---lt---0.001) stages, type of surgery (partial gastrectomy 59% vs. total gastrectomy 41%, p = 0.005), as well as the lymph node ratio (p ---lt---0.001) were prognostic factors for survival in patients with gastric cancer undergoing surgical therapy. Conclusions: The survival of gastric cancer patients is significantly influenced by tumor localization, T stage, vascular invasion, type of surgery, N stage and the lymph node ratio based on univariate analysis. Also, the lymph node ratio proved to be an independent prognostic factor for survival.

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