scholarly journals Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Honghu Wang ◽  
Hao Qi ◽  
Xiaofang Liu ◽  
Ziming Gao ◽  
Iko Hidasa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Prognostic Index ◽  
Staging System ◽  
R0 Resection ◽  
Remnant Gastric Cancer ◽  
Curative Intent ◽  
Node Ratio

AbstractThe staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.

Lymph-Node Ratio Classification Strongly Correlates with Cancer Survivals of Patients Who Underwent R0 Resection for Gastric Cancer with More than 15 Nodes Harvested

2014 ◽  
Vol 53 (1-4) ◽  
pp. 1-10 ◽  
Author(s):  
Laura Lorenzon ◽  
Paolo Mercantini ◽  
Mario Ferri ◽  
Marco La Torre ◽  
Alessandra Sparagna ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Ratio ◽  
R0 Resection ◽  
Node Ratio

Metastatic Lymph Node Ratio: A New Staging System for Gastric Cancer

2009 ◽  
Vol 33 (10) ◽  
pp. 2106-2111 ◽  
Author(s):  
Roberto Persiani ◽  
Stefano Rausei ◽  
Vincenzo Antonacci ◽  
Alberto Biondi ◽  
Francesco Casella ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Ratio ◽  
Metastatic Lymph Node ◽  
Staging System ◽  
Metastatic Lymph ◽  
Node Ratio

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

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.

A novel simplified approach to incorporating lymph node ratio into gastric cancer staging.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 24-24
Author(s):  
Sarah B. Fisher ◽  
Malcolm Hart Squires ◽  
Sameer H. Patel ◽  
David A. Kooby ◽  
Kenneth Cardona ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Ratio ◽  
Staging System ◽  
Cancer Staging ◽  
Lymph Node Staging ◽  
Cox Regression Analysis ◽  
Simplified Approach ◽  
Staging Systems ◽  
Node Ratio

24 Background: Previous investigators have reported on the value of lymph node ratio (LNR, defined as the number of positive nodes divided by the total number of nodes assessed) in gastric adenocarcinoma (GAC) staging. Given the complexity of previously proposed staging systems, it has not gained widespread acceptance. The aim of our study was to offer a novel simplified approach to incorporating LNR into gastric cancer staging. Methods: 131 patients who underwent curative intent resection with lymphadenectomy for GAC between 1/00-6/11 were identified. Clinicopathologic factors were assessed. Primary outcome was overall survival (OS). Results: Median age was 64 yrs, 51% were male. Median tumor size was 3.5 cm, 67% were poorly differentiated, 20% had perineural invasion, 31% had lymphovascular invasion, and 6% had a positive margin. Locoregional nodal metastases were present in 59% (n=77, N0: 41%, N1: 18%, N2: 22%, N3a: 14%, N3b: 5%). Median number of lymph nodes (LN) assessed was 15.5. Mean FU was 27.3 mos, median OS was 29.3 mos. Median LNR was 0.4 (.04-1). Patients with LNR ≥0.4 had decreased OS as compared to patients with LNR <0.4 (15.1 vs 41.5 mos, p<0.0001); the survival of patients with LNR <0.4 was similar to that of node negative pts (48 mos, p=0.882). On Cox regression analysis, LNR ≥0.4 was more strongly associated with decreased OS (HR 3.09, 95%CI: 1.81-5.26; p<0.0001) compared to the AJCC 7th edition N stage (HR 1.36, 95%CI: 1.11-1.68; p=0.004). In the subset of patients who were inadequately staged and had <16 nodes examined, a LNR ≥0.4 was associated with reduced survival compared to a LNR <0.4 (17.3 vs 41.5 mos, p=.04). Conclusions: Compared to the current lymph node staging system, a lymph node ratio using 0.4 as the cutoff may more accurately predict survival outcomes. It seems to be particularly useful in patients who have inadequate nodal assessment. This simplified approach to lymph node ratio may be a more valuable staging tool than the current AJCC nodal staging system for gastric cancer and needs to be validated.

Is Metastatic Lymph Node Ratio Superior to the Number of Metastatic Lymph Nodes to Assess Outcome and Survival of Gastric Cancer?

2010 ◽  
Vol 33 (3) ◽  
pp. 101-105 ◽  
Author(s):  
Ahmet Bilici ◽  
Bala B.O. Ustaalioglu ◽  
Mahmut Gumus ◽  
Mesut Seker ◽  
Burcak Yilmaz ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Metastatic Lymph Node ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Node Ratio

Lymph Node Ratio-based Staging System Outperforms the Seventh AJCC System for Gastric Cancer

2017 ◽  
Vol 40 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Yueh-Chang Lee ◽  
Po-Jen Yang ◽  
Yuxin Zhong ◽  
Thomas E. Clancy ◽  
Ming-Tsan Lin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Ratio ◽  
Staging System ◽  
Node Ratio

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

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.

Prognostic impact of lymph node retrieval and ratio in gastric cancer: A single-center U.S. experience.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 17-17
Author(s):  
Joyce Wong ◽  
Shams Rahman ◽  
Nadia Saeed ◽  
Hui-Yi Lin ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Free Survival ◽  
Lymph Node Retrieval ◽  
Node Ratio ◽  
Disease Free

17 Background: Recommendations for extended lymphadenectomy in gastric cancer is thought to be associated with improved overall survival (OS), although defining adequate lymphadenectomy remains controversial. Methods: A single-institution, prospectively-maintained database of patients referred for surgical care of gastric cancer was reviewed. Patients were stratified by number of examined lymph nodes (eLN): <5, 6-10, 11-15, and >15 and positive LNs (LN+) stratified by 0, 1-2, 3-6, 7-15, and >15. Lymph node ratio (LN+:eLN) was evaluated, stratified by 0, 0.01-0.2, 0.21-0.5, and >0.5. Disease-free-survival (DFS) and OS were the primary endpoints, determined by Kaplan-Meier analyses. Results: From 1997-2012, 222 patients were included; most were male (N=122, 55%) with median age 67 (range 17-92) years. Of 220 (99%) patients surgically explored, 164 (74%) ultimately underwent resection. Median OS of the entire cohort was 22 months. Gender, ethnicity, and smoking status did not impact OS. Pathologic factors such as perineural invasion, lymphovascular invasion, and poor differentiation adversely affected OS, P<0.05. A median 14 lymph nodes (LN) were retrieved (range 0-45), with a median of one positive LN (range 0-31). No OS or disease-free survival (DFS) difference was observed when comparing <5, 6-10, 11-15, and >15 eLN, P=0.30. LN+ affected both OS and DFS: median OS was 52 months for 0 LN+ and decreased to 21 months with 1-2 LN+, 34 months 3-6 LN+, 25 months 7-15 LN+, and 11.5 months with >15 LN+. Similarly, median DFS decreased from 35 months with 0 LN+ to 19 months with 1-2 LN+, 9 months with 3-6 LN+, 13.5 months with 7-15 LN+, and 7.5 months with >15 LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months for ratio of 0, 37 months for 0.01-0.2, 27 months for 0.21-0.5, and 12 months for >0.5, P<0.0001. DFS was similar: 35months for ratio of 0, 22 months for 0.01-0.2, 13 months for 0.21-0.5, and 7 months for >0.5, P<0.0001. Conclusions: Extent of lymphadenectomy does not impact OS or DFS. Presence of LN+ adversely impacts OS and DFS. Lymph node ratio may be a better prognostic indicator than number of eLN or LN+ in gastric cancer.

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