Lymph Node Ratio Predicts Overall Survival in pT4 Gastric Cancer Patients who Underwent Curative Surgery
Abstract Background: Lymph node ratio (LNR), the ratio of metastatic lymph nodes to the total number of examined lymph nodes, has been considered a prognostic factor in gastric cancer (GC) patients. However, the predictive values of LNR vary as characteristics of patients are different. We confirmed its prognostic value and investigated the differences between patients with different pathological features.Methods: Totally, 211 GC patients who underwent curative gastrectomy between October 2004 and November 2016 were retrospectively investigated. Patients were classified into LNR 0, 1 and 2, using cutoff values 0.05 and 0.2. Cutoff values were calculated by Youden index. Relationships between LNR and clinicopathological characteristics were investigated by chi-square test or Fisher's exact test. Survival analysis were based on Cox proportional hazard regression model and Kaplan-Meier method.Results: LNR were related to tumor size (p = 0.003), Lauren classification (p = 0.007), grade of differentiation (p = 0.041), pT stage (p = 0.050) and pN stage (p < 0.001). In multivariable analysis, LNR was an independent prognostic factor (HR = 7.023, p < 0.001). In stratification analysis, LNR showed independent prognostic value (HR = 4.852, p < 0.001) in pT4 patients, but not in pT3 patients (p = 0.361) and pT1-2 patients (p = 0.123). Conclusions: LNR is an independent predictor of overall survival in pT4 GC patients who underwent curative surgery.