Prognostic Significance of Metastatic Lymph Node Ratio in Patients with Gastric Cancer After Curative Gastrectomy: A Large sample, Single center Retrospective Study

Background: The aim of this study was to examine the prognostic value of Metastatic lymph node ratio (MLNR) in patients with gastric cancer (GC) after curative gastrectomy and the potential for new indicators to strengthen the current guidelines.Methods:We retrospectively examined 3864 patients with GC who underwent curative gastrectomy between February 2011 and February 2016. Patients were classified into low-MLNR (L-MLNR), and high-MLNR (H-MLNR) groups according to adjusted X-tile cutoff-value of 0.25 for MLNR, and their clinicopathological characteristics and survival rates were compared.Results: Survival analysis indicated that MLNR was negatively associated with overall survival (OS) (P<0.001) and was an independent prognostic predictor in 3864 GC patients (P<0.001). Stratum analysis and univariate COX proportional hazards analysis were performed to validate the prognostic value of MLNR in various subgroups with clinicopathological characteristics (gender, age at surgery, tumor location, tumor size, type of gastrectomy, T stage, N stage, ELN, perineural invasion, vascular invasion, and TNM stage). MLNR is a prognostic indicator for patients with GC, regardless whether the number of lymph nodes examined is <16 or ≥16.Conclusions:The MLNR may become a new indicator for evaluating prognosis of patients with curative gastrectomy and complement the current guidelines.