ASO Author Reflections: Association Between the Lymph Node Ratio and Survival in Patients with Pathological Stage II/III
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Association Between the Lymph Node Ratio and Survival in Patients with Pathological Stage II/III Gastric Cancer Kazuki Kano, MD, PhD, Takanobu Yamada, MD, PhD, and Takashi Oshima, MD, PhD Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
PAST The metastatic lymph node (LN) ratio (LNR), defined as the number of metastatic LNs divided by the total LNs examined, reflects the quantity of metastatic LNs and extent of LN dissection in gastric cancer (GC).1,2 However, it remains unclear whether the LNR is a prognostic factor in each pathological substage, as defined by the Union for International Cancer Control TNM classification, which considers the number of metastatic LNs. We investigated the association between the LNR and survival in pathological stage (pStage) II and III GC patients and explored whether the LNR is a prognostic factor. PRESENT We harvested a substantial number of LNs from 838 GC patients receiving standard treatment3 using the methylene blue-assisted technique for harvesting LNs after gastrectomy.4 We evaluated the accuracy of different predictive values using time-dependent receiver operating characteristic curves. For survival, the LNR had a predictive value equal to that of pathological N factor in patients with
pStage II GC and better than that of pathological N factor in patients with pStage III GC. The overall survival and relapse-free survival rates in the high LNR group in each pathological substage were found to be worse than those of the low LNR group. FUTURE This study suggests that LNRs may be used to identify GC patients, particularly pStage III patients, with high recurrence risks. Patients with pStage III tumors showed unsatisfactory outcomes in controlled trials of adjuvant therapy, and a switch to neoadjuvant chemotherapy is being considered.5 However, it is not currently possible to preoperatively identify patients with high LNRs, and whether the LNR is a prognostic factor among patients who receive neoadjuvant chemotherapy followed by curative resection remains unclear. While these results await further validation, they may assist in optimizing the management, planning, and development of personalized treatment strategies. DISCLOSURES interest.
All the authors have declared no conflict of
REFERENCES
Ó Society of Surgical Oncology 2020 First Received: 16 May 2020 T. Oshima, MD, PhD e-mail: [email protected]
1. Xu D, Geng Q, Long Z, et al. Positive lymph node ratio is an independent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2009;16: 319–26. 2. Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002;9:775–84. 3. Kano K, Yamada T, Yamamoto K, et al. Association between lymph node ratio and survival in patients with pathological stage II/III gastric cancer. Ann Surg Oncol. 2020. https://doi.org/10.12 45/s10434-020-08616-1.
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