Association Between Lymph Node Ratio and Survival in Patients with Pathological Stage II/III Gastric Cancer
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ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Association Between Lymph Node Ratio and Survival in Patients with Pathological Stage II/III Gastric Cancer Kazuki Kano, MD, PhD1,2, Takanobu Yamada, MD, PhD1,2, Kouji Yamamoto, PhD3, Keisuke Komori, MD1,2, Hayato Watanabe, MD1,2, Kentaro Hara, MD2, Yota Shimoda, MD1, Yukio Maezawa, MD, PhD2, Hirohito Fujikawa, MD, PhD1,2, Toru Aoyama, MD, PhD2, Hiroshi Tamagawa, MD, PhD2, Naoto Yamamoto, MD, PhD1, Haruhiko Cho, MD, PhD4, Manabu Shiozawa, MD, PhD1, Norio Yukawa, MD, PhD2, Takaki Yoshikawa, MD, PhD5, Soichiro Morinaga, MD, PhD1, Yasushi Rino, MD, PhD2, Munetaka Masuda, MD, PhD2, Takashi Ogata, MD, PhD1, and Takashi Oshima, MD, PhD1 1
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan; 2Department of Surgery, Yokohama City University, Yokohama, Japan; 3Department of Biostatistics, Yokohama City University, Yokohama, Japan; 4Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan; 5Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
ABSTRACT Background. Lymph node ratio (LNR), defined as the ratio of metastatic nodes to the total number of examined lymph nodes, has been proposed as a sensitive prognostic factor in patients with gastric cancer (GC). We investigate its association with survival in pathological stage (pStage) II/III GC and explore whether this is a prognostic factor in each Union for International Cancer Control pStage (7th edition). Patients and Methods. We retrospectively examined 838 patients with pStage II/III GC who underwent curative gastrectomy between June 2000 and December 2018. Patients were classified into low-LNR (L-LNR), middleLNR (M-LNR), and high-LNR (H-LNR) groups according to adjusted X-tile cutoff values of 0.1 and 0.25 for LNR, and their clinicopathological characteristics and survival rates were compared.
Kazuki Kano and Takanobu Yamada equally contributed to this article. Society of Surgical Oncology 2020 First Received: 18 February 2020 T. Oshima, MD, PhD e-mail: [email protected]
Results. The 5-year recurrence-free survival (RFS) and overall survival (OS) rates postsurgery showed significant differences among the groups (P \ 0.001). Multivariate analysis demonstrated that LNR was a significant predictor of poor RFS [M-LNR: hazard ratio (HR) 3.128, 95% confidence interval (CI) 2.254–4.342, P \ 0.001; H-LNR: HR 5.148, 95% CI 3.546–7.474, P \ 0.001] and OS (MLNR: HR 2.749, 95% CI 2.038–3.708, P \ 0.001; H-LNR: HR 4.654, 95% CI 3.288–6.588, P \ 0.001). On subset analysis stratified by pStage, significant differences were observed between the groups in terms of the RFS curves of pStage II and III GC (P \ 0.001 and \ 0.001, respectively) and OS curves of pStage II and III GC (P = 0.001 and \ 0.001, respectively). Conclusions. High LNR is a predictor of worse prognosis in pStage II/III GC, including each substage.
Gastric cancer (GC) is the fifth most commonly diagnosed malignancy and the third most common cause of cancer-
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