Prognostic value of metastatic lymph node ratio for patients with gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Zhijian , WANG Keshen , REN Yanxian ,  JIAO Zuoyi

The First Deparrtment of General Surgery, Lanzhou University Second Hospital, Lanzhou 730000, P. R. China;

Corresponding author：

JIAO Zuoyi, Email: jiaozy@lzu.edu.cn

Keywords：

metastatic lymph node ratio; rN stage; N stage; gastric cancer; prognosis

DOI：

10.7507/1007-9424.202003025

Video：

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Objective To investigate the value of metastatic lymph node ratio (abbreviation: rN) in the prognosis of patients with gastric cancer.Methods The clinical data of 255 patients with gastric cancer who underwent the radical gastrec-tomy in the First Department of General Surgery of Lanzhou University Second Hospital from January 2014 to July 2019 were retrospectively reviewed. The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model. The receiver operating characteristic (ROC) curve was used to compare the accuracy of rN stage and N stage for prognosis judgment of patients with gastric cancer, and the Spearman correlation analysis method was used to analyze the correlation between rN or number of metastatic lymph node and total number of lymph nodes detected.Results The univariate survival analysis showed that the vascular invasion, nerve invasion, histologic grade, tumor diameter, T stage, N stage, and rN stage were significantly associated with the prognosis of patients with gastric cancer (P<0.05); The multivariate survival analysis demonstrated that the prognosis model based on the rN stage had a higher HR value (1.756 versus 1.610) and a smaller –2 log likelihood value (648.548 versus 649.469) than the N stage. Correlation analysis results showed that rN was indepen-dent of the number of lymph nodes detected when the number was <15 and ≥15 (r_s=0.275, P=0.058; r_s=0.075, P=0.285). In addition, when the number of lymph nodes detected was <15 and ≥15, the rN staging could accurately stratify the prognosis of gastric cancer patients (χ²=11.24, P=0.009; χ²=30.25, P<0.001). ROC curve analysis results showed that when the number of lymph nodes detected was less than 15, rN stage had a higher area under ROC curve value ［0.863, 95%CI (0.752, 0.974) and 0.813, 95%CI (0.687, 0.938)］ as compared with N stage.Conclusion rN stage might be more accurate than N stage in predicting prognosis of patients with gastric cancer when number of lymph nodes harvested is less than 15.

Citation： MA Zhijian, WANG Keshen, REN Yanxian, JIAO Zuoyi. Prognostic value of metastatic lymph node ratio for patients with gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(11): 1352-1356. doi: 10.7507/1007-9424.202003025 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
3.	Van Cutsem E, Sagaert X, Topal B, et al. Gastric cancer. Lancet, 2016, 388(10060): 2654-2664.
4.	Cammerer G, Formentini A, Karletshofer M, et al. Evaluation of important prognostic clinical and pathological factors in gastric cancer. Anticancer Res, 2012, 32(5): 1839-1842.
5.	王利锋, 马艳飞, 高强. 肝十二指肠韧带淋巴结转移对胃癌患者预后影响的研究. 中国普外基础与临床杂志, 2018, 25(11): 1337-1342.
6.	Siewert JR, Böttcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg, 1998, 228(4): 449-461.
7.	D’Ugo D, Pacelli F, Persiani R, et al. Impact of the latest TNM classification for gastric cancer: retrospective analysis on 94 D2 gastrectomies. World J Surg, 2002, 26(6): 672-677.
8.	Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
9.	Inoue K, Nakane Y, Iiyama H, et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol, 2002, 9(1): 27-34.
10.	Wu XJ, Miao RL, Li ZY, et al. Prognostic value of metastatic lymph node ratio as an additional tool to the TNM stage system in gastric cancer. Eur J Surg Oncol, 2015, 41(7): 927-933.
11.	Deng J, Zhang R, Wu L, et al. Superiority of the ratio between negative and positive lymph nodes for predicting the prognosis for patients with gastric cancer. Ann Surg Oncol, 2015, 22(4): 1258-1266.
12.	Espín F, Bianchi A, Llorca S, et al. Metastatic lymph node ratio versus number of metastatic lymph nodes as a prognostic factor in gastric cancer. Eur J Surg Oncol, 2012, 38(6): 497-502.
13.	Sun Z, Zhu GL, Lu C, et al. The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2 159 patients. Ann Oncol, 2009, 20(5): 897-905.
14.	Graziosi L, Marino E, Cavazzoni E, et al. Prognostic value of the seventh AJCC/UICC TNM classification of non-cardia gastric cancer. World J Surg Oncol, 2013, 11: 103.
15.	Celen O, Yildirim E, Berberoglu U. Prognostic impact of positive lymph node ratio in gastric carcinoma. J Surg Oncol, 2007, 96(2): 95-101.
16.	Zhang BY, Yuan J, Cui ZS, et al. Evaluation of the prognostic value of the metastatic lymph node ratio for gastric cancer. Am J Surg, 2014, 207(4): 555-565.
17.	Lee S R, Son B H, Shin J H, et al. Prognostic significance of the metastatic lymph node ratio in patients with gastric cancer. World J Surg, 2012, 36(5): 1096-1101.
18.	Bando E, Yonemura Y, Taniguchi K, et al. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol, 2002, 9(8): 775-784.
19.	Deng J, Liang H, Wang D, et al. Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes. Ann Surg Oncol, 2010, 17(4): 1043-1051.
20.	Kutlu OC, Watchell M, Dissanaike S. Metastatic lymph node ratio successfully predicts prognosis in Western gastric cancer patients. Surg Oncol, 2015, 24(2): 84-88.
21.	Roviello F, Rossi S, Marrelli D, et al. Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol, 2006, 94(4): 275-280.
22.	Mullaney PJ, Wadley MS, Hyde C, et al. Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer. Br J Surg, 2002, 89(11): 1405-1408.
23.	Dikken JL, van de Velde CJ, Gönen M, et al. The New American Joint Committee on Cancer/International Union Against Cancer staging system for adenocarcinoma of the stomach: increased complexity without clear improvement in predictive accuracy. Ann Surg Oncol, 2012, 19(8): 2443-2451.
24.	Wong J, Rahman S, Saeed N, et al. Prognostic impact of lymph node retrieval and ratio in gastric cancer: a U. J Gastrointest Surg, 2013, 17(12): 2059-2066.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
3. Van Cutsem E, Sagaert X, Topal B, et al. Gastric cancer. Lancet, 2016, 388(10060): 2654-2664.
4. Cammerer G, Formentini A, Karletshofer M, et al. Evaluation of important prognostic clinical and pathological factors in gastric cancer. Anticancer Res, 2012, 32(5): 1839-1842.
5. 王利锋, 马艳飞, 高强. 肝十二指肠韧带淋巴结转移对胃癌患者预后影响的研究. 中国普外基础与临床杂志, 2018, 25(11): 1337-1342.
6. Siewert JR, Böttcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg, 1998, 228(4): 449-461.
7. D’Ugo D, Pacelli F, Persiani R, et al. Impact of the latest TNM classification for gastric cancer: retrospective analysis on 94 D2 gastrectomies. World J Surg, 2002, 26(6): 672-677.
8. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
9. Inoue K, Nakane Y, Iiyama H, et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol, 2002, 9(1): 27-34.
10. Wu XJ, Miao RL, Li ZY, et al. Prognostic value of metastatic lymph node ratio as an additional tool to the TNM stage system in gastric cancer. Eur J Surg Oncol, 2015, 41(7): 927-933.
11. Deng J, Zhang R, Wu L, et al. Superiority of the ratio between negative and positive lymph nodes for predicting the prognosis for patients with gastric cancer. Ann Surg Oncol, 2015, 22(4): 1258-1266.
12. Espín F, Bianchi A, Llorca S, et al. Metastatic lymph node ratio versus number of metastatic lymph nodes as a prognostic factor in gastric cancer. Eur J Surg Oncol, 2012, 38(6): 497-502.
13. Sun Z, Zhu GL, Lu C, et al. The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2 159 patients. Ann Oncol, 2009, 20(5): 897-905.
14. Graziosi L, Marino E, Cavazzoni E, et al. Prognostic value of the seventh AJCC/UICC TNM classification of non-cardia gastric cancer. World J Surg Oncol, 2013, 11: 103.
15. Celen O, Yildirim E, Berberoglu U. Prognostic impact of positive lymph node ratio in gastric carcinoma. J Surg Oncol, 2007, 96(2): 95-101.
16. Zhang BY, Yuan J, Cui ZS, et al. Evaluation of the prognostic value of the metastatic lymph node ratio for gastric cancer. Am J Surg, 2014, 207(4): 555-565.
17. Lee S R, Son B H, Shin J H, et al. Prognostic significance of the metastatic lymph node ratio in patients with gastric cancer. World J Surg, 2012, 36(5): 1096-1101.
18. Bando E, Yonemura Y, Taniguchi K, et al. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol, 2002, 9(8): 775-784.
19. Deng J, Liang H, Wang D, et al. Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes. Ann Surg Oncol, 2010, 17(4): 1043-1051.
20. Kutlu OC, Watchell M, Dissanaike S. Metastatic lymph node ratio successfully predicts prognosis in Western gastric cancer patients. Surg Oncol, 2015, 24(2): 84-88.
21. Roviello F, Rossi S, Marrelli D, et al. Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol, 2006, 94(4): 275-280.
22. Mullaney PJ, Wadley MS, Hyde C, et al. Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer. Br J Surg, 2002, 89(11): 1405-1408.
23. Dikken JL, van de Velde CJ, Gönen M, et al. The New American Joint Committee on Cancer/International Union Against Cancer staging system for adenocarcinoma of the stomach: increased complexity without clear improvement in predictive accuracy. Ann Surg Oncol, 2012, 19(8): 2443-2451.
24. Wong J, Rahman S, Saeed N, et al. Prognostic impact of lymph node retrieval and ratio in gastric cancer: a U. J Gastrointest Surg, 2013, 17(12): 2059-2066.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prognostic value of metastatic lymph node ratio for patients with gastric cancer

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