Prognostic value of metastatic lymph node ratio in gastric cancer underwent radical gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yinghua ¹ , YANG Rui ² , YANG Qingqiang ² ,  HAN Yunwei ¹

1. Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Gastrointestinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

HAN Yunwei, Email: 530018842@qq.com

Keywords：

gastric cancer; radical gastrectomy; metastatic lymph node ratio

DOI：

10.7507/1007-9424.202007078

Video：

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Objective To explore the predictive value of metastatic lymph node ratio (MLNR) on prognosis of patients with gastric cancer after radical gastrectomy, and to evaluate whether MLNR can be used as a reference tool to guide the formulation of postoperative adjuvant treatment strategies and prognosis prediction of gastric cancer.Methods The clinicopathologic features of patients who underwent D2 radical gastrectomy from January 2014 to December 2017 were retrospectively analyzed. The factors influencing the disease specific survival of gastric cancer were analyzed by Cox proportional hazards model, then the variables with statistical significance in multivariate analysis were included in the construction of nomograms model for prognosis of patients with gastric cancer.Results A total of 262 patients with gastric cancer were included. There was no correlation between MLNR and total number of lymph nodes (r_s=0.037, P=0.547), there was a positive correlation between MLNR and pN stage (r_s=0.909, P<0.001). Multivariate Cox regression analysis showed that pT stage, pN stage, MLNR, and postoperative chemotherapy were the independent predictors of prognosis of gastric cancer after radical gastrectomy. Four variables including pT stage, pN stage, postoperative chemotherapy, and MLNR were included in the construction of nomogram model, the C index of MLNR and pN stage model was 0.707 and 0.692 respectively. Survival analysis showed that the higher the MLNR, the worse the prognosis.Conclusions The ability of MLNR to predict prognosis of gastric cancer might be better than pN stage. Therefore, it is considered that MLNR could be used as an important evaluation tool to guide adjuvant treatment and prognosis prediction after radical gastrectomy.

Citation： LI Yinghua, YANG Rui, YANG Qingqiang, HAN Yunwei. Prognostic value of metastatic lymph node ratio in gastric cancer underwent radical gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 595-600. doi: 10.7507/1007-9424.202007078 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.	顾秀瑛, 赫捷. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3.	Baiocchi GL, Kodera Y, Marrelli D, et al. Follow-up after gastrectomy for cancer: results of an international web round table. World J Gastroenterol, 2014, 20(34): 11966-11971.
4.	Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg, 2011, 253(5): 900-911.
5.	Hundahl SA. Staging, stage migration, and patterns of spread in gastric cancer. Semin Radiat Oncol, 2002, 12(2): 141-149.
6.	Riihimäki M, Hemminki A, Sundquist K, et al. Metastatic spread in patients with gastric cancer. Oncotarget, 2016, 7(32): 52307-52316.
7.	Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet, 2012, 379(9813): 315-321.
8.	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.
9.	Wagner AD, Grothe W, Haerting J, et al. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol, 2006, 24(18): 2903-2909.
10.	Huang CM, Lin JX, Zheng CH, et al. Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy. World J Gastroenterol, 2010, 16(16): 2055-2060.
11.	Chen Y, Zhang G, Zhao B, et al. A better prognostic stratification for the 8th edition of the AJCC staging system of gastric cancer by incorporating pT4aN0M0 into stage ⅢA. Surg Oncol, 2019, 29: 90-96.
12.	Saedi HS, Fanipakdel A, Shafaghi A, et al. Evaluating the relation between patients-related factors and dissected lymph node ratio in gastric cancer. Indian J Cancer, 2015, 52(1): 48-51.
13.	Melis M, Masi A, Pinna A, et al. Does lymph node ratio affect prognosis in gastroesophageal cancer? Am J Surg, 2015, 210(3): 443-450.
14.	张军, 胡伟. 淋巴结阳性率对非小细胞肺癌的预后判断. 郑州大学, 2017.
15.	Spolverato G, Ejaz A, Kim Y, et al. Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis. J Am Coll Surg, 2014, 219(4): 664-675.
16.	王欢, 于壮. 淋巴结转移比率与Lauren分型对胃癌根治术后预后预测价值的研究. 青岛大学, 2017.
17.	Lee JH, Kang JW, Nam BH, et al. Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study. Eur J Surg Oncol, 2017, 43(2): 432-439.
18.	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.
19.	Jiao XG, Deng JY, Zhang RP, et al. Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol, 2014, 20(13): 3640-3648.
20.	Hou Y, Wang X, Chen J. Prognostic significance of metastatic lymph node ratio: the lymph node ratio could be a prognostic indicator for patients with gastric cancer. World J Surg Oncol, 2018, 16(1): 198.
21.	黎焕君, 刘琦, 陈志良, 等. 淋巴结转移率对胃癌D2根治术患者的预后分析. 肿瘤学杂志, 2016, 22(4): 300-304.
22.	Zhao LY, Li CC, Jia LY, et al. Superiority of lymph node ratio-based staging system for prognostic prediction in 2 575 patients with gastric cancer: validation analysis in a large single center. Oncotarget, 2016, 7(32): 51069-51081.
23.	周荣健, 张恒, 束平, 等. Ⅲ期胃癌根治术后预后因素分析及淋巴结转移率对预后的预测价值(附995例报告). 中华消化外科杂志, 2019, 18(3): 250-258.
24.	Kong SH, Lee HJ, Ahn HS, et al. Stage migration effect on survival in gastric cancer surgery with extended lymphadenectomy: the reappraisal of positive lymph node ratio as a proper N-staging. Ann Surg, 2012, 255(1): 50-58.
25.	马志坚, 王科深, 任彦先, 等. 淋巴结转移率对胃癌患者的预后价值. 中国普外基础与临床杂志, 2020, 27(11): 1352-1356.
26.	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.
27.	Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1 853 patients. Ann Surg, 2007, 245(4): 543-552.
28.	Zhang H, Wang W, Diao D, et al. Ratio of metastatic to examined lymph nodes, a helpful staging system and independent prognostic factor of esophagogastric junction cancer. PLoS One, 2013, 8(8): e73238.
29.	陈烽, 林建清, 黄志军, 等. 淋巴结转移率在评估T4a期胃癌患者预后的探讨. 中国卫生标准管理, 2018, 9(21): 32-35.
30.	Liu F, Zhou R, Jiang F, et al. Proposal of a nomogram for predicting survival in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction after preoperative radiation. Ann Surg Oncol, 2019, 26(5): 1292-1300.
31.	权峰涛, 杨维桢. 淋巴结转移率在评估胃癌患者预后中的价值. 中国临床研究, 2017, 30(6): 804-806.
32.	詹友庆, 李威, 孙晓卫, 等. 胃癌外科治疗的远期疗效研究. 中华外科杂志, 2005, 43(17): 1109-1113.
33.	李小宝, 訾永宏, 曹波, 等. 淋巴结转移率对检出不同淋巴结数量的胃癌患者预后的评价价值. 中华普通外科杂志, 2017, 32(7): 577-580.

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. 顾秀瑛, 赫捷. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. Baiocchi GL, Kodera Y, Marrelli D, et al. Follow-up after gastrectomy for cancer: results of an international web round table. World J Gastroenterol, 2014, 20(34): 11966-11971.
4. Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg, 2011, 253(5): 900-911.
5. Hundahl SA. Staging, stage migration, and patterns of spread in gastric cancer. Semin Radiat Oncol, 2002, 12(2): 141-149.
6. Riihimäki M, Hemminki A, Sundquist K, et al. Metastatic spread in patients with gastric cancer. Oncotarget, 2016, 7(32): 52307-52316.
7. Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet, 2012, 379(9813): 315-321.
8. 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.
9. Wagner AD, Grothe W, Haerting J, et al. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol, 2006, 24(18): 2903-2909.
10. Huang CM, Lin JX, Zheng CH, et al. Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy. World J Gastroenterol, 2010, 16(16): 2055-2060.
11. Chen Y, Zhang G, Zhao B, et al. A better prognostic stratification for the 8th edition of the AJCC staging system of gastric cancer by incorporating pT4aN0M0 into stage ⅢA. Surg Oncol, 2019, 29: 90-96.
12. Saedi HS, Fanipakdel A, Shafaghi A, et al. Evaluating the relation between patients-related factors and dissected lymph node ratio in gastric cancer. Indian J Cancer, 2015, 52(1): 48-51.
13. Melis M, Masi A, Pinna A, et al. Does lymph node ratio affect prognosis in gastroesophageal cancer? Am J Surg, 2015, 210(3): 443-450.
14. 张军, 胡伟. 淋巴结阳性率对非小细胞肺癌的预后判断. 郑州大学, 2017.
15. Spolverato G, Ejaz A, Kim Y, et al. Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis. J Am Coll Surg, 2014, 219(4): 664-675.
16. 王欢, 于壮. 淋巴结转移比率与Lauren分型对胃癌根治术后预后预测价值的研究. 青岛大学, 2017.
17. Lee JH, Kang JW, Nam BH, et al. Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study. Eur J Surg Oncol, 2017, 43(2): 432-439.
18. 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.
19. Jiao XG, Deng JY, Zhang RP, et al. Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol, 2014, 20(13): 3640-3648.
20. Hou Y, Wang X, Chen J. Prognostic significance of metastatic lymph node ratio: the lymph node ratio could be a prognostic indicator for patients with gastric cancer. World J Surg Oncol, 2018, 16(1): 198.
21. 黎焕君, 刘琦, 陈志良, 等. 淋巴结转移率对胃癌D2根治术患者的预后分析. 肿瘤学杂志, 2016, 22(4): 300-304.
22. Zhao LY, Li CC, Jia LY, et al. Superiority of lymph node ratio-based staging system for prognostic prediction in 2 575 patients with gastric cancer: validation analysis in a large single center. Oncotarget, 2016, 7(32): 51069-51081.
23. 周荣健, 张恒, 束平, 等. Ⅲ期胃癌根治术后预后因素分析及淋巴结转移率对预后的预测价值(附995例报告). 中华消化外科杂志, 2019, 18(3): 250-258.
24. Kong SH, Lee HJ, Ahn HS, et al. Stage migration effect on survival in gastric cancer surgery with extended lymphadenectomy: the reappraisal of positive lymph node ratio as a proper N-staging. Ann Surg, 2012, 255(1): 50-58.
25. 马志坚, 王科深, 任彦先, 等. 淋巴结转移率对胃癌患者的预后价值. 中国普外基础与临床杂志, 2020, 27(11): 1352-1356.
26. 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.
27. Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1 853 patients. Ann Surg, 2007, 245(4): 543-552.
28. Zhang H, Wang W, Diao D, et al. Ratio of metastatic to examined lymph nodes, a helpful staging system and independent prognostic factor of esophagogastric junction cancer. PLoS One, 2013, 8(8): e73238.
29. 陈烽, 林建清, 黄志军, 等. 淋巴结转移率在评估T4a期胃癌患者预后的探讨. 中国卫生标准管理, 2018, 9(21): 32-35.
30. Liu F, Zhou R, Jiang F, et al. Proposal of a nomogram for predicting survival in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction after preoperative radiation. Ann Surg Oncol, 2019, 26(5): 1292-1300.
31. 权峰涛, 杨维桢. 淋巴结转移率在评估胃癌患者预后中的价值. 中国临床研究, 2017, 30(6): 804-806.
32. 詹友庆, 李威, 孙晓卫, 等. 胃癌外科治疗的远期疗效研究. 中华外科杂志, 2005, 43(17): 1109-1113.
33. 李小宝, 訾永宏, 曹波, 等. 淋巴结转移率对检出不同淋巴结数量的胃癌患者预后的评价价值. 中华普通外科杂志, 2017, 32(7): 577-580.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prognostic value of metastatic lymph node ratio in gastric cancer underwent radical gastrectomy

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