ObjectiveTo investigate the value of metastatic lymph node ratio (abbreviation: rN) in the prognosis of patients with gastric cancer.MethodsThe 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.ResultsThe 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 (rs=0.275, P=0.058; rs=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.ConclusionrN 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.
ObjectiveTo 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.MethodsThe 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.ResultsA total of 262 patients with gastric cancer were included. There was no correlation between MLNR and total number of lymph nodes (rs=0.037, P=0.547), there was a positive correlation between MLNR and pN stage (rs=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.ConclusionsThe 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.