Comparison of different lymph node staging systems in prognosis of gastric cancer: a bi-institutional study from Hungary

Abstract

ObjectiveThe Union for International Cancer Control (UICC) Node (N) classification is the most common used staging method for the prognosis of gastric cancer. It demands adequate, at least 16 lymph nodes (LNs) to be dissected; therefore different staging systems were invented.MethodsBetween March 2005 and March 2010, 164 patients were evaluated at the Department of General Surgery in the Kenézy Gyula Hospital and at the Department of General, Thoracic and Vascular Surgery in the Kaposi Mór Hospital. The 6th, 7th and 8th UICC N-staging systems, the number of examined LNs, the number of harvested negative LNs, the metastatic lymph node ratio (MLR) and the log odds of positive LNs (LODDS) were determined to measure their 5-year survival rates and to compare them to each other.ResultsThe overall 5-year survival rate for all patients was 55.5% with a median overall survival time of 102 months. The tumor stage, gender, UICC N-stages, MLR and the LODDS were significant prognostic factors for the 5-year survival with univariate analysis. The 6th UICC N-stage did not follow the adequate risk in comparing N2 vs. N0 and N3 vs. N0 with multivariate investigation. Comparison of performances of the residual N classifications proved that the LODDS system was first in the prediction of prognosis during the evaluation of all patients and in cases with less than 16 harvested LNs. The MLR gave the best prognostic prediction when adequate (more than or equal to 16) lymphadenectomy was performed. ConclusionsWe suggest the application of LODDS system routinely in western patients and the usage of MLR classification in cases with extended lymphadenectomy.

Impact of Retrieved Lymph Nodes Count on Short-term Complications in Patients With Gastric Cancer: A Retrospective Study

“…Nodal involvement signi cantly affected the prognosis of GC patients because it is the major root of tumor relapse after surgery [13,14]. Thus, standardized lymph nodes dissection is the basic requirement for curative (R0) gastrectomy.…”

Impact of retrieved lymph nodes count on short-term complications in patients with gastric cancer: a retrospective study

“…Nodal involvement significantly affected the prognosis of GC patients because it is the major root of tumor relapse after surgery [14,15]. Thus, standardized lymph nodes dissection is the basic requirement for curative (R0) gastrectomy.…”

Comparison of the 8th union for international cancer control lymph node staging system for gastric cancer with two other lymph node staging systems

“…A noteworthy difference in the 8th edition system involves separate consideration of N3a and N3b in the TNM staging system, which has been demonstrated to achieve improved prognosis prediction in patients with stage III gastric cancer (5,6). A number of previous studies have indicated that the MLR is an improved method for evaluating the prognosis of patients with gastric cancer compared with the previous TNM staging system (18,19). In addition, the LODDS staging system has been demonstrated to be superior in terms of accuracy compared with the MLR and TNM systems with regard to Table III.…”

“…Furthermore, this study concluded that LODDS was the superior staging system. Tóth et al (19) revealed that the LODDS staging system was the best predictor of prognosis when <16 LNs were retrieved and the MLR should be applied in patients who underwent extended lymphadenectomies. Aurello et al (23) analyzed 177 patients and identified that the LODDS staging system, nodal ratio and pN are all prognostic factors based on multivariate analysis, and the LODDS staging system was capable of predicting survival According to mixed analysis of the five groups, the 5-year survival rate was 84.6% for T1, 72.3% for T2, 44.7% for T3, 37.9% for T4a and 27.3% for T4b.…”

“…Cut-off values can also be adopted based on commonly used values in previous studies. Tóth et al (19) categorized MLR with four subgroups according to previously published cut-off values. In addition, the median MLR may be used as the cut-off value (1,2).…”