Does lymph node ratio affect prognosis in gastroesophageal cancer?

Melis, Marcovalerio; Masi, Antonio; Pinna, Antonio; Cohen, Steven M.; Hatzaras, Ioannis; Berman, Russell S.; Newman, Elliot

doi:10.1016/j.amjsurg.2014.12.042

Cited by 16 publications

(12 citation statements)

References 24 publications

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“…Recently, van der Schaaf and colleagues questioned whether a more extensive lymph node clearance improves survival and only leads to stage migration. On the other hand, the ratio of metastatic lymph nodes to the total number of examined lymph nodes may be a valuable prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

Changes in treatment and outcome of oesophageal cancer in Denmark between 2004 and 2013

Kjær

Larsson

Svendsen

et al. 2017

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Changes in treatment and outcome of oesophageal cancer in Denmark between 2004 and 2013

Kjær

Larsson

Svendsen

et al. 2017

British Journal of Surgery

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“…Furthermore, not all patients seem to benefit equally from an extensive LAD, it seems to depend on nodal involvement and/or depth of tumor invasion. Moreover, several prognostic factors have been identified-e.g., total number of LNs removed irrespective of tumor involvement, number of negative LNs, number of positive LNs, and LNR (6)(7)(8)(9)(10)(11)(13)(14)(15)(16)(17)(18)(19)(20). The suggested range is large and all data are based on retrospective, often multicenter analyses, since no prospective randomized trials are available.…”

Section: Prognostic Role In Primarily Resected Gastric Cancermentioning

confidence: 99%

“…In many reports the LNR is judged to improve the TNM staging classification and reduce the stage migration of UICC N-categories (10,18,19). Further the LNR is associated with adverse pathological features like advanced T-stage, lymphangiosis, vascular or perineural invasion and is a negative prognostic factor (14,17). The grouping of LNR with prognostic impact varies from two groups ≤20% 14, ≤40% for the subgroup of pN3 (15), up to four groups 0 vs. 1-9% vs. 10-25% vs. >25% (19,20,29) or 0 vs. 1-30% vs. 31-60% vs. <60% (17).…”

Section: Prognostic Role In Primarily Resected Gastric Cancermentioning

confidence: 99%

“…Further the LNR is associated with adverse pathological features like advanced T-stage, lymphangiosis, vascular or perineural invasion and is a negative prognostic factor (14,17). The grouping of LNR with prognostic impact varies from two groups ≤20% 14, ≤40% for the subgroup of pN3 (15), up to four groups 0 vs. 1-9% vs. 10-25% vs. >25% (19,20,29) or 0 vs. 1-30% vs. 31-60% vs. <60% (17). The best prognostic cutoff remains unclear, however often groups of 0%, 1-20% and 20% are used in clinical routine with a good prediction of prognosis.…”

Section: Prognostic Role In Primarily Resected Gastric Cancermentioning

confidence: 99%

“…A greater extent of LAD is associated with improved survival (6)(7)(8)(9)(10)13). Also, the lymph node ratio (LNR) has been described as independent predictor of survival by several authors (13)(14)(15)(16)(17)(18)(19)(20). But the LNR does not represent a generally established prognostic factor and has not been integrated into the current staging system.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic impact of nodal status and therapeutic implications

Ott¹,

Blank²,

Ruspi³

et al. 2017

Transl. Gastroenterol. Hepatol.

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The prognostic impact of lymph node (LN) metastases in gastric cancer is generally accepted. In primarily resected patients the pN-category and LN ratio are independent prognostic factors. Number of involved LNs, number of resected LNs, lymphangiosis and micrometastases also influence the prognosis significantly. To guarantee a proper D2 lymphadenectomy (LAD) at least 25 LNs according to the German S3 guidelines for the treatment of gastric cancer should be removed. Also in neoadjuvantly treated patients the ypN-category and LN ratio play an important prognostic role, despite the fact that UICC staging system was development based only on primarily resected patients. The role of response of LNs in neoadjuvantly treated patients is still unclear and needs further investigation. It seems to be less important than the response of the primary tumor. Limited data exists, suggesting that preoperative treatment might reduce the number of LNs involved and improve ypN-category. Due to further development in gastric cancer like laparoscopic resection and effective perioperative treatment in locally advanced tumor the role and the prognostic impact of LAD is again in the focus of discussion.

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Accurate Risk Stratification of Patients with Node‐Positive Gastric Cancer by Lymph Node Ratio

et al. 2020

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Background We aimed to clarify the utility of lymph node ratio (LNR) for assessing the prognosis of patients with node‐positive gastric cancer after curative gastrectomy. Methods We retrospectively analyzed data of 973 patients with node‐positive gastric cancer who had undergone curative gastrectomy at nine institutions from 2010 to 2014. Survival analysis was performed by comparing LNR low and high groups according to the optimal cutoff value of LNR, which was determined using receiver operating characteristic curve analysis. Results LNR high was significantly associated with shorter disease‐free survival and was an independent predictor of recurrence in all patients. Moreover, we obtained the similar results from analysis of each N stage. The prevalence of lymph node and peritoneal recurrence appeared to be higher in the LNR high group. Correlation analysis showed that LNR was negatively correlated with the number of retrieved nodes within every N stage; however, disease‐free survival did not differ significantly between LNR low and high groups of each N stage with 16–30, 31–40, or >40 retrieved nodes. Conclusions LNR is a strong prognostic factor and predictor of recurrence in patients with node‐positive gastric cancer who have undergone curative gastrectomy. The combination of LNR and N staging permits more accurate prognostic stratification of patients with gastric cancer and may contribute to developing novel prognostic models.

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Does lymph node ratio affect prognosis in gastroesophageal cancer?

Cited by 16 publications

References 24 publications

Changes in treatment and outcome of oesophageal cancer in Denmark between 2004 and 2013

Changes in treatment and outcome of oesophageal cancer in Denmark between 2004 and 2013

Prognostic impact of nodal status and therapeutic implications

Accurate Risk Stratification of Patients with Node‐Positive Gastric Cancer by Lymph Node Ratio

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