Lymph-Node Ratio Classification Strongly Correlates with Cancer Survivals of Patients Who Underwent R0 Resection for Gastric Cancer with More than 15 Nodes Harvested

Abstract

Background: During the last few years, the gastric cancer nodal staging has been extensively revised. Lately, a new system emerged in this field with the purpose of implementing the prognostic stratification: the lymph-node ratio (LNR). The aim of this study was to investigate the prognostic value of the LNR in relation to cancer survivors undergoing resection for gastric adenocarcinoma. Methods: Off 227 patients undergoing surgical resection for gastric cancer at our Department, 129 curative gastric resections with more than 15 nodes harvested were selected. The LNR was calculated and patients were stratified into 6 subgroups based on the ratio values. The subgroups were compared for data analysis. Survivals were calculated by the Kaplan-Meier method, and the mean follow-up period was 40 months. ROC curves were calculated in order to analyze the performance of the LNR system. Results: LNR stratification correlated with the stage of the disease, with the rate of patients undergoing chemotherapy and patients presenting with a relapse of disease at follow-up. Moreover, an increased ratio correlated with a worse overall, a disease-free and a disease-specific survival of the patients. The ROC curves documented a significant performance of the stratification system with the endpoints of disease-free and disease-specific survivals. Conclusion: LNR stratification correlated with cancer-related survivals in our case series. It is a reliable system that might improve current nodal staging and thereby the identification of patients with a higher risk of recurrence or cancer-related mortality.

Down‐regulated miRs specifically correlate with non‐cardial gastric cancers and Lauren's classification system

“…Of note, however, standard pathological factors including advanced Stages, LNR categories and a LNH <15 were confirmed as the significant independent variables associated with a worse prognosis, also in line with our previous works and those reported by others …”

“…From each patient, we retrieved and analyzed: the clinical and demographic data (age at the time of surgery, sex), tumor localization, and surgical procedure as well as the pathological records (T stage, N Stage, Stage, number of positive nodes, lymph nodes harvested—LNH, lymph node ratio—LNR, Grading, lymph‐vascular invasion—LV, Lauren's classification type, presence/absence of adjacent chronic atrophic gastritis, Helicobacter pylori , and intestinal metaplasia). LNR groups were classified according to the criteria proposed by Lee and co‐authors (LNR0; LNR1 0.01‐0.05; LNR2 0.06‐0.1; LNR3 0.11‐0.2; LNR4 0.21‐0.3; LNR5 >0.30) . Non‐tumor gastric tissues were randomly selected from 16 of these patients and used as controls sampling tissues located at least 5 cm from the tumor.…”

“…LNR groups were classified according to the criteria proposed by Lee and co-authors (LNR0; LNR1 0.01-0.05; LNR2 0.06-0.1; LNR3 0.11-0.2; LNR4 0.21-0.3; LNR5 >0.30). 14,15 Non-tumor gastric tissues were randomly selected from 16 of these patients and used as controls 16 sampling tissues located at least 5 cm from the tumor.…”

Clinicopathologic implication of meticulous pathologic examination of regional lymph nodes in gastric cancer patients

“…Different cut-off values—more than ten sets to our knowledge—were applied in previous studies on MLR (Table 4) [13,17,23–31]. When higher cut-off values were applied (e.g.…”

Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy

“…First, there is no difference among the patients with negative lymph nodes between the pN and LNR systems, indicating that LNR does not have the ability to distinguish the difference in survival in pN0 patients. Moreover, the cut-off value of LNR reported in several studies is varied [14, 16, 17]. In addition, the patients in the same LNR stage may have different survival outcomes, with a different number of tested lymph nodes [18].…”