Metastatic lymph node ratio successfully predicts prognosis in western gastric cancer patients

Kutlu, Onur; Watchell, Mitchell; Dissanaike, Sharmila

doi:10.1016/j.suronc.2015.03.001

Cited by 52 publications

(36 citation statements)

References 33 publications

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“…In last decades, many researchers suggested that LNR could be a prognostic factor in different types of malignancies especially most of the gastrointestinal cancers [43–46]. This meta-analysis confirmed that higher LNR is statistically significantly associated with a poor survival of colorectal cancer.…”

Section: Discussionsupporting

confidence: 61%

Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis

et al. 2016

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The lymph node ratio (LNR) (i.e. the number of metastatic lymph nodes divided by the number of totally resected lymph nodes) has recently emerged as an important prognostic factor in colorectal cancer (CRC). However, the tumor node metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a meta-analysis to evaluate the prognostic role of the LNR in node positive CRC. A systematic search was performed in PubMed, Embase and the Cochrane Library for relevant studies up to November 2015. As a result, a total of 75,838 node positive patients in 33 studies were included in this meta-analysis. Higher LNR was significantly associated with shorter overall survival (OS) (HR = 1.91; 95% CI 1.71–2.14; P = 0.0000) and disease free survival (DFS) (HR = 2.75; 95% CI: 2.14–3.53; P = 0.0000). Subgroup analysis showed similar results. Based on these results, LNR was an independent predictor of survival in colorectal cancer patients and should be considered as a parameter in future oncologic staging systems.

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Section: Discussionsupporting

confidence: 61%

Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis

et al. 2016

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“…Comparison analysis on survival prediction illustrated that Nr staging system had a better discriminatory prognostic ability and a more predictive accuracy than that of N staging system. Although our findings were consistent with the majority of studies [6–9], Espin et al concluded that, Nr stage showed no improvement in predictive accuracy than N stage, despite that Nr and N stage were both demonstrated to be independent prognostic factors [14], which was due to the consideration that the proportion of patients with retrieved lymph nodes ≥ 15 in our study was not so much as that in Espin's study. Besides, nomogram, was also applied in our study to demonstrate the prognostic significance of independent factors on gastric cancer patients.…”

Section: Discussionsupporting

confidence: 89%

Superiority of lymph node ratio-based staging system for prognostic prediction in 2575 patients with gastric cancer: validation analysis in a large single center

Zhao

Jia

et al. 2016

Oncotarget

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This study aimed to evaluate the prognostic significance of node ratio (Nr), the ratio of metastatic to retrieved lymph nodes, and to investigate whether a modified staging system based on Nr can improve prognostic ability for gastric cancer patients following gastrectomy. A total of 2572 patients were randomly divided into training set and validation set, and the cutoff points for Nr were produced using X-tile. The relationships between Nr and other clinicopathologic factors were analyzed, while survival prognostic discriminatory ability and accuracy were compared among different staging systems by AIC and C-index in R program. Patients were categorized into four groups as follows: Nr0, Nr1: 0.00–0.15, Nr2: 0.15–0.40 and Nr3: > 0.40. Nr was significantly associated with clinicopathologic factors including macroscopic type, tumor differentiation, lymphovascular invasion, perineural invasion, tumor size, T stage, N stage and TNM stage. Besides, for all patients, Nr and TNrM staging system showed a smaller AIC and a larger C-index than that of N and TNM staging system, respectively. Moreover, in subgroup analysis for patients with retrieved lymph nodes < 15, Nr was demonstrated to have a smaller AIC and a larger C-index than N staging system. Furthermore, in validation analysis, Nr, categorized by our cutoff points, showed a larger C-index and a smaller AIC value than those produced in previous studies. Nr could be considered as a reliable prognostic factor, even in patients with insufficient (< 15) retrieved lymph nodes, and TNrM staging system may improve the prognostic discriminatory ability and accuracy for gastric cancer patients undergoing radical gastrectomy.

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“…The MLR is defined as the ratio of the number of metastatic LNs to the total number of examined LNs. It is known for its flexibility in various clinical situation: D1 or D2 dissection, and LNs less than 15 or more than 16 [16]. Although there are still ongoing debates regarding the cut-off values of MLRs, recent studies state that MLR has less influence on stage migration [14] and is more accurate in the prediction of prognosis [17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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BackgroundWe aimed to investigate effect of increased number of examined lymph nodes (LNs) to pN category, and compare various N categories in gastric cancer: American Joint Committee on Cancer (AJCC) 7th edition, metastatic LN ratio (MLR), and log odds of positive LNs (LODDS).MethodsFour cohorts with a total of 2,309 gastric cancer patients were enrolled. For cohort 1 and 2, prognostic significance of each method by disease-specific survival was analyzed using Akaike and Bayesian information criterion (AIC and BIC).ResultsThe total LNs in four cohorts significantly differed [median (range), 28 (6–97) in cohort 1, 37 (8–120) in cohort 2, 48 (7–122) in cohort 3, and 54 (4–221) in cohort 4; p<0.001]. The numbers of negative LNs increased with increase of total LN (p<0.001), but the numbers of metastatic LNs did not increase from cohort 1 to 4. MLR and LODDS in four cohorts had decreasing tendency with increase of total LNs in each pT3 and pT4 category (p<0.001), while the numbers of metastatic LNs did not differ significantly in any pT category (p>0.05). The AIC and BIC varied according to different cut-off values for MLR; model by cut-offs of 0.2 and 0.5 being better for cohort 1, while cut-offs 0.1 and 0.25 was better for cohort 2.ConclusionOur study showed that the number of metastatic LNs did not increase with maximal pathologic examination of regional LNs. AJCC 7th system is suggested as the simplest method with single cut-off value, but prognostic significance of MLR may be influenced by various cut-offs.

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Metastatic lymph node ratio successfully predicts prognosis in western gastric cancer patients

Cited by 52 publications

References 33 publications

Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis

Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis

Superiority of lymph node ratio-based staging system for prognostic prediction in 2575 patients with gastric cancer: validation analysis in a large single center

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

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