Ratio Between Metastatic and Examined Lymph Nodes (N Ratio) May Have Low Clinical Utility in Gastric Cancer Patients Treated by Limited Lymphadenectomy: Results from a Single‐Center Experience of 526 Patients

Pedrazzani, Corrado; Sīviņš, Armands; Ancāns, Guntis; Marrelli, Daniele; Corso, Giovanni; Krumins, V.; Roviello, Franco; Leja, Mārcis

doi:10.1007/s00268-009-0288-8

Cited by 31 publications

(23 citation statements)

References 36 publications

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“…To evaluate the rN staging system, some previous reports excluded patients with fewer than 16 LNs retrieved [16,20,22]; some researchers preferred the patients treated by limited lymphadenectomy, [9,10,18,23]; and some centers evaluated the rN system as an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy, or in both [15 and B15 LNs examined [17,19,24,25], as we did in our report. All the reports indicated that the rN staging system has superiority in prognosis assessment compared with the traditional AJCC pN system.…”

Section: Discussionmentioning

confidence: 87%

“…The Cox multivariate analysis showed that rN has a prognostic value independent of the extent of lymphadenectomy. Many previous reports used Cox multivariate examinations, including both pN stage and rN stage, for proving the superiority of the LN ratio system [9,[15][16][17][18][19][20]. The pN and rN systems, two definitions of classifications for staging lymph node status, were highly correlated.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is much controversy regarding the most appropriate cutoff ratio because the ratios differ among investigators. The following cutoff values have been proposed: 0, 0.20, 0.50 [10,24], 0, 0.30, 0.60 [15,25], 0, 0.10, 0.25 [9,16,20], 0, 0.30, 0.70 [17], 0, 0.015, 0.40 [23], 0, 0.10, 0.25 [19], 0, 0.25, 0.50 [18], and 0, 0.10, 0.40 [22]. The cutoff values showed great variety in different countries, even in different centers in the same country.…”

Section: Discussionmentioning

confidence: 99%

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The evaluation of metastatic lymph node ratio staging system in gastric cancer

et al. 2012

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Background To evaluate the prognostic value and staging accuracy of the metastatic lymph node ratio (rN) staging system for gastric cancer. Methods A total of 1,075 patients with gastric cancer who underwent curative surgery between 2000 and 2009 at our institute were analyzed. Lymph node status was assigned according to the American Joint Committee on Cancer (AJCC) pN system and rN system. Patients with [15 (group 1, n = 691) and B15 lymph nodes (group 2, n = 384) retrieved were analyzed separately. Results The rN staging system was generated using 0.2 and 0.5 as the cutoff values of lymph node ratio and then compared with AJCC pN stages. A linear regression model revealed that the number of retrieved lymph nodes was related to the number of metastatic lymph nodes, but not with rN. After a median follow-up of 47.66 months, the 5-year survival rates of N0, N1, N2, and N3 patients of group 1 were significantly better than group 2, whereas the differences were not obvious in the rN classification. Conclusions The rN category is a better prognostic tool than the AJCC pN category for gastric cancer patients after curative surgery regardless of the number of lymph node examined.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The evaluation of metastatic lymph node ratio staging system in gastric cancer

et al. 2012

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“…Because of the low number of patients with a low N-ratio we used a higher cut-off point. This can bias our results and give a seemingly higher prognostic value than the TNMclassification; some authors have questioned the clinical usefulness in case of low numbers of nodes [29]. In the new AJCC/UICC TNM classification ( …”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 93%

Lymph node examination among patients with gastric cancer: Variation between departments of pathology and prognostic impact of lymph node ratio

Lemmens

Dassen

Wurff

et al. 2011

European Journal of Surgical Oncology (EJSO)

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. Lymph node examination among patients with gastric cancer: variation between departments of pathology and prognostic impact of lymph node ratio. EJSO -European Journal of Surgical Oncology, WB Saunders, 2011, 37 (6) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT

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“…For more accurate staging and a more reliable assessment of the prognosis, a new classification system was proposed, based on the ratio of the metastatic lymph nodes to the total number of lymph nodes (N ratio). The N ratio classification is advocated to avoid the stage migration phenomenon, and to be more effective in determining the prognosis, and thus it can be used in instead of the N clas sification [1,3,13,14,[16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Can the ratio of metastatic to examined lymph nodes (N ratio) be used as an independent prognostic factor in patients with gastric cancer? Is the hypothetical TRM (tumor-ratio-metastasis) staging system an alternative to the TNM (tumor-node-metastasis) staging system?

İlhan¹,

Zengel²,

Şimşek³

et al. 2013

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K Ke ey y w wo or rd ds s: : gastric cancer, ratio, hypothetical TRM staging.A Ad dd dr re es ss s f fo or r c co or rr re es sp po on nd de en nc ce e: : Dr Enver Ilhan, Department of Surgery, Izmir Bozyaka Education and Research Hospital, Esentepe Mah. 49 sokak no 8 Daire 22, Karabaǧlar, 35350 Izmir, Turkey, phone: +905322539565, fax: +902322614444, e-mail: enverhan60@gmail.com Original paper AbstractA Ai im m: : Lymph node metastasis is the most important prognostic factor in patients with gastric cancer. However, lymph node classification is controversial. We reported the prognostic factors of gastric cancer and the impact of N ratio classification in predicting prognosis and the suitability of TRM classification as an alternative to TNM(tumor-node-metastasis) classification for lymph nodes to avoid stage migration in gastric cancer. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : A total of 90 patients, who underwent R0 resection for gastric cancer, were analyzed. Independent variables of the study were age, gender, tumor site, type of surgery, lymph node dissection, tumor size, T stage, differentiation, total number of removed lymph nodes, number of metastatic lymph nodes, N ratio, N stage, and TNM stage. N ratio was used instead of N stage in the hypothetical TRM staging system. Dependent variables of the study were 2-year and 5-year survival rates. R Re es su ul lt ts s: : The N ratio cutoff points were 0, 0.10, and 0.25. The 2-year and 5-year survival rates were significantly higher in patients who had low T stages (p < 0.001, p < 0.001), N stages (p < 0.001, p < 0.001), N ratio (p < 0.001, p < 0.001), TNM stages (p < 0.001, p < 0.001), and underwent subtotal gastrectomy (p = 0.006, p = 0.030). When the TNM stages of the patients according to the UICC/AJCC TNM sixth and seventh edition staging system were compared to theTRM hypothetical staging system, stage migration phenomenon was observed at 36.6% and 8.8%, respectively. C Co on nc cl lu us si io on ns s: : N ratio classification can be used as an independent prognostic factor. The use of TRM hypothetical staging system for minimizing stage migration phenomenon requires further discussion.

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Ratio Between Metastatic and Examined Lymph Nodes (N Ratio) May Have Low Clinical Utility in Gastric Cancer Patients Treated by Limited Lymphadenectomy: Results from a Single‐Center Experience of 526 Patients

Abstract: When a small number of lymph nodes are analyzed, the N ratio can discriminate patients better than TNM classification. However, because a small number of retrieved nodes produced only a small number of pNR1 patients, the N ratio classification cannot be justified for clinical use.

Cited by 31 publications

References 36 publications

The evaluation of metastatic lymph node ratio staging system in gastric cancer

The evaluation of metastatic lymph node ratio staging system in gastric cancer

Lymph node examination among patients with gastric cancer: Variation between departments of pathology and prognostic impact of lymph node ratio

Can the ratio of metastatic to examined lymph nodes (N ratio) be used as an independent prognostic factor in patients with gastric cancer? Is the hypothetical TRM (tumor-ratio-metastasis) staging system an alternative to the TNM (tumor-node-metastasis) staging system?

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