Young age increases risk for lymph node positivity in gastric cancer: A Chinese multi-institutional database and US SEER database study

Jiang, Yuming; Huang, Weicai; Xie, Jingjing; Han, Zhen; Chen, Chuanli; Shi, Xi; Sun, Zhiwei; Hu, Yanfeng; Zhao, Liying; Yu, Jiang; Li, Tuanjie; Zhou, Zhiwei; Cai, Shirong; Li, Guoxin

doi:10.7150/jca.37531

Cited by 12 publications

(6 citation statements)

References 33 publications

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“…Recent articles proved an increase of incidence in young onset gastric cancer cases and prognosis is worse than the late onset patients [26]. However, in this study LNR high groups are more common in young patients.…”

Section: Discussioncontrasting

confidence: 46%

Reliability of the Lymph Node Ratio in the Prediction of Gastric Cancer Survival

Kamali¹,

Ulusoy²,

Kamali³

2023

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Background. Lymph node metastasis is the major determinant factor in the prognosis of gastric cancer. There is still no definite consensus on the lymph node number that should be harvested during gastric cancer surgery. Lymph Node Ratio (LNR) is defined as the ratio of metastatic nodes to the total number of pathologically examined lymph nodes. LNR has been proposed to be a sensitive prognostic factor in patients with gastric cancer. In this study the reliability of the LNR is tested for being a prognostic factor in gastric cancer survival. Methods. Medical records of 244 patients, with neither distant metastases nor neoadjuvant treatment underwent curative gastrectomy, were analyzed retrospectively in terms of survival according to the lymph node ratio (LNR). Patients were divided in two groups by using LNR cut-off value. Results. LNR of 0.4 was proved to be the best cut-off value to predict the prognosis of patients with gastric cancer. Univariate and multivariate analysis revealed that age over 65 (p < 0.001), and LNR ≥ 0.4 (p = 0.02) were independent factors in gastric cancer survival. Patients with LNR ≥ 0.4 presented with worse outcomes regarding other prognostic parameters (tumor differentiation, tumor diameter, lymphovascular invasion or perineural invasion), despite similar numbers of lymph nodes being harvested in both groups during surgery. Conclusion. Lymph node ratio is a reliable parameter to predict the survival in gastric cancer.

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Section: Discussioncontrasting

confidence: 46%

Reliability of the Lymph Node Ratio in the Prediction of Gastric Cancer Survival

Kamali¹,

Ulusoy²,

Kamali³

2023

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“…The LNM rate of patients aged 20–39 year was 46.51%, while LNM rate aged >=80 years was 24.96% which was far lower than that of 20–39 years patients. Similarly, some tumors showed the same results, such as colorectal cancer and gastric cancer 25,26 . The increased risk to occur LNM for younger patients suggested it ought to be carefully and pay more attention for younger patients during the process of making decisions.…”

Section: Discussionmentioning

confidence: 82%

Analyzing and predicting the LNM rate and prognosis of patients with intraductal papillary mucinous neoplasm of the pancreas

et al. 2021

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Background Current the surveillance and management are controversial for patients with IPMN. We aimed to develop an alternative nomogram to individualize IPMN prognosis and LNM. Methods Based on the data from SEER database of patients diagnosed with IPMN between 2004 and 2015, a nomogram predicting the survival and LNM of IPMN based on univariate and multivariate and Lasso regression analysis was performed, internally and externally validated, and measured by C‐index, and decision curve analysis (DCA), and compared to the 7th TNM stage. Results A total of 941 patients were included. Age, T stage examined nodes, tumor size, and pathology grade were identified as an independent factor for predicting LNM. The nomogram we established to predict LNM had a high predicting value with a C‐index value of 0.735 and an AUC value of 0.753. Interestingly, including T1 stage, we found an inverse correlation was between age and LNM. In addition, nomogram for predicting CSS also performed better than TNM stage both in the internal validation group (1‐year AUC:0.753 vs. 0.693, 3‐year AUC: 0.801 vs. 0.731, 5‐year AUC: 0.803 vs. 0.733) and external validation group (1‐year AUC: 0.761 vs. 0.701, 3‐year AUC: 0.772 vs. 0.713, 5‐year AUC:0.811 vs. 0.735). DCA analysis showed the nomogram showed a greater benefit across the period of follow‐up compared to 7th TNM stage. Conclusion A nomogram based on multivariate and Lasso regression analysis showed great clinical usability compared with current criteria. Also, for LNM of IPMN, younger age patients with IPMN should be attached more importance.

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“…Recently, several lines of findings have reported an increasing trend in the incidence of GC patients in young age (2,3,13,45). GC in the young has a more aggressive growth pattern and carries a worse clinical outcome compared with older individuals (6,9,(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Prognostic performance of different lymph node classification systems in young gastric cancer

Chen¹,

Wang²,

Li³

et al. 2021

J Gastrointest Oncol

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Background: Accurate staging plays a pivotal role in cancer care. The lymph node (LN) ratio (LNR) and the log odds of positive LNs (LODDS) have been suggested as alternatives to the N staging since the TNM system has the risk of stage migration. The prognostic significance of LNR and LODDS in young patients with gastric cancer (GC) has not been reported. This study aims to investigate the correlations between LNR and LODDS and survival of young patients with GC, and compare the predictive performance of these LN staging methods.Methods: GC patients before the age of 40 from 2004 to 2016 in the Surveillance, Epidemiology and End Results database were enrolled. The prognostic evaluation of the N factor, LNR and LODDS was compared using the time-dependent receiver operating characteristic (ROC) analysis, area under the curve (AUC), C-index and Akaike information criterion (AIC).Results: Multivariate survival analysis identified that the LNR and LODDS were significantly independent prognostic indicators for overall survival (OS) in young patients with GC and in the subgroups comprised of patients with ≤15 LNs examined. The time-dependent ROC curves of the LNR and LODDS were continuously superior to that of the N factor in predicting OS during the observation period. And the AUCs revealed that the predictive accuracy of the LNR and LODDS was remarkably superior to the N factor at 1 and 3 years (P<0.05). The model incorporating LNR or LODDS had higher C-index and lower AIC when comparing to the model incorporating the N factor. Conclusions:The LNR and LODDS improve accuracy of survival risk prediction in young patients with GC when comparing to the N factor. These two novel LN classification methods should be considered as alternatives to the N staging for the prognostic prediction of young patients with GC.

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Young age increases risk for lymph node positivity in gastric cancer: A Chinese multi-institutional database and US SEER database study

Cited by 12 publications

References 33 publications

Reliability of the Lymph Node Ratio in the Prediction of Gastric Cancer Survival

Reliability of the Lymph Node Ratio in the Prediction of Gastric Cancer Survival

Analyzing and predicting the LNM rate and prognosis of patients with intraductal papillary mucinous neoplasm of the pancreas

Prognostic performance of different lymph node classification systems in young gastric cancer

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