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Association Between Lymph Node Ratio and Survival in Patients with Pathological Stage II/III Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Lymph node ratio (LNR), defined as the ratio of metastatic nodes to the total number of examined lymph nodes, has been proposed as a sensitive prognostic factor in patients with gastric cancer (GC). We investigate its association with survival in pathological stage (pStage) II/III GC and explore whether this is a prognostic factor in each Union for International Cancer Control pStage (7th edition).

Patients and Methods

We retrospectively examined 838 patients with pStage II/III GC who underwent curative gastrectomy between June 2000 and December 2018. Patients were classified into low-LNR (L-LNR), middle-LNR (M-LNR), and high-LNR (H-LNR) groups according to adjusted X-tile cutoff values of 0.1 and 0.25 for LNR, and their clinicopathological characteristics and survival rates were compared.

Results

The 5-year recurrence-free survival (RFS) and overall survival (OS) rates postsurgery showed significant differences among the groups (P < 0.001). Multivariate analysis demonstrated that LNR was a significant predictor of poor RFS [M-LNR: hazard ratio (HR) 3.128, 95% confidence interval (CI) 2.254–4.342, P < 0.001; H-LNR: HR 5.148, 95% CI 3.546–7.474, P < 0.001] and OS (M-LNR: HR 2.749, 95% CI 2.038–3.708, P < 0.001; H-LNR: HR 4.654, 95% CI 3.288–6.588, P < 0.001). On subset analysis stratified by pStage, significant differences were observed between the groups in terms of the RFS curves of pStage II and III GC (P < 0.001 and < 0.001, respectively) and OS curves of pStage II and III GC (P = 0.001 and < 0.001, respectively).

Conclusions

High LNR is a predictor of worse prognosis in pStage II/III GC, including each substage.

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Acknowledgements

The authors express their sincere gratitude to Ms. Natsumi Sato and Ms. Rika Takahashi for their excellent data management in this study.

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Author notes

  1. Kazuki Kano and Takanobu Yamada equally contributed to this article.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan

    Kazuki Kano MD, PhD, Takanobu Yamada MD, PhD, Keisuke Komori MD, Hayato Watanabe MD, Yota Shimoda MD, Hirohito Fujikawa MD, PhD, Naoto Yamamoto MD, PhD, Manabu Shiozawa MD, PhD, Soichiro Morinaga MD, PhD, Takashi Ogata MD, PhD & Takashi Oshima MD, PhD

  2. Department of Surgery, Yokohama City University, Yokohama, Japan

    Kazuki Kano MD, PhD, Takanobu Yamada MD, PhD, Keisuke Komori MD, Hayato Watanabe MD, Kentaro Hara MD, Yukio Maezawa MD, PhD, Hirohito Fujikawa MD, PhD, Toru Aoyama MD, PhD, Hiroshi Tamagawa MD, PhD, Norio Yukawa MD, PhD, Yasushi Rino MD, PhD & Munetaka Masuda MD, PhD

  3. Department of Biostatistics, Yokohama City University, Yokohama, Japan

    Kouji Yamamoto PhD

  4. Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan

    Haruhiko Cho MD, PhD

  5. Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan

    Takaki Yoshikawa MD, PhD

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  1. Kazuki Kano MD, PhD
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  2. Takanobu Yamada MD, PhD
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  13. Haruhiko Cho MD, PhD
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Corresponding author

Correspondence to Takashi Oshima MD, PhD.

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Kano, K., Yamada, T., Yamamoto, K. et al. Association Between Lymph Node Ratio and Survival in Patients with Pathological Stage II/III Gastric Cancer. Ann Surg Oncol 27, 4235–4247 (2020). https://doi.org/10.1245/s10434-020-08616-1

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  • DOI: https://doi.org/10.1245/s10434-020-08616-1

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