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Positive Lymph Node Ratio Is an Independent Prognostic Factor in Gastric Cancer After D2 Resection Regardless of the Examined Number of Lymph Nodes

  • Gastrointestinal Oncology
  • Published:
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Abstract

The purpose of this study was to clarify the outcome of the ratio between metastatic and examined lymph nodes (N ratio) in gastric cancer patients with ≤15 examined lymph nodes after D2 lymphadenectomy. A retrospective study was performed in 906 patients with gastric cancer who had undergone D2 resection. Patients with ≤15 examined lymph nodes (group 1, n = 729) and those with >15 lymph nodes (group 2, n = 177) were analyzed separately. N ratio categories were identified as follows: N ratio 0, 0%; N ratio 1, 1% to 9%; N ratio 2, 10% to 25%; N ratio 3, >25%. Univariate analysis found that both the tumor, node, metastasis system (N staging system) and N ratio system well classified patients with significantly different prognosis. By multivariate analysis, only the N ratio classification was retained as an independent prognostic factor in both group 1 and 2 compared with the N stage system. Furthermore, when patients were divided into four groups according to the number of lymph nodes examined (1 to 3, 4 to 7, 8 to 11, and 12 to 15), the 5-year survival rates remained similar between groups according to the same N ratio (p > .05). Positive N ratio classification is a better prognostic tool compared with N staging system after D2 resection in patients with gastric cancer. It can prevent stage migration and can be used regardless of the examined number of lymph nodes.

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Acknowledgment

Supported by National High Technology Research and Development (863) Program of China.

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Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou, 510060, China

    Da-zhi Xu MD, Qi-rong Geng, Zi-jie Long PhD, You-qing Zhan MD, Wei Li, Zhi-wei Zhou MD, Ying-bo Chen, Xiao-wei Sun, Gong Chen MD & Quentin Liu MD, PhD

  2. Department of Abdominal Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, 510060, China

    Da-zhi Xu MD, You-qing Zhan MD, Wei Li, Ying-bo Chen, Xiao-wei Sun & Gong Chen MD

  3. Department of Medical Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, 510060, China

    Qi-rong Geng

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  1. Da-zhi Xu MD
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Correspondence to Da-zhi Xu MD or You-qing Zhan MD.

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Da-zhi Xu and Qi-rong Geng contributed equally to this work.

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Xu, Dz., Geng, Qr., Long, Zj. et al. Positive Lymph Node Ratio Is an Independent Prognostic Factor in Gastric Cancer After D2 Resection Regardless of the Examined Number of Lymph Nodes. Ann Surg Oncol 16, 319–326 (2009). https://doi.org/10.1245/s10434-008-0240-4

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  • DOI: https://doi.org/10.1245/s10434-008-0240-4

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