Gastrointestinal Oncology

Annals of Surgical Oncology

, Volume 16, Issue 2, pp 319-326

First online:

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

  • Da-zhi XuAffiliated withState Key Laboratory of Oncology in South ChinaDepartment of Abdominal Surgery, Cancer Center, Sun Yat-sen University Email author 
  • , Qi-rong GengAffiliated withState Key Laboratory of Oncology in South ChinaDepartment of Medical Oncology, Cancer Center, Sun Yat-sen University
  • , Zi-jie LongAffiliated withState Key Laboratory of Oncology in South China
  • , You-qing ZhanAffiliated withState Key Laboratory of Oncology in South ChinaDepartment of Abdominal Surgery, Cancer Center, Sun Yat-sen University Email author 
  • , Wei LiAffiliated withState Key Laboratory of Oncology in South ChinaDepartment of Abdominal Surgery, Cancer Center, Sun Yat-sen University
  • , Zhi-wei ZhouAffiliated withState Key Laboratory of Oncology in South China
  • , Ying-bo ChenAffiliated withState Key Laboratory of Oncology in South ChinaDepartment of Abdominal Surgery, Cancer Center, Sun Yat-sen University
  • , Xiao-wei SunAffiliated withState Key Laboratory of Oncology in South ChinaDepartment of Abdominal Surgery, Cancer Center, Sun Yat-sen University
  • , Gong ChenAffiliated withState Key Laboratory of Oncology in South ChinaDepartment of Abdominal Surgery, Cancer Center, Sun Yat-sen University
    • , Quentin LiuAffiliated withState Key Laboratory of Oncology in South China

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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.