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Journal of Gastrointestinal Surgery

, Volume 17, Issue 12, pp 2059–2066 | Cite as

Prognostic Impact of Lymph Node Retrieval and Ratio in Gastric Cancer: a U.S. Single Center Experience

  • Joyce WongEmail author
  • Shams Rahman
  • Nadia Saeed
  • Hui-Yi Lin
  • Khaldoun Almhanna
  • Ravi Shridhar
  • Sarah Hoffe
  • Kenneth L. Meredith
Original Article

Abstract

Introduction

Increased lymph node (LN) retrieval for gastric cancer has been associated with improved overall survival (OS). This study examines the impact of number of examined LN (eLN) and lymph node ratio.

Methods

Patients referred for surgical care of gastric cancer were stratified by number of eLN, positive LNs (LN+), and lymph node ratio (LN+/eLN). Clinicopathologic factors were compared; OS and disease-free survival (DFS) were the primary endpoints.

Results

From 1997 to 2012, 222 patients, median age 67 (range, 17–92) years, were analyzed. Of 220 (99 %) explored, 164 (74 %) underwent resection. Median OS was 22 (range, 0.3–140) months. Perineural and lymphovascular invasion and poor differentiation adversely affected OS, p < 0.05. A median 14 eLN (range, 0–45), with median 1 LN+ (range, 0–31), was observed. There were no OS or DFS differences when comparing the eLN groups. Both OS and DFS were impacted by LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months (0) to 37 months (0.01–0.2), 27 months (0.21–0.5), and 12 months (>0.5), p < 0.0001. DFS was similar: 35 months (0), decreasing to 22 months (0.01–0.2), 13 months (0.21–0.5), and 7 months (>0.5), p < 0.0001.

Conclusion

Number of eLN did not impact survival, while LN+ adversely affected survival. Lymph node ratio may predict prognosis better than number of eLN or LN+ in gastric cancer.

Keywords

Gastric cancer Lymph node ratio Prognosis 

References

  1. 1.
    American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012.Google Scholar
  2. 2.
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Gastric Cancer. Version 2.2013. NCCN.org.Google Scholar
  3. 3.
    Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, p 120.Google Scholar
  4. 4.
    Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. The Lancet Oncology, 2006; 7(4): 309–315.PubMedCrossRefGoogle Scholar
  5. 5.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer, 2011; 14: 113–123.CrossRefGoogle Scholar
  6. 6.
    Hartgrink HH, van de Velde CJH, Putter J, et al. Extended Lymph Node Dissection for Gastric Cancer: Who May Benefit? Final Results of the Randomized Dutch Gastric Cancer Group Trial. Journal of Clinical Oncology, 2004; 22: 2069–2077.PubMedCrossRefGoogle Scholar
  7. 7.
    Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized survival trial. British Journal of Cancer, 1999; 79: 1522–1530.PubMedCrossRefGoogle Scholar
  8. 8.
    Songun I, Putter H, Kranenbarg EMK, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncology, 2010; 11: 439–49.PubMedCrossRefGoogle Scholar
  9. 9.
    Kattan MW, Karpeh MS, Mazumdar M, Brennan MF. Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. Journal of Clinical Oncology, 2003; 21 (19): 3647–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Son T, Hyung WJ, Lee JH, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer, 2012; 118 (19): 4687–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Xu D, Huang Y, Geng Q, et al. Effect of lymph node number on survival of patients with lymph node-negative gastric cancer according to the 7th edition UICC TNM system. PLoS ONE, 2012; 7(6): e38681.PubMedCrossRefGoogle Scholar
  12. 12.
    Wang J, Dang P, Raut CP, et al. Comparison of a lymph node ratio-based staging system with the 7th AJCC system for gastric cancer: analysis of 18,043 patients from the SEER database. Annals of Surgery, 2012; 255(3): 478–85.PubMedCrossRefGoogle Scholar
  13. 13.
    Lemmens VEPP, Dassen AE, van der Wurff AAM, et al. Lymph node examination among patients with gastric cancer: Variation between departments of pathology and prognostic impact of lymph node ratio. European Journal of Surgical Oncology, 2011; 37(6): 488–496.PubMedCrossRefGoogle Scholar
  14. 14.
    Wang W, Xu DZ, Li YF, et al. Tumor-ratio-metastasis staging system as an alternative to the 7th edition UICC TNM system in gastric cancer after D2 resection-results of a single-institution study of 1343 Chinese patients. Annals of Oncology, 2011; 22(9): 2049–56.PubMedCrossRefGoogle Scholar
  15. 15.
    Maduekwe UN, Lauwers GY, Fernandez-Del-Castillo C, et al. New metastatic lymph node ratio system reduces stage migration in patients undergoing D1 lymphadenectomy for gastric adenocarcinoma. Annals of Surgical Oncology, 2010; 17(5): 1267–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Fukuda N, Sugiyama Y, Midorikawa A, Mushiake H. Prognostic significance of the metastatic lymph node ratio in gastric cancer patients. World Journal of Surgery, 2009; 33(11): 2378–82.PubMedCrossRefGoogle Scholar
  17. 17.
    Zhou Y, Zhang J, Cao S, and Li Y. The evaluation of metastatic lymph node ratio staging system in gastric cancer. Gastric Cancer, 2012; 16(3): 309–17.PubMedCrossRefGoogle Scholar
  18. 18.
    Sun Z, Zhu GL, Lu C, et al. The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients. Annals of Oncology, 2009; 20(5): 897–905.PubMedCrossRefGoogle Scholar
  19. 19.
    Peeters KC, Kattan MW, Hartgrink HH, et al. Validation of a nomogram for predicting disease-specific survival after an R0 resection for gastric carcinoma. Cancer, 2005; 103(4): 702–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Han DS, Suh YS, Kong SH, et al. Nomogram predicting long-term survival after D2 gastrectomy for gastric cancer. Journal of Clinical Oncology, 2012; 30(31): 3834–40.PubMedCrossRefGoogle Scholar
  21. 21.
    Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Annals of Surgery, 2010; 251(4): 640–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Latengbaolide A, Lin D, Li Y, et al. Lymph Node Ratio Is an Independent Prognostic Factor in Gastric Cancer After Curative Resection (R0) Regardless of the Examined Number of Lymph Nodes. American Journal of Clinical Oncology, 2012; 36(4): 325–30.CrossRefGoogle Scholar
  23. 23.
    Deng J, Liang H, Wang D, et al. Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes. Annals of Surgical Oncology, 2010; 17(4): 1043–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Kulig J, Sierzega M, Kolodziejczyk P, et al. Ratio of metastatic to resected lymph nodes for prediction of survival in patients with inadequately staged gastric cancer. British Journal of Surgery, 2009; 96(8): 910–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Kong SH, Lee HJ, Ahn HS, et al. Stage migration effect on survival in gastric cancer surgery with extended lymphadenectomy: the reappraisal of positive lymph node ratio as a proper N-staging. Annals of Surgery, 2012; 255(1): 50–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Du C, Zhou Y, Cai H, et al. Poor prognostic factors in patients with stage I gastric cancer according to the seventh edition TNM classification: a comparative analysis of three subgroups. Journal of Surgical Oncology, 2012; 105(3): 323–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee IS, Yook JH, Kim TH, et al. Prognostic factors and recurrence pattern in node-negative advanced gastric cancer. European Journal of Surgical Oncology, 2013; 39(2): 136–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Bilici A, Seker M, Ustaalioglu BB, et al. Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection. Annals of Surgical Oncology, 2010; 17(8): 2037–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Reid-Lombardo KM, Gay G, Patel-Parekh L, et al. Treatment of Gastric Adenocarcinoma May Differ Among Hospital Types in the United States, a Report from the National Cancer Data Base. Journal of Gastrointestinal Surgery, 2007; 11(4): 410–420.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Joyce Wong
    • 1
    Email author
  • Shams Rahman
    • 2
    • 3
  • Nadia Saeed
    • 1
  • Hui-Yi Lin
    • 2
  • Khaldoun Almhanna
    • 1
  • Ravi Shridhar
    • 1
  • Sarah Hoffe
    • 1
  • Kenneth L. Meredith
    • 1
  1. 1.Department of Gastrointestinal OncologyMoffitt Cancer CenterTampaUSA
  2. 2.Department of BiostatisticsMoffitt Cancer CenterTampaUSA
  3. 3.Department of Epidemiology and Biostatistics, College of Public HealthUniversity of South FloridaTampaUSA

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