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Journal of Gastrointestinal Surgery

, Volume 20, Issue 9, pp 1565–1571 | Cite as

Positive Lymph Node Ratio as an Indicator of Prognosis and Local Tumor Clearance in N3 Gastric Cancer

  • Shuhei KomatsuEmail author
  • Daisuke Ichikawa
  • Mahito Miyamae
  • Toshiyuki Kosuga
  • Kazuma Okamoto
  • Tomohiro Arita
  • Hirotaka Konishi
  • Ryo Morimura
  • Yasutoshi Murayama
  • Atsushi Shiozaki
  • Yoshiaki Kuriu
  • Hisashi Ikoma
  • Masayoshi Nakanishi
  • Hitoshi Fujiwara
  • Eigo Otsuji
Original Article

Abstract

Background

Nodal metastasis is an important clinical issue in gastric cancer patients. This study was designed to investigate the clinical usefulness of the positive lymph node ratio (PLNR), which reflects both metastatic and retrieved lymph node numbers, in patients with pN3 gastric cancer.

Methods

We retrospectively analyzed the records of 138 consecutive pN3 patients who underwent curative gastrectomy with lymphadenectomy from 2000 to 2012.

Results

A PLNR of 0.4 was proved to be the best cutoff value to stratify the prognosis of patients with pN3 gastric cancer (P < 0.001). Univariate and multivariate analyses revealed that older age, larger tumor size (≥10 cm), and PLNR ≥ 0.4 [P < 0.001, HR 3.1 (95 % CI 1.7–5.4)] were independent prognostic factors in pN3 gastric cancer. Regarding the recurrence, patients with PLNR <0.4 had a significantly lower rate of lymph node recurrence than those with PLNR ≥0.4 (P = 0.020). There was no significant difference in the lymph node recurrence rate between N3a and N3b patients in the PLNR <0.4 group [P = 0.546, 11.6 % (7/60) vs. 12.5 (1/8)], indicating a better local control regardless of pN3 subgroups.

Conclusions

PLNR is useful to stratify the prognosis and evaluate the extent of local tumor clearance in pN3 gastric cancer.

Keywords

Positive lymph node ratio Prognosis Curability Stage migration Gastric cancer 

Notes

Authors’ contributions

Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Toshiyuki Kosuga, Kazuma Okamoto, Tomohiro Arita, Hirotaka Konishi, Ryo Morimura, Yasutoshi Murayama, Atsushi Shiozaki, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Hitoshi Fujiwara, and Eigo Otsuji performed the research and analyzed data, and Shuhei Komatsu wrote the paper.

References

  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, et al.: Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386.CrossRefPubMedGoogle Scholar
  2. 2.
    Hartgrink HH, Jansen EP, van Grieken NC, van de Velde CJ. : Gastric cancer. The Lancet 2009; 374: 477-490.CrossRefGoogle Scholar
  3. 3.
    Kawaguchi T, Komatsu S, Ichikawa D, et al.: Clinical significance and prognostic impact of the total diameter of enlarged lymph nodes on preoperative multidetector computed tomography in patients with gastric cancer. J Gastroenterol Hepatol 2015;30(11):1603-1609.CrossRefPubMedGoogle Scholar
  4. 4.
    Bonenkamp JJ, Hermans J, Sasako M, et al.: Extended lymph-node dissection for gastric cancer. New England Journal of Medicine 1999; 340: 908-914.CrossRefPubMedGoogle Scholar
  5. 5.
    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. Ann Surg 2010;251:640-646.CrossRefPubMedGoogle Scholar
  6. 6.
    Bickenbach K, Strong VE. Comparison of Gastric Cancer Treatments: East vs. West. J Gastric Cancer 2012;12: 55-62.CrossRefPubMedGoogle Scholar
  7. 7.
    Strong VE, Yoon SS.: Extended Lymphadenectomy in Gastric Cancer Is Debatable. World journal of surgery 2013; 37: 1773-1777.CrossRefPubMedGoogle Scholar
  8. 8.
    Degiuli M, Sasako M, Ponti A.: Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. British Journal of Surgery 2010; 97: 643-649.CrossRefPubMedGoogle Scholar
  9. 9.
    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. The lancet oncology 2010; 11: 439-449.CrossRefPubMedGoogle Scholar
  10. 10.
    Komatsu S, Ichikawa D, Okamoto K, et al.: Differences of the lymphatic distribution and surgical outcomes between remnant gastric cancers and primary proximal gastric cancers. J Gastrointest Surg 2012 ;16(3):503-508.CrossRefPubMedGoogle Scholar
  11. 11.
    Pawlik TM, Gleisner AL, Cameron JL, et al.: Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 2007 ;141:610-618.CrossRefPubMedGoogle Scholar
  12. 12.
    Herr HW.: Superiority of ratio based lymph node staging for bladder cancer. J Urol 2003;169:943-945.CrossRefPubMedGoogle Scholar
  13. 13.
    Rosenberg R, Friederichs J, Schuster T, et al.: Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg 2008;248:968-978.CrossRefPubMedGoogle Scholar
  14. 14.
    Kulig J, Sierzega M, Kolodziejczyk P, et al.; Polish Gastric Cancer Study Group: Ratio of metastatic to resected lymph nodes for prediction of survival in patients with inadequately staged gastric cancer. Br J Surg 2009;96:910-918.CrossRefPubMedGoogle Scholar
  15. 15.
    Marchet A, Mocellin S, Ambrosi A, et al.; Italian Research Group for Gastric Cancer (IRGGC): The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg 2007;245:543-552.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Nakajima T.: Gastric cancer treatment guidelines in Japan. Gastric Cancer 2002;5:1-5.CrossRefPubMedGoogle Scholar
  17. 17.
    Japanese Gastric Cancer Association: Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14:113–123.CrossRefGoogle Scholar
  18. 18.
    Japanese Gastric Cancer Association: Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14:101–112.CrossRefGoogle Scholar
  19. 19.
    Sobin L, Gospodarowicz M, Wittekind C, et al.: International union against cancer. TNM classification of malignant tumours, 7th edition. New York: Wiley-Blackwell; 2010.Google Scholar
  20. 20.
    Okajima W, Komatsu S, Ichikawa D, et al.: Prognostic impact of the number of retrieved lymph nodes in patients with gastric cancer. J Gastroenterol Hepatol. 2016 Feb 3. doi:  10.1111/jgh.13306. Epub ahead of print,
  21. 21.
    Rodríguez Santiago JM, Muñoz E, Martí M, et al.; Metastatic lymph node ratio as a prognostic factor in gastric cancer. Eur J Surg Oncol 2005;31:59–66.CrossRefPubMedGoogle Scholar
  22. 22.
    Kunisaki C, Shimada H, Nomura M, et al.; Clinical impact of metastatic lymph node ratio in advanced gastric cancer. Anticancer Res 2005;25:1369–1375.PubMedGoogle Scholar
  23. 23.
    Bando E, Yonemura Y, Taniguchi K, et al.; Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002;9:775–784.CrossRefPubMedGoogle Scholar
  24. 24.
    Sun Z, Zhu GL, Lu C, et al.; The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients. Ann Oncol 2009;20:897-905.CrossRefPubMedGoogle Scholar
  25. 25.
    Wong J, Rahman S, Saeed N, et al.; Prognostic impact of lymph node retrieval and ratio in gastric cancer: a U.S. single center experience. J Gastrointest Surg 2013;17:2059-2066.CrossRefPubMedGoogle Scholar
  26. 26.
    Wu XJ, Miao RL, Li ZY, et al.; Prognostic value of metastatic lymph node ratio as an additional tool to the TNM stage system in gastric cancer. Eur J Surg Oncol 2015;41:927-933.CrossRefPubMedGoogle Scholar
  27. 27.
    Kutlu OC, Watchell M, Dissanaike S. Metastatic lymph node ratio successfully predicts prognosis in western gastric cancer patients. Surg Oncol 2015;24:84-88CrossRefPubMedGoogle Scholar
  28. 28.
    Kodera Y, Yamamura Y, Shimizu Y, et al.; Lymph node status assessment for gastric carcinoma: is the number of metastatic lymph nodes really practical as a parameter for N categories in the TNM Classification? Tumor Node Metastasis. J Surg Oncol 1998;69:15–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Kim C, Yang D. Adjustment of N stages of gastric cancer by the ratio between the metastatic and examined lymph nodes. Ann Surg Oncol 2009;16:1868–1874.CrossRefPubMedGoogle Scholar
  30. 30.
    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. Ann Surg 2012;255:50-58.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Shuhei Komatsu
    • 1
    Email author
  • Daisuke Ichikawa
    • 1
  • Mahito Miyamae
    • 1
  • Toshiyuki Kosuga
    • 1
  • Kazuma Okamoto
    • 1
  • Tomohiro Arita
    • 1
  • Hirotaka Konishi
    • 1
  • Ryo Morimura
    • 1
  • Yasutoshi Murayama
    • 1
  • Atsushi Shiozaki
    • 1
  • Yoshiaki Kuriu
    • 1
  • Hisashi Ikoma
    • 1
  • Masayoshi Nakanishi
    • 1
  • Hitoshi Fujiwara
    • 1
  • Eigo Otsuji
    • 1
  1. 1.Division of Digestive Surgery, Department of SurgeryKyoto Prefectural University of MedicineKamigyo-kuJapan

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