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Lymph node ratio-based the ypTNrM staging system for gastric cancer after neoadjuvant therapy: a large population-based study

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Abstract

Purposes

The lymph node ratio (LNR) has been considered a better prognostic factor than traditional N staging in patients with gastric cancer (GC), but its accuracy is unclear for those who receive neoadjuvant therapy (NAT). We aimed to compare the node ratio (Nr) staging with the ypN staging and to thereby develop a modified staging system incorporating Nr staging.

Methods

A total of 1791 patients who underwent gastrectomy after NAT in the Surveillance, Epidemiology, and End Results database were retrospectively analyzed. ypTNrM staging was established based on the overall survival (OS).

Results

The Nr staging was generated using 0.2 and 0.5 as the cutoff values of LNR and represented patients with more homogeneous OS compared with ypN staging. The 5-year OS rates for ypTNrM stages IA, IB, II, IIIA, and IIIB were 70.2%, 54.2%, 36.0%, 21.2%, and 6.6%, respectively, compared with 58.8%, 39.1%, and 21.6% for ypTNM stages I, II, and III, respectively. Compared with the ypTNM staging system, the ypTNrM staging system had a lower misclassification rate (3.0% vs. 50.9%) and better prognostic predictive power (C-index: 0.645 vs. 0.589, P < 0.001).

Conclusions

The ypTNrM staging system incorporating Nr staging may provide a more accurate assessment in the clinical decision-making process for GC after NAT.

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Authors and Affiliations

  1. Department of Surgery, Qingyang People’s Hospital, No. 608 South Road, Qingyang, 745000, Gansu Province, China

    Jia-Xian Chen, Jian-Wei Sun, Yi Wang & Bang-Ce Lv

  2. The Graduate School of Fujian Medical University, Fujian Medical University, Fuzhou, 350001, China

    Tao Pan & Li-Zhen Lin

  3. Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, 350001, China

    Lv-Ping Zhuang

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Chen, JX., Sun, JW., Wang, Y. et al. Lymph node ratio-based the ypTNrM staging system for gastric cancer after neoadjuvant therapy: a large population-based study. Surg Today 52, 783–794 (2022). https://doi.org/10.1007/s00595-021-02386-3

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