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Lymph Node Ratio Is an Independent Prognostic Factor for Patients with Siewert Type II Adenocarcinoma of Esophagogastric Junction: Results from a 10-Year Follow-up Study

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Abstract

Purpose

Emerging evidences suggest that lymph node ratio (LNR), the number of metastatic lymph node (LN) to the total number of dissected lymph nodes (NDLN), may predict survival in multiple types of solid tumor. However, the prognostic role of LNR in adenocarcinoma of the esophagogastric junction (AEG) remains uninvestigated. The present study is intended to determine the prognostic value of LNR in the patients with Siewert type II AEG.

Methods

A total of 342 patients with Siewert type II AEG who underwent R0 resection were enrolled in this study. The optimal cutoff of LNR was stratified into tertiles using X-tile software. The log-rank test was used to evaluate the survival differences, and multivariate Cox regression analyses were performed to determine the independent prognostic variables.

Results

The optimal cutoff of LNR were classified as LNR = 0, LNR between 0.01 and 0.40, and LNR > 0.41. Patients with high LNR had a shorter 5- and 10-year disease-specific survival (DSS) rate (8.5%, 1.4%) compared with those with moderate LNR (20.4%, 4.9%) and low LNR (58.0%, 27.5%) (P < 0.001). Multivariate Cox regression analysis indicated that LNR was an independent factor for DSS after adjusting for confounding variables (P < 0.05). Furthermore, after stratification by NDLN between NDLN < 15 group and NDLN ≥ 15 group, the LNR remained a significant predictor for DSS (P < 0.05).

Conclusions

LNR is an independent predictor for DSS in patients with Siewert type II AEG regardless of NDLN. Patients with higher LNR have significantly shorter DSS.

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Abbreviations

AEG:

adenocarcinoma of the esophagogastric junction

AJCC:

American Joint Committee on Cancer

CI:

confidence interval

DSS:

disease-specific survival

EGJ:

esophagogastric junction carcinoma

HR:

hazard risk

LN:

lymph node

LNR:

lymph node ratio

NDLN:

number of dissected lymph nodes

UICC:

Union for International Cancer Control

TNM:

tumor node metastases

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Funding

This work was supported by the Natural Science Foundation of Guangdong Province, China (Grant No. 2018A030313562), the Science and Technology Project of Shantou, China (Grant No. 190816095262235, No. 190819145262877, and No. 170828211930352), the Youth Scientific Research Fund of Cancer Hospital affiliated to Shantou University Medical College (No. 2020A003), the 2018 Special Fund for Science and Technology Innovation Strategy of Guangdong Province (No. Shantou Government 2018-49), and the 2019 Science and Technology Special Fund of Guangdong Province (No. Shantou Government 2019-132).

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Authors and Affiliations

  1. Department of Medical Information, Shantou University Medical College Cancer Hospital, Shantou, China

    Yuling Zhang

  2. Department of Thoracic Surgery, Shantou University Medical College Cancer Hospital, Shantou, China

    Ditian Liu

  3. Department of Medical Oncology, Shantou University Medical College Cancer Hospital, Shantou, China

    De Zeng

  4. Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Shantou, China

    De Zeng

  5. The Breast Centre, Shantou University Medical College Cancer Hospital, Shantou, China

    Chunfa Chen

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  1. Yuling Zhang
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  2. Ditian Liu
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Contributions

Conception and study: Yuling Zhang, Chunfa Chen, and De Zeng; acquiring data: Yuling Zhang and Ditian Liu; statistical analysis: Yuling Zhang, Ditian Liu, and Chunfa Chen; drafting article and critical revision of article: Chunfa Chen and De Zeng. All authors read and approved the final manuscript.

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The disease-specific survival was significantly different between the subgroup of number of dissected lymph nodes (NDLN) < 15 and NDLN ≥15. (PNG 643 kb)

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Zhang, Y., Liu, D., Zeng, D. et al. Lymph Node Ratio Is an Independent Prognostic Factor for Patients with Siewert Type II Adenocarcinoma of Esophagogastric Junction: Results from a 10-Year Follow-up Study. J Gastrointest Canc 52, 983–992 (2021). https://doi.org/10.1007/s12029-020-00468-y

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