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New Metastatic Lymph Node Ratio System Reduces Stage Migration in Patients Undergoing D1 Lymphadenectomy for Gastric Adenocarcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system for gastric cancer incorporates the absolute number of metastatic lymph nodes (N status) and is optimally used when ≥15 nodes are examined. The ratio of metastatic to examined nodes (N ratio) is an effective prognostic tool, but has not been examined in Western patients undergoing primarily D1 lymphadenectomy.

Methods

Two hundred and fifty seven patients with gastric adenocarcinoma who underwent gastric resection between 1995 and 2005 at our institution were examined. Novel N ratio intervals were determined using the best cutoff approach (Nr0: N ratio = 0 and ≥15 nodes examined; Nr1: 0 ≤ N ratio ≤ 0.3; Nr2: 0.3 < N ratio ≤ 0.7; and Nr3: N ratio > 0.7). Overall survival was examined according to N status and N ratio.

Results

83% of patients underwent D1 lymphadenectomy with a median of 14 lymph nodes examined. Overall survival stratified by N status was significantly different in patients with <15 nodes examined compared with those with ≥15 nodes examined. When we stratified by N ratio intervals, there was no significant difference in overall survival in patients with <15 versus ≥ 15 nodes examined. On multivariate analysis, N ratio but not N status was retained as an independent prognostic factor.

Conclusions

The use of N status for staging patients undergoing primarily D1 lymphadenectomy results in significant stage migration due to varying numbers of nodes examined. Use of N ratio reduces stage migration and may be a more reliable method of staging these patients.

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Acknowledgment

The authors would like to thank Carol Venuti of the Massachusetts General Hospital Cancer Data Registry. Dr. Maduekwe was supported by the Scholars in Clinical Science Program at Harvard Medical School under National Institutes of Health grant no. 1 KL2 RR025757-0 1, Harvard Clinical and Translational Science Center (KL1).

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Author notes

  1. Sam S. Yoon MD

    Present address: Departments of Surgery and Cancer Biology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Ugwuji N. Maduekwe MD, MMSc, Carlos Fernandez-del-Castillo MD, David L. Berger MD, Charles M. Ferguson MD, David W. Rattner MD & Sam S. Yoon MD

  2. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Gregory Y. Lauwers MD

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  1. Ugwuji N. Maduekwe MD, MMSc
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Correspondence to Sam S. Yoon MD.

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Maduekwe, U.N., Lauwers, G.Y., Fernandez-del-Castillo, C. et al. New Metastatic Lymph Node Ratio System Reduces Stage Migration in Patients Undergoing D1 Lymphadenectomy for Gastric Adenocarcinoma. Ann Surg Oncol 17, 1267–1277 (2010). https://doi.org/10.1245/s10434-010-0914-6

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  • DOI: https://doi.org/10.1245/s10434-010-0914-6

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