Prognostic value of metastatic lymph node ratio in gastric cancer underwent radical gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yinghua ¹ , YANG Rui ² , YANG Qingqiang ² ,  HAN Yunwei ¹

1. Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Gastrointestinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

HAN Yunwei, Email: 530018842@qq.com

Keywords：

gastric cancer; radical gastrectomy; metastatic lymph node ratio

DOI：

10.7507/1007-9424.202007078

Video：

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Objective To explore the predictive value of metastatic lymph node ratio (MLNR) on prognosis of patients with gastric cancer after radical gastrectomy, and to evaluate whether MLNR can be used as a reference tool to guide the formulation of postoperative adjuvant treatment strategies and prognosis prediction of gastric cancer.Methods The clinicopathologic features of patients who underwent D2 radical gastrectomy from January 2014 to December 2017 were retrospectively analyzed. The factors influencing the disease specific survival of gastric cancer were analyzed by Cox proportional hazards model, then the variables with statistical significance in multivariate analysis were included in the construction of nomograms model for prognosis of patients with gastric cancer.Results A total of 262 patients with gastric cancer were included. There was no correlation between MLNR and total number of lymph nodes (r_s=0.037, P=0.547), there was a positive correlation between MLNR and pN stage (r_s=0.909, P<0.001). Multivariate Cox regression analysis showed that pT stage, pN stage, MLNR, and postoperative chemotherapy were the independent predictors of prognosis of gastric cancer after radical gastrectomy. Four variables including pT stage, pN stage, postoperative chemotherapy, and MLNR were included in the construction of nomogram model, the C index of MLNR and pN stage model was 0.707 and 0.692 respectively. Survival analysis showed that the higher the MLNR, the worse the prognosis.Conclusions The ability of MLNR to predict prognosis of gastric cancer might be better than pN stage. Therefore, it is considered that MLNR could be used as an important evaluation tool to guide adjuvant treatment and prognosis prediction after radical gastrectomy.

Citation： LI Yinghua, YANG Rui, YANG Qingqiang, HAN Yunwei. Prognostic value of metastatic lymph node ratio in gastric cancer underwent radical gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 595-600. doi: 10.7507/1007-9424.202007078 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	顧秀瑛, 赫捷. 2015年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2019, 41(1): 19-28.
3.	Baiocchi GL, Kodera Y, Marrelli D, et al. Follow-up after gastrectomy for cancer: results of an international web round table. World J Gastroenterol, 2014, 20(34): 11966-11971.
4.	Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg, 2011, 253(5): 900-911.
5.	Hundahl SA. Staging, stage migration, and patterns of spread in gastric cancer. Semin Radiat Oncol, 2002, 12(2): 141-149.
6.	Riihim?ki M, Hemminki A, Sundquist K, et al. Metastatic spread in patients with gastric cancer. Oncotarget, 2016, 7(32): 52307-52316.
7.	Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet, 2012, 379(9813): 315-321.
8.	Graziosi L, Marino E, Cavazzoni E, et al. Prognostic value of the seventh AJCC/UICC TNM classification of non-cardia gastric cancer. World J Surg Oncol, 2013, 11: 103.
9.	Wagner AD, Grothe W, Haerting J, et al. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol, 2006, 24(18): 2903-2909.
10.	Huang CM, Lin JX, Zheng CH, et al. Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy. World J Gastroenterol, 2010, 16(16): 2055-2060.
11.	Chen Y, Zhang G, Zhao B, et al. A better prognostic stratification for the 8th edition of the AJCC staging system of gastric cancer by incorporating pT4aN0M0 into stage ⅢA. Surg Oncol, 2019, 29: 90-96.
12.	Saedi HS, Fanipakdel A, Shafaghi A, et al. Evaluating the relation between patients-related factors and dissected lymph node ratio in gastric cancer. Indian J Cancer, 2015, 52(1): 48-51.
13.	Melis M, Masi A, Pinna A, et al. Does lymph node ratio affect prognosis in gastroesophageal cancer? Am J Surg, 2015, 210(3): 443-450.
14.	張軍, 胡偉. 淋巴結陽性率對非小細胞肺癌的預后判斷. 鄭州大學, 2017.
15.	Spolverato G, Ejaz A, Kim Y, et al. Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis. J Am Coll Surg, 2014, 219(4): 664-675.
16.	王歡, 于壯. 淋巴結轉移比率與Lauren分型對胃癌根治術后預后預測價值的研究. 青島大學, 2017.
17.	Lee JH, Kang JW, Nam BH, et al. Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study. Eur J Surg Oncol, 2017, 43(2): 432-439.
18.	Dikken JL, van de Velde CJ, G?nen M, et al. The New American Joint Committee on Cancer/International Union Against Cancer staging system for adenocarcinoma of the stomach: increased complexity without clear improvement in predictive accuracy. Ann Surg Oncol, 2012, 19(8): 2443-2451.
19.	Jiao XG, Deng JY, Zhang RP, et al. Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol, 2014, 20(13): 3640-3648.
20.	Hou Y, Wang X, Chen J. Prognostic significance of metastatic lymph node ratio: the lymph node ratio could be a prognostic indicator for patients with gastric cancer. World J Surg Oncol, 2018, 16(1): 198.
21.	黎煥君, 劉琦, 陳志良, 等. 淋巴結轉移率對胃癌D2根治術患者的預后分析. 腫瘤學雜志, 2016, 22(4): 300-304.
22.	Zhao LY, Li CC, Jia LY, et al. Superiority of lymph node ratio-based staging system for prognostic prediction in 2 575 patients with gastric cancer: validation analysis in a large single center. Oncotarget, 2016, 7(32): 51069-51081.
23.	周榮健, 張恒, 束平, 等. Ⅲ期胃癌根治術后預后因素分析及淋巴結轉移率對預后的預測價值(附995例報告). 中華消化外科雜志, 2019, 18(3): 250-258.
24.	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(1): 50-58.
25.	馬志堅, 王科深, 任彥先, 等. 淋巴結轉移率對胃癌患者的預后價值. 中國普外基礎與臨床雜志, 2020, 27(11): 1352-1356.
26.	Kutlu OC, Watchell M, Dissanaike S. Metastatic lymph node ratio successfully predicts prognosis in Western gastric cancer patients. Surg Oncol, 2015, 24(2): 84-88.
27.	Marchet A, Mocellin S, Ambrosi A, et al. 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 1 853 patients. Ann Surg, 2007, 245(4): 543-552.
28.	Zhang H, Wang W, Diao D, et al. Ratio of metastatic to examined lymph nodes, a helpful staging system and independent prognostic factor of esophagogastric junction cancer. PLoS One, 2013, 8(8): e73238.
29.	陳烽, 林建清, 黃志軍, 等. 淋巴結轉移率在評估T4a期胃癌患者預后的探討. 中國衛生標準管理, 2018, 9(21): 32-35.
30.	Liu F, Zhou R, Jiang F, et al. Proposal of a nomogram for predicting survival in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction after preoperative radiation. Ann Surg Oncol, 2019, 26(5): 1292-1300.
31.	權峰濤, 楊維楨. 淋巴結轉移率在評估胃癌患者預后中的價值. 中國臨床研究, 2017, 30(6): 804-806.
32.	詹友慶, 李威, 孫曉衛, 等. 胃癌外科治療的遠期療效研究. 中華外科雜志, 2005, 43(17): 1109-1113.
33.	李小寶, 訾永宏, 曹波, 等. 淋巴結轉移率對檢出不同淋巴結數量的胃癌患者預后的評價價值. 中華普通外科雜志, 2017, 32(7): 577-580.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 顧秀瑛, 赫捷. 2015年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2019, 41(1): 19-28.
3. Baiocchi GL, Kodera Y, Marrelli D, et al. Follow-up after gastrectomy for cancer: results of an international web round table. World J Gastroenterol, 2014, 20(34): 11966-11971.
4. Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg, 2011, 253(5): 900-911.
5. Hundahl SA. Staging, stage migration, and patterns of spread in gastric cancer. Semin Radiat Oncol, 2002, 12(2): 141-149.
6. Riihim?ki M, Hemminki A, Sundquist K, et al. Metastatic spread in patients with gastric cancer. Oncotarget, 2016, 7(32): 52307-52316.
7. Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet, 2012, 379(9813): 315-321.
8. Graziosi L, Marino E, Cavazzoni E, et al. Prognostic value of the seventh AJCC/UICC TNM classification of non-cardia gastric cancer. World J Surg Oncol, 2013, 11: 103.
9. Wagner AD, Grothe W, Haerting J, et al. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol, 2006, 24(18): 2903-2909.
10. Huang CM, Lin JX, Zheng CH, et al. Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy. World J Gastroenterol, 2010, 16(16): 2055-2060.
11. Chen Y, Zhang G, Zhao B, et al. A better prognostic stratification for the 8th edition of the AJCC staging system of gastric cancer by incorporating pT4aN0M0 into stage ⅢA. Surg Oncol, 2019, 29: 90-96.
12. Saedi HS, Fanipakdel A, Shafaghi A, et al. Evaluating the relation between patients-related factors and dissected lymph node ratio in gastric cancer. Indian J Cancer, 2015, 52(1): 48-51.
13. Melis M, Masi A, Pinna A, et al. Does lymph node ratio affect prognosis in gastroesophageal cancer? Am J Surg, 2015, 210(3): 443-450.
14. 張軍, 胡偉. 淋巴結陽性率對非小細胞肺癌的預后判斷. 鄭州大學, 2017.
15. Spolverato G, Ejaz A, Kim Y, et al. Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi-institutional analysis. J Am Coll Surg, 2014, 219(4): 664-675.
16. 王歡, 于壯. 淋巴結轉移比率與Lauren分型對胃癌根治術后預后預測價值的研究. 青島大學, 2017.
17. Lee JH, Kang JW, Nam BH, et al. Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study. Eur J Surg Oncol, 2017, 43(2): 432-439.
18. Dikken JL, van de Velde CJ, G?nen M, et al. The New American Joint Committee on Cancer/International Union Against Cancer staging system for adenocarcinoma of the stomach: increased complexity without clear improvement in predictive accuracy. Ann Surg Oncol, 2012, 19(8): 2443-2451.
19. Jiao XG, Deng JY, Zhang RP, et al. Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol, 2014, 20(13): 3640-3648.
20. Hou Y, Wang X, Chen J. Prognostic significance of metastatic lymph node ratio: the lymph node ratio could be a prognostic indicator for patients with gastric cancer. World J Surg Oncol, 2018, 16(1): 198.
21. 黎煥君, 劉琦, 陳志良, 等. 淋巴結轉移率對胃癌D2根治術患者的預后分析. 腫瘤學雜志, 2016, 22(4): 300-304.
22. Zhao LY, Li CC, Jia LY, et al. Superiority of lymph node ratio-based staging system for prognostic prediction in 2 575 patients with gastric cancer: validation analysis in a large single center. Oncotarget, 2016, 7(32): 51069-51081.
23. 周榮健, 張恒, 束平, 等. Ⅲ期胃癌根治術后預后因素分析及淋巴結轉移率對預后的預測價值(附995例報告). 中華消化外科雜志, 2019, 18(3): 250-258.
24. 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(1): 50-58.
25. 馬志堅, 王科深, 任彥先, 等. 淋巴結轉移率對胃癌患者的預后價值. 中國普外基礎與臨床雜志, 2020, 27(11): 1352-1356.
26. Kutlu OC, Watchell M, Dissanaike S. Metastatic lymph node ratio successfully predicts prognosis in Western gastric cancer patients. Surg Oncol, 2015, 24(2): 84-88.
27. Marchet A, Mocellin S, Ambrosi A, et al. 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 1 853 patients. Ann Surg, 2007, 245(4): 543-552.
28. Zhang H, Wang W, Diao D, et al. Ratio of metastatic to examined lymph nodes, a helpful staging system and independent prognostic factor of esophagogastric junction cancer. PLoS One, 2013, 8(8): e73238.
29. 陳烽, 林建清, 黃志軍, 等. 淋巴結轉移率在評估T4a期胃癌患者預后的探討. 中國衛生標準管理, 2018, 9(21): 32-35.
30. Liu F, Zhou R, Jiang F, et al. Proposal of a nomogram for predicting survival in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction after preoperative radiation. Ann Surg Oncol, 2019, 26(5): 1292-1300.
31. 權峰濤, 楊維楨. 淋巴結轉移率在評估胃癌患者預后中的價值. 中國臨床研究, 2017, 30(6): 804-806.
32. 詹友慶, 李威, 孫曉衛, 等. 胃癌外科治療的遠期療效研究. 中華外科雜志, 2005, 43(17): 1109-1113.
33. 李小寶, 訾永宏, 曹波, 等. 淋巴結轉移率對檢出不同淋巴結數量的胃癌患者預后的評價價值. 中華普通外科雜志, 2017, 32(7): 577-580.

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Prognostic value of metastatic lymph node ratio in gastric cancer underwent radical gastrectomy

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