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Metastatic lymph node ratio is an independent prognostic factor in gastric cancer



Metastatic lymph node ratio is an independent prognostic factor in gastric cancer



Hepato-Gastroenterology 56(91-92): 908-913



The metastatic status of the regional lymph node is the most significant prognostic factor for gastric cancer. However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study is to evaluate the prognostic significance of the ratio of metastatic to examined lymph nodes (N ratio) for identifying a high-risk subgroup of patients with gastric cancer. The postoperative survival of 264 consecutive patients with operable gastric cancer was analyzed with regard to its N ratio and current N classification. Survival was determined by the Kaplan-Meier method and differences were assessed by the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model in forward stepwise regression. The lymph node ratio was classified as follows N ratio 1, 1 to 10, N ratio 2, 11 to 25; and N ratio 3, >25. The 5-year survival rates stratified by N ratio were N ratio 1, 81%; N ratio 2, 49%; N ratio 3, 25%. The rates of survival were significantly different according to the N ratio in pN1 and pN2 classification of the UICC/TNM classification (p<0.05). Cox regression analysis revealed that N ratio was sensitive prognostic factor in these surgically treated patients, which were also significantly correlated with extent of lymph node dissection and pathologic tumor stage (p<0.05). N ratio can be recommended as an applicable parameter for lymph node involvement of gastric cancer. It is a more effective and precise indicator for prognostic stratification of patients with lymph node positive gastric cancer than the current N classification of the tumor-node-metastasis system.

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Accession: 054350264

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PMID: 19621727


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