Prognostic Importance of the Positive Lymph Node Ratio in the Gastric Cancer

Year 2020, Volume: 46 Issue: 2, 203 - 208, 01.08.2020

Fatma Yalçın Müsri Ahmet Bilici Melek Karakurt Eryılmaz Özgür Cem Müsri Gökhan Tazegül Selver Işık Mehmet Kaplan

https://doi.org/10.32708/uutfd.759405

Abstract

Herein, we aimed to evaluate the prognostic significance of the ratio of metastatic lymph nodes to the total number of removed lymph nodes (LNR) in Stage 1-3 operated gastric carcinoma (GC). A total of 233 patients with stage 1-3 GC operated between 2012 and 2019 were retrospectively evaluated. Survival curves were constructed using the Kaplan-Meier method. The median number of metastatic and dissected lymph nodes were 5 and 27, respectively, with a median LNR of 0.1. Patients were categorized into two groups as those with a LNR <0.1 and ≥0.1. Median OS in patients with a median LNR of <0.1 and ≥0.1 were 76 vs. 26.9 months (p<0.001). In univariate analysis gender, lymphovascular invasion (LVI), and perineural invasion (PNI) were found to be significant predictors of median OS (p=0.043, <0.001 and <0.001, respectively). LNR and LVI emerged as independent predictors of OS in the multivariate analyses (p<0.01 and 0.02, respectively). LNR has prognostic significance for OS in operated GC patients where increasing LNR is associated with reduced overall survival. Thus, LNR may be used as a substitute for pathological nodal classification in patients with insufficient lymph node dissection or D1 dissection.

Keywords

gastric cancer, lymph node ratio, overall survival

Supporting Institution

N/A

Project Number

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Thanks

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Mide Kanserinde Pozitif Lenf Nodu Oranının Prognostik Önemi

Abstract

Bu çalışmada, evre 1-3 gastrik karsinomda (GK) metastatik lenf nodlarının toplam çıkarılan lenf nodu sayısına oranının (LNO) prognostik önemini değerlendirmeyi amaçladık. 2012-2019 yılları arasında opere edilen evre 1-3 GK’lı toplam 233 hasta retrospektif olarak değerlendirildi. Sağkalım eğrileri Kaplan-Meier yöntemi kullanılarak oluşturuldu. Medyan metastatik ve disseke lenf nodu sayısı sırasıyla 5 ve 27 idi, ortalama LNO 0.1 idi. Hastalar LNO <0.1 ve ≥0.1 olanlar olmak üzere iki gruba ayrıldı. Medyan LNO <0.1 ve ≥0.1 olan hastalarda medyan genel sağkalım 26.9 ay ve 76 ay idi (p <0.001). Tek değişkenli analizde cinsiyet, lenfovasküler invazyon (LVİ) ve perinöral invazyon (PNİ) medyan genel sağkalımda anlamlı bulundu (sırasıyla p=0.043, <0.001 ve <0.001). LNO ve LVİ, çok değişkenli analizde genel sağkalımın bağımsız prediktörleri olarak saptandı (sırasıyla p<0.01 ve 0.02). GK hastalarında artan LNO, opere edilen hastalarda azalmış genel sağkalım açısından prognostik bir öneme sahiptir. Bu nedenle, LNO, yetersiz lenf nodu diseksiyonu veya D1 diseksiyonu olan hastalarda patolojik nodal sınıflandırma yerine kullanılabilir.

Keywords

mide kanseri, lenf nodu oranı, genel sağkalım

Project Number

N/A

References

• Bray F, Ferlay J, Soerjomataram I, ve ark. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68:394‐424.
• Hartgrink HH, Jansen EP, vanGrieken NC ve VandeVelde CJ. Gastric cancer. Lancet 2009; 374:477–490
• Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma-2nd English Edition. Gastric Cancer 1998; 1: 10-24.
• Ajani JA, In H, Sano T, ve ark. Stomach. In: AJCC CancerStaging Manual, 8th ed. Amin MB (Ed). AJCC, Chicago, 2017; 203.
• Kwon SJ ve Kim GS: Prognostic significance of lymph node metastasis in advanced carcinoma of the stomach. Br J Surg 1996;83:1600–3.
• Kim JP, Lee JH, Kim SJ, ve ark. Clinicopathologic characteristics and prognostic factors in 10,783 patients with gastric cancer. Gastric Cancer 1998; 1:125–33.
• Bando E, Yonemura Y, Taniguchi K, ve ark. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002;9:775–84.
• Inoue K, Nakane Y, Iiyama H, ve ark. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 2002; 9:27–34.
• Kodera Y, Yamamura Y, Shimizu Y, ve ark. Metastatic gastric lymph node rate is a significant prognostic factor for resectable stage IV stomach cancer. J Am Coll Surg 1997; 185:65–9.
• Hyung WJ, Noh SH, Yoo CH, ve ark. Prognostic significance of metastatic lymph node ratio in T3 gastric cancer. World J Surg 2002; 26:323–9.
• Marchet A, Mocellin S, Ambrosi A, ve ark. The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series. Eur J Surg Oncol 2008; 34: 159-165
• Rodríguez Santiago JM, Muñoz E, Martí M, ve ark. Metastatic lymph node ratio as a prognostic factor in gastric cancer. Eur J Surg Oncol 2005; 31: 59-66
• Kunisaki C, Shimada H, Nomura M, ve ark. Clinical impact of metastatic lymph node ratio in advanced gastric cancer. Anticancer Res 2005; 25:1369–75.
• Celen O, Yildirim E ve Berberoglu U: Prognostic impact of positive lymph node ratio in gastric carcinoma. J Surg Oncol 2007; 96:95–101.
• Sobin LH ve Wittekind CH. International Union Against Cancer (UICC). TNM Classification of Malignant Tumours. 5th ed. New York: Wiley, 1997.
• Roder JD, Böttcher K, Busch R, ve ark. Classification of regional lymph node metastasis from gastric carcinoma. German Gastric Cancer Study Group. Cancer 1998; 82: 621-631
• Ichikura T, Tomimatsu S, Uefuji K, ve ark. Evaluation of the New American Joint Committee on Cancer/International Union against cancer classification of lymph node metastasis from gastric carcinoma in comparison with the Japanese classification. Cancer 1999; 86: 553-558
• Saito H, Fukumoto Y, Osaki T, ve ark. Prognostic significance of level and number of lymph node metastases in patients with gastric cancer. Ann Surg Oncol 2007; 14: 1688-1693
• Nitti D, Marchet A, Olivieri M, ve ark. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol 2003;10:1077–85.
• Hartgrink HH, van de Velde CJ, Putter H, ve ark. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004; 22:2069‐2077.
• Cuschieri A, Weeden S, Fielding J, ve ark. Patient survival after D1 and D2 resections for gastric cancer: long‐term results of the MRC randomized surgical trial. Surgical Co‐operative Group. Br J Cancer 1999; 79:1522‐1530.
• Wu CW, Hsiung CA, Lo SS, ve ark. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006; 7:309‐315.
• Yu W, Choi GS, Whang I, ve ark. Comparison of five systems for staging lymph node metastasis in gastric cancer. Br J Surg 1997; 84:1305-9.
• Attaallah W , Uprak K, Gunal Ö, ve ark. Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Gastric Cancer Indian J Surg Oncol 2016; 7(1):67-72.
• Wohnrath DR, Araujo RLC. Positive node-ratio in curative-intent treatment for gastric cancer is a strong independent prognostic factor for 5-year overall survival. J Surg Oncol 2020;121(5):777-783.
• Siewert JR, Bottcber FK, Stein HJ, ve ark. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998; 228:449-61.
• Wu HL, Tian Q, Peng CW, ve ark. Multivariate survival and outcome analysis of 154 patients with gastric cancer at a single Chinese institution. Asian Pac J Cancer Prev 2011; 12:3341–3345
• Lee SY, Hwang I, Park YS, ve ark. Metastatic lymph node ratio in advanced gastric carcinoma: a better prognostic factor than number of metastatic lymph nodes? Int J Oncol 2010; 36(6): 1461–1467
• Marchet A, Mocellin S, Ambrosi A, ve ark. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy. Ann Surg 2007; 245:543–552
• Liu C, Lu P, Lu Y, ve ark. Clinical implications of metastatic lymph node ratio in gastric cancer. BMC Cancer 2007; 7:200