The metastatic lymph node ratio is a better prognostic factor than the number of metastatic limph node after curative resection for gastric cancer

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Mario Giuffrida
Lorenzo Viani
Gioacchino Giovanni Iapichino
Federico Cozzani
Paolo Dell'Abate
Paolo Del Rio


gastric cancer, gastrectomy, survival, lymphadenectomy, lymph node ratio.


Aim: Evaluate impact of lymph node ratio as prognostic factor in gastric cancer.

Methods: We studied 463 patients with gastric cancer who underwent curative gastric surgery with D1 or D2 lymphadenectomy, Data were collected from May 1996 through December 2010 at Department of General Surgery of Parma University Hospital. We divided patients in two groups according to number of nodes removed

Results: The results of the present nonrandomized retrospective single centre study confirm the promising role of the LNR as an independent prognostic factor. Overall survival between LNR categories are statistically significant different between LNR0 and LNR1.

Conclusion: The ratio between the number of metastatic and analysed lymph nodes in patients with gastric cancer can discriminate patients better than the AJCC/UICC staging system: it seems to be related to a more sensitive in the evaluation of overall survival.


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1. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th edition. Oxford: Wiley-Blackwell; 2010
2. Dicken BJ, Bigam DL, Cass C, et al. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg 2005; 241:27–39.
3. Hogenberger O, Gretschel S. Gastric cancer. Lancet 2003;362: 305–15.
4. Okusa T, Nakane Y, Boku T, et al. Quantitative analysis of nodal involvement with respect to survival rate after curative gastrectomy for carcinoma. Surg Gynecol Obstet 1990; 170: 488–94.
5. Zhao LY, Li CC, Jia LY, Chen XL, Zhang WH, Chen XZ, Yang K, Liu K, Wang YG, Xue L, et al: Superiority of lymph node ratio-based staging system for prognostic prediction in 2575 patients with gastric cancer: Validation analysis in a large single center. Oncotarget. 7:51069–51081. 2016.
6. Adachi Y, Kamakura T, Mori M et al (1994) Prognostic significance of the number of positive lymph nodes in gastric carcinoma. Br J Surg 81: 414-416.

7. Fukuda N, Sugiyama Y, Midorikawa A, Mushiake H. (2009) Prognostic significance of the metastatic Lymph node ratio in Gastric cancer patients. World J Surg 33: 2378-2382.

8. Nitti D, Marchet A, Olivieri M et al. 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(9): 1077-1085.

9. Siewert JR, Bittcher K, Stein HJ et al. Relevant prognostic factors in gastric cancer: ten years results of the German gastric cancer study. Ann Surg 1998; 228: 449-461.

10. Dicken BJ, Bigam DL, Cass C et al. Gastric cancer. Lancet 2003; 362: 305-315.

11. Sianesi M, Bezer L, Del Rio P, Dell'Abate P, Iapichino G, Soliani P, Tacci S. The node ratio ad prognostic factor after curative resection for gastric cancer. J Gastrointest Surtg (2010) 14: 614-619.

12. UJCC

13. JCGA

14. Persiani R, Rausei S, Antonacci V, Biondi A, Casella F, Ciccoritti L, D'Ugo D. Metastatic Lymph node ratio: a new staging system for gastric cancer. (2009) World J Surg 33: 2106-2111.

15. Degiuli M, Sasako M, Ponti A et al (2004). Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J cancer 90: 1727-1732.

16. Bonenkamo JJ, Hermans J, Sasako M et al. (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340: 908-914.

17. De Manzoni G, Verlato G, Roviello F et al. The new classification of lymph node metastasis monimises stage migration problems in gastric cancer patients. Br J Cancer 2002; 87 (2): 171-174

18. Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistic for survival in cancer. N Engl J Med 1985; 312: 1604-1608.

19. Imoue K, Nakane Y, Liyama H et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 2002; 9 (1): 27-34.

20. Yoshikawa T, Sasako M, Sano T et al. Stage migration caused by D2 dissection with para-aortic lymphadenectomy for gastric cancer from the results of a prospective randomized controlled trial. Br J Surg 2006; 93(12): 1526-1529.

21. Liu C, Lu P, Lu Y et al. Clinical implications of metastatic lymph node ratio in gastric cancer. BMC Cancer 2007; 7:200.

22. Bonenkamp JJ, Hermans S, Sasako M et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999; 340: 908-914.

23. Marchet A, Mocellin S, Ambrosi A et al. The prognostic value of N-ratio in patients with gastric cancer: validation in a large multicenter series. Eur J Surg Oncol 2008; 34(2): 159-165.

24. Saito H, Fukumoto Y, Osaki T et al. Prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in patients with advanced gastric cancer. J Surg Oncol 2008; 97 (2): 132-135.

25. Marchet A, Mocellin S, Ambrosi A et al. The ratio between metastatic and examined lymph nodes (N ratio) is an indipendent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg 2003; 245(4): 543-552.

26. Xu DZ, Geng QR, Long ZJ et al. Positive lymph node ratio is an indipendent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol 2009; 16(2): 319-326.

27. Persiani R, Rausei S, Biondi A et al. Ratio of metastatic lymph nodes: impact on staging and survival of gastric cancer. Eur J Surg Oncol 2008; 34(5): 519-524.

28. Japanese Research Society for Gastric Cancer. The general rules for the gastric cancer study in surgery and pathology. Part 1. Clinical classificatio. Jpn J Surg 1981; 11: 127-139.

29. Verlato G, Roviello F, Marchet A et al (2009) Indexes of surgical quality in gastric cancer surgery: experience of an Italian network. Ann Surg Oncol 16: 594-602.

30. De Manzoni G, Verlato G, Guglielmi A et al (1999) Classification of lymph node metastases from carcinoma of the stomach: comparison of the old (1987) to new (1997) TNM system. World J Surg 23:664-669.

31. Bando E, Yonemura Y, Taniguchi K et al. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002;9:775-784.

32. Volpe CM, Driscoll DL, Douglass HO jr. Outcome of patients with proximal gastric cancer depends on extent of resectionand number of rected lymoh nodes. Ann Surg Oncol 2000; 7(2): 139-144.

33. Ichikura T, Tomimatsu S, Ueguji K et al. 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(4):553-558.

34. Roder JD, Bottcher K, Busch R et al. Classification of regional lymph node metastasis from gastric carcinoma. Cancer 1998; 82(4):621-631.

35. Bunt AM, Hermans J, Smit VT et al. Surgical/pathologic-stage migration confronts comparisions of gastric cancer serviva rate between Japan and Western countries. J Clin Oncol 1995;13:19-25.

36. Xu D, Geng Q, Long Z et al (2009). Positive lymph node ratio i san independent prognostic factor in gastric cancer after D2 resection regardless of the esamine number of lymph nodes. Ann Surg Oncol 16: 319-326.

37. Sun Z, Zhu GL, Lu C et al (2009) The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrive: results from a Chinese mono-institutional study in 2159 patients. Ann Oncol 20:897-905.

38. Wang XF, Sun YH, Liang DJ, Wang C et al. Clinical values of estende lymph node dissection for gastric cancer: a meta-analysis for D1 vs D2 gastrectomy. Zhonghua Wei Chang Wai Ke Za Zhi 2007; 10 (5): 425-430.

39. Kulig J, Popiela T, Kolodziejczyk P et al. Standard D2 versus estende D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of multi center, randomized, clinical trial. Am J Surg 2007; 193(1):10-15.

40. Japanese Gastric Cancer Association (2004) Gastric cancer treatment guidelin, 2nd edn. Kanehara, Tokyo.

41. Maria Teresa Mita, Federico Marchesi, Stefano Cecchini, Francesco Tartamella, Matteo Riccò, Hariscine Keng Abongwa, Luigi Roncoroni. Prognostic assessment of gastric cancer: retrospective analysis of two decades. Acta Biomed 2016; Vol. 87, N. 2: 205-211

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