AIMS: The proportion between metastatic and examined lymph nodes (N-ratio) has been proposed as an independent prognostic factor in patients with gastric cancer. In the present work we validated the reliability of N-ratio in a large, multicenter series. PATIENTS AND METHODS: We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma. Survival of patients with >15 (Group-1, n=1421) and those with < or =15 (Group-2, n=432) lymph nodes examined was separately analyzed in order to evaluate the influence of lymph node dissection on disease staging. N-ratio categories (N-ratio 0, 0%; N-ratio 1, 1-9%; N-ratio 2, 10-25%; N-ratio 3, >25%) were determined by the best cut-off approach. RESULTS: At multivariate analysis, N-ratio (but not TNM N-category) was retained as an independent prognostic factor both in Group-1 and Group-2 (HR for N-ratio 1, N-ratio 2 and N-ratio 3=1.67, 2.96 and 6.59, and 1.56, 2.68 and 4.28, respectively). After a median follow-up of 45.5 months, the 5-year overall survival rates of TNM N0, N1 and N2 patients were significantly different in Group-1 vs Group-2. This was not the case when adopting the N-ratio classification, suggesting that a low number of excised lymph nodes can lead to patients being understaged using the N-category, but not N-ratio. Moreover, N-ratio identified subsets of patients with significantly different survival rates within TNM N1 and N2 categories in both groups. CONCLUSIONS: N-ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer, including those cases with limited lymph node dissection. These data support the rationale to propose the implementation of N-ratio into the current TNM staging system.
AIMS: The proportion between metastatic and examined lymph nodes (N-ratio) has been proposed as an independent prognostic factor in patients with gastric cancer. In the present work we validated the reliability of N-ratio in a large, multicenter series. PATIENTS AND METHODS: We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma. Survival of patients with >15 (Group-1, n=1421) and those with < or =15 (Group-2, n=432) lymph nodes examined was separately analyzed in order to evaluate the influence of lymph node dissection on disease staging. N-ratio categories (N-ratio 0, 0%; N-ratio 1, 1-9%; N-ratio 2, 10-25%; N-ratio 3, >25%) were determined by the best cut-off approach. RESULTS: At multivariate analysis, N-ratio (but not TNM N-category) was retained as an independent prognostic factor both in Group-1 and Group-2 (HR for N-ratio 1, N-ratio 2 and N-ratio 3=1.67, 2.96 and 6.59, and 1.56, 2.68 and 4.28, respectively). After a median follow-up of 45.5 months, the 5-year overall survival rates of TNM N0, N1 and N2 patients were significantly different in Group-1 vs Group-2. This was not the case when adopting the N-ratio classification, suggesting that a low number of excised lymph nodes can lead to patients being understaged using the N-category, but not N-ratio. Moreover, N-ratio identified subsets of patients with significantly different survival rates within TNM N1 and N2 categories in both groups. CONCLUSIONS: N-ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer, including those cases with limited lymph node dissection. These data support the rationale to propose the implementation of N-ratio into the current TNM staging system.
Authors: Giovanni De Manzoni; Gian Luca Baiocchi; Massimo Framarini; Maurizio De Giuli; Domenico D'Ugo; Alberto Marchet; Donato Nitti; Daniele Marrelli; Paolo Morgagni; Andrea Rinnovati; Riccardo Rosati; Franco Roviello; Rosaldo Allieta; Stefano Berti; Umberto Bracale; Patrizio Capelli; Angelo Cavicchi; Natale Di Martino; Annibale Donini; Angelo Filippini; Gianfranco Francioni; Marco Frascio; Alfredo Garofalo; Stefano Maria Giulini; Giovanni Battista Grassi; Paolo Innocenti; Antonio Martino; Gualtiero Mazzocconi; Lorenzo Mazzola; Severino Montemurro; Nicola Palasciano; Gianni Pantuso; Heinrich Pernthaler; Roberto Petri; Diego Piazza; Rosario Sacco; Giovanni Sgroi; Carlo Staudacher; Michele Testa; Carlo Vallicelli; Nereo Vettoretto; Costantino Zingaretti; Lorenzo Capussotti; Mario Morino; Giorgio Maria Verdecchia Journal: Updates Surg Date: 2014-03
Authors: Gennaro Galizia; Michele Orditura; Francesca Ferraraccio; Paolo Castellano; Margherita Pinto; Anna Zamboli; Sabrina Cecere; Ferdinando De Vita; Carlo Pignatelli; Eva Lieto Journal: World J Surg Date: 2009-12 Impact factor: 3.352