Jiang Zhu1, Zhao Xue2, Shumei Zhang1, Xinxin Guo2, Laihui Zhai2, Shipeng Shang1, Yan Zhang3, Haibo Lu4. 1. College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China. 2. Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, 150040, China. 3. College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China. Electronic address: tyozhang@ems.hrbmu.edu.cn. 4. Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, 150040, China. Electronic address: 13613657491@126.com.
Abstract
BACKGROUND: The lymph node ratio (LNR) as a prognostic parameter for gastric cancer has yet to be fully validated in the current tumor node metastasis staging system. We assessed the prognostic role of LNR in lymph node-positive gastric cancer through a meta-analysis. MATERIALS AND METHODS: PubMed and EMBASE were searched for relevant studies up until December 2016. The effect measure for meta-analysis of primary outcomes was the hazard ratio (HR) for overall survival. Pooled HRs and 95% confidence intervals were calculated using random effects models. The I2 statistic was used to measure heterogeneity. Subgroup analysis and meta-regression were chosen to illustrate the potential heterogeneity of the risk factors of outcomes. Publication bias was assessed using Egger's test and Begg's funnel plots. Sensitivity analysis was applied to evaluate the origin of the heterogeneity. RESULTS: We included 27 studies in this meta-analysis. Higher LNRs were significantly associated with a shorter overall survival (OS). High heterogeneity among the studies was identified (I2 = 85.6), and the publication bias was moderate. Subgroup analysis showed similar results, and elevated LNR was associated with late-stage gastric cancer and indicative of a worse prognosis. Univariate meta-regression analysis of OS indicated that both treatment type and ethnicity may be causes of heterogeneity in patients with gastric cancer (p values were 0.005 and 0.008, respectively). CONCLUSION: LNR was associated with a significantly poorer OS and LNR was an independent predictor of survival in patients with gastric cancer. LNR should be added as one of the parameters to be used in future tumor staging classification systems.
BACKGROUND: The lymph node ratio (LNR) as a prognostic parameter for gastric cancer has yet to be fully validated in the current tumor node metastasis staging system. We assessed the prognostic role of LNR in lymph node-positive gastric cancer through a meta-analysis. MATERIALS AND METHODS: PubMed and EMBASE were searched for relevant studies up until December 2016. The effect measure for meta-analysis of primary outcomes was the hazard ratio (HR) for overall survival. Pooled HRs and 95% confidence intervals were calculated using random effects models. The I2 statistic was used to measure heterogeneity. Subgroup analysis and meta-regression were chosen to illustrate the potential heterogeneity of the risk factors of outcomes. Publication bias was assessed using Egger's test and Begg's funnel plots. Sensitivity analysis was applied to evaluate the origin of the heterogeneity. RESULTS: We included 27 studies in this meta-analysis. Higher LNRs were significantly associated with a shorter overall survival (OS). High heterogeneity among the studies was identified (I2 = 85.6), and the publication bias was moderate. Subgroup analysis showed similar results, and elevated LNR was associated with late-stage gastric cancer and indicative of a worse prognosis. Univariate meta-regression analysis of OS indicated that both treatment type and ethnicity may be causes of heterogeneity in patients with gastric cancer (p values were 0.005 and 0.008, respectively). CONCLUSION: LNR was associated with a significantly poorer OS and LNR was an independent predictor of survival in patients with gastric cancer. LNR should be added as one of the parameters to be used in future tumor staging classification systems.
Authors: Karol Rawicz-Pruszyński; Bogumiła Ciseł; Radosław Mlak; Jerzy Mielko; Magdalena Skórzewska; Magdalena Kwietniewska; Agnieszka Pikuła; Katarzyna Gęca; Katarzyna Sędłak; Andrzej Kurylcio; Wojciech P Polkowski Journal: Cancers (Basel) Date: 2019-12-01 Impact factor: 6.639
Authors: Joonseon Park; Chul Hyo Jeon; So Jung Kim; Ho Seok Seo; Kyo Young Song; Han Hong Lee Journal: J Gastric Cancer Date: 2021-03-26 Impact factor: 3.720
Authors: Steffen Spoerl; Michael Gerken; Andreas Mamilos; René Fischer; Stefanie Wolf; Felix Nieberle; Christoph Klingelhöffer; Johannes K Meier; Silvia Spoerl; Tobias Ettl; Torsten E Reichert; Gerrit Spanier Journal: Clin Oral Investig Date: 2020-08-04 Impact factor: 3.573