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Clinical implications of metastatic lymph node ratio in gastric cancer.

Liu C, Lu P, Lu Y, Xu H, Wang S, Chen J - BMC Cancer (2007)

Bottom Line: A Cox regression revealed that the metastatic node ratio, the number of metastatic nodes, histological type, and histological growth pattern independently influenced prognosis.The metastatic lymph node ratio is a simple and useful independent prognostic factor.It may obviate possible confounding factors that are related to stage migration, and should be considered as an important component in the lymph node category.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, First Affiliated Hospital of China Medial University, Shenyang, China. luping2999@yahoo.com.cn

ABSTRACT

Background: The 5-year survival rate in patients with gastric cancer is still poor, and lymph node metastasis is considered one of the most important prognostic factors. However, there are controversies in the classification of lymph node metastasis in gastric cancer. This study was carried out to investigate whether the metastatic lymph node ratio is a reliable classification of lymph node metastasis in gastric cancer in Chinese.

Methods: 224 cases with gastric cancer with more than D1 dissection were retrospectively reviewed. The association between the total number of resected lymph nodes and the number of metastatic lymph nodes was determined. The prognostic value of the metastastic node ratio, defined as the ratio of the number of metastatic lymph nodes over the total number of resected lymph nodes, and the pN classification was assessed.

Results: The number of metastatic lymph node increased with the number of total resected lymph nodes. A Cox regression revealed that the metastatic node ratio, the number of metastatic nodes, histological type, and histological growth pattern independently influenced prognosis. The 5-year survival rates were 78%, 61%, 25%, 0% in cases with a metastastic node ratio of 0%, > 0% but < 40%, 40-80%, > 80%, respectively (P < 0.001), and were 78%, 62%, 38%, 0% in cases with gastric cancer histologically classified as pN0, pN1, pN2, pN3, respectively (P < 0.001).

Conclusion: The metastatic lymph node ratio is a simple and useful independent prognostic factor. It may obviate possible confounding factors that are related to stage migration, and should be considered as an important component in the lymph node category.

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Related in: MedlinePlus

Survival curve and comparison of cumulative survival rates after surgery according to the metastatic lymph node ratio, calculated by dividing the total number of lymph nodes that have been removed and examined by the number of metastatic lymph nodes (0%, < 40%, 40–79, and ≥ 80%). There were significant differences among the groups (P < 0.00; Kaplan-Meier and log-rank test).
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Figure 2: Survival curve and comparison of cumulative survival rates after surgery according to the metastatic lymph node ratio, calculated by dividing the total number of lymph nodes that have been removed and examined by the number of metastatic lymph nodes (0%, < 40%, 40–79, and ≥ 80%). There were significant differences among the groups (P < 0.00; Kaplan-Meier and log-rank test).

Mentions: The 5-year survivals were 78%, 61%, 25%, 0% in cases with a metastastic node ratio of 0%, < 40%, 40–79, and ≥ 80%, respectively (P < 0.00), and 78%, 62%, 38%, 0% in cases with pN0, pN1, pN2, and pN3, respectively (P < 0.00). There was only a slight difference in the survival rates between patients with pN0 and pN1 and between those with a metastatic lymph node ratio of 0 and < 40%, but the survival rates decreased significantly in other groups (Figures 2 &3). Further analyses revealed that in patients with a metastatic node ratio of 40–79% and cases with the ratio of ≥ 80%, there was no significant difference in survival among the patients with pN1, pN2 and pN3 (Figures 4 &5). However, in cases with pN3, there was a significant difference in the survival rate among the patients with a lymph node ratio of < 40%, 40–79% and ≥ 80%) (P = 1/20.025) (Figure 6), although this difference was absent in patients with pN1 and pN2 (Figure 7).


Clinical implications of metastatic lymph node ratio in gastric cancer.

Liu C, Lu P, Lu Y, Xu H, Wang S, Chen J - BMC Cancer (2007)

Survival curve and comparison of cumulative survival rates after surgery according to the metastatic lymph node ratio, calculated by dividing the total number of lymph nodes that have been removed and examined by the number of metastatic lymph nodes (0%, < 40%, 40–79, and ≥ 80%). There were significant differences among the groups (P < 0.00; Kaplan-Meier and log-rank test).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2194781&req=5

Figure 2: Survival curve and comparison of cumulative survival rates after surgery according to the metastatic lymph node ratio, calculated by dividing the total number of lymph nodes that have been removed and examined by the number of metastatic lymph nodes (0%, < 40%, 40–79, and ≥ 80%). There were significant differences among the groups (P < 0.00; Kaplan-Meier and log-rank test).
Mentions: The 5-year survivals were 78%, 61%, 25%, 0% in cases with a metastastic node ratio of 0%, < 40%, 40–79, and ≥ 80%, respectively (P < 0.00), and 78%, 62%, 38%, 0% in cases with pN0, pN1, pN2, and pN3, respectively (P < 0.00). There was only a slight difference in the survival rates between patients with pN0 and pN1 and between those with a metastatic lymph node ratio of 0 and < 40%, but the survival rates decreased significantly in other groups (Figures 2 &3). Further analyses revealed that in patients with a metastatic node ratio of 40–79% and cases with the ratio of ≥ 80%, there was no significant difference in survival among the patients with pN1, pN2 and pN3 (Figures 4 &5). However, in cases with pN3, there was a significant difference in the survival rate among the patients with a lymph node ratio of < 40%, 40–79% and ≥ 80%) (P = 1/20.025) (Figure 6), although this difference was absent in patients with pN1 and pN2 (Figure 7).

Bottom Line: A Cox regression revealed that the metastatic node ratio, the number of metastatic nodes, histological type, and histological growth pattern independently influenced prognosis.The metastatic lymph node ratio is a simple and useful independent prognostic factor.It may obviate possible confounding factors that are related to stage migration, and should be considered as an important component in the lymph node category.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, First Affiliated Hospital of China Medial University, Shenyang, China. luping2999@yahoo.com.cn

ABSTRACT

Background: The 5-year survival rate in patients with gastric cancer is still poor, and lymph node metastasis is considered one of the most important prognostic factors. However, there are controversies in the classification of lymph node metastasis in gastric cancer. This study was carried out to investigate whether the metastatic lymph node ratio is a reliable classification of lymph node metastasis in gastric cancer in Chinese.

Methods: 224 cases with gastric cancer with more than D1 dissection were retrospectively reviewed. The association between the total number of resected lymph nodes and the number of metastatic lymph nodes was determined. The prognostic value of the metastastic node ratio, defined as the ratio of the number of metastatic lymph nodes over the total number of resected lymph nodes, and the pN classification was assessed.

Results: The number of metastatic lymph node increased with the number of total resected lymph nodes. A Cox regression revealed that the metastatic node ratio, the number of metastatic nodes, histological type, and histological growth pattern independently influenced prognosis. The 5-year survival rates were 78%, 61%, 25%, 0% in cases with a metastastic node ratio of 0%, > 0% but < 40%, 40-80%, > 80%, respectively (P < 0.001), and were 78%, 62%, 38%, 0% in cases with gastric cancer histologically classified as pN0, pN1, pN2, pN3, respectively (P < 0.001).

Conclusion: The metastatic lymph node ratio is a simple and useful independent prognostic factor. It may obviate possible confounding factors that are related to stage migration, and should be considered as an important component in the lymph node category.

Show MeSH
Related in: MedlinePlus