Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study

Lee, J.H.; Kang, Jin‐Ju; Nam, Byung–Ho; Cho, G.S.; Hyung, Woo Jin; Kim, M.C.; Lee, H.-J.; Ryu, Keun Won; Ryu, Seung Wan; Shin, Dong Woo; Kim, C.-Y.

doi:10.1016/j.ejso.2016.09.007

Cited by 28 publications

(22 citation statements)

References 19 publications

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“…The lymph node count has been shown to be an indispensable factor for assessing the pathological stage correctly 33 . Another study showed that a higher lymph node count was related to better survival 34 . The present study identified that the number of harvested lymph nodes in the RADG group was statistically higher than that in the LADG group, which was less than in previous research 14 .…”

Section: Discussionmentioning

confidence: 98%

Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Shi

Liu

et al. 2020

Sci Rep

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Reports in the field of robotic surgery for gastric cancer are increasing. However, studies only on patients with advanced gastric cancer (AGC) are lacking. This retrospective study was to compare the short-term outcomes of robotic-assisted distal gastrectomy (RADG) and laparoscopic-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for AGC. From December 2014 to November 2019, 683 consecutive patients with AGC underwent mini-invasive assisted distal gastrectomy. Propensityscore matching (PSM) analysis was conducted to reduce patient selection bias. Short-term outcomes were compared between the two groups. The clinical features were well matched in the PSM cohort. Compared with the LADG group, the RADG group was associated with less operative blood loss, a lower rate of postoperative blood transfusion, less volume of abdominal drainage, less time to remove abdominal drainage tube, retrieved more lymph node, and lower rates of surgical complications and pancreatic fistula (P <0.05). However, the time to recovery bowel function, the length of postoperative stay, the rates of other subgroups of complications and unplanned readmission were similar between the two groups (P > 0.05). This study suggests that RADG is a safe and feasible technique with better short-term outcomes than LADG for AGC.Gastric cancer continues to be a major public health problem worldwide, especially in developing countries, such as China 1,2 . Every year, approximately 680,000 new patients are diagnosed with gastric cancer in China; among them, more than 80% of these patients have advanced-stage disease 1,3 . For patients with advanced gastric cancer (AGC), multidisciplinary comprehensive treatment is usually required, and gastrectomy with lymph node dissection is currently considered to be the only curable treatment 4 .In the past few decades, with the development of science and technology, much advanced surgical equipment has been invented, particularly in the field of mini-invasive surgery (MIS). Since laparoscopy-assisted Billroth I gastrectomy was first reported in 1994, several randomized controlled trials (RCTs) have demonstrated that laparoscopic gastrectomy (LG) for AGC is a safe and feasible technique with better short-term outcomes than and similar oncological outcomes to open gastrectomy [5][6][7][8][9] . Although LG has obtained greater acceptance among abdominal surgeons, because of the limitations of laparoscopic instruments, it is difficult to perform precisely, as is the case with D2 lymphadenectomy 10,11 .Robotic surgery systems, as another MIS method, were invented to overcome the drawbacks of laparoscopy and are becoming increasingly accepted by abdominal surgeons. Since Hashizume et al. first reported the use of robotic surgery for gastric cancer in 2002, a number of studies have shown the safety and advantages of robotic

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Section: Discussionmentioning

confidence: 98%

Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Shi

Liu

et al. 2020

Sci Rep

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“…Our results are consistent with those of previous authors. Lee et al proved the LNR to be a better predictor for survival than the N category of the UICC/AJCC staging system because the LNR formula includes the TLNE [30]. Spolverato et al found that the LODDS score was the best predictor of survival when assessed as a continuous variable; however, the LNR became the best predictor when LN status was included [31].…”

Section: Discussionmentioning

confidence: 99%

Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

Zhang

2020

Preprint

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Background: The tumor-node-metastasis (TNM) pN stage, which is based on the number of positive lymph nodes (LNs), is an important prognostic factor for patients with adenocarcinoma of the esophagogastric junction (AEG). The lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) staging systems are new effective indicators of prognosis. We aimed to evaluate their prognostic value in Siewert type II AEG.Methods: Patients diagnosed with Siewert type II AEG who underwent curative resection between 2004 and 2014 at Guangdong General Hospital were recruited. A Cox regression model was constructed, and prognostic performance was measured using Harrell’s concordance index (C-index) and the Akaike information criterion (AIC).Results: When LN status was modeled as a continuous variable, the LODDS system (C-index: 0.729; AIC: 940.483) outperformed the other staging systems, including the number of positive LNs (LNP) (C-index: 0.721; AIC: 946.935) and LNR (C-index: 0.725; AIC: 938.918).However,when assessed as categorical variables, the LNR staging system had a better prognostic performance (C-index: 0.752; AIC: 926.350) than the American Joint Committee on Cancer (AJCC) 8th edition TNM pN (C-index: 0.740; AIC: 934.349) and LODDS (C-index: 0.737; AIC: 939.087) staging systems. Each LNR stage is more evenly distributed than the other two staging systems. Moreover, the LODDS stage is more dependent on the TLNE.Conclusion: The LNR represented the best prognostic factor when assessed as a categorical variable and may serve as an alternative nodal staging system for AEG.

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“…Our results are in line with those of previous authors. Lee et al proved the LNR to be superior to the conventional nodal staging systems (pN from the TNM7). Sun et al demonstrated that the use of LODDS categories is more reliable than the use of pN and LNR categories in stratifying the prognosis of GC patients.…”

Section: Discussionmentioning

confidence: 99%

“…LNR was defined as the ratio between the number of metastatic nodes and the total number of examined nodes. Five LNR categories were defined on the basis of the current literature, 9,11,21 Then, a subgroup analysis was conducted for patients with <16 nodes and ≥16 nodes examined. In every subgroup, the accuracy of the four staging systems was compared using the ROC curve graphs and their AUCs with 95% confidence interval (CI), and the predictive capacity of the four staging systems was evaluated conducting a Cox univariable analysis, and calculating AIC and BIC for every model.…”

Section: Statistics and Criteria For Assessing The Best Staging Systemmentioning

confidence: 99%

“…13,14 To date, the prognostic advantage of alternative staging systems has been investigated in a significant number of studies, which mostly compared the difference between the sole nodal classification systems (N, LNR e LODDS), with discordant results. 12,[14][15][16][17][18][19][20][21][22] Most of these studies have been conducted in Asia [15][16][17][18][20][21][22][23] and, so far, no study has compared the prognostic value of a full TNM classification system based on the LNR and LODDS classification with the TNM 8th edition. Therefore, the aim of this multicenter study is to define two full classification systems based on the LNR and LODDS classification and to compare their prognostic value with those of TNM 7th and 8th editions.…”

Section: Introductionmentioning

confidence: 99%

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Ratio‐based staging systems are better than the 7th and 8th editions of the TNM in stratifying the prognosis of gastric cancer patients: A multicenter retrospective study

Agnes

Biondi

Cananzi

et al. 2019

Journal of Surgical Oncology

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Background The current and the previous editions of the tumor‐node‐metastasis (TNM) system for gastric cancer (GC; TNM8 and TNM7) have a high risk of stage‐migration bias when the node count after gastrectomy is suboptimal. Hence, they are possibly not the optimal staging systems for GC patients. This study aims to compare the TNM with two systems less affected by the stage‐migration bias, namely, the lymph nodes ratio (LNR) and the log odds of positive lymph nodes (LODDS), to assess which one is the best in stratifying the prognosis of GC patients. Methods The sample study included 1221 GC patients. Two 7‐cluster staging systems based on the combination of pT categories and LNR and LODDS categories (TLNR and TLODDS) were compared with the two last editions of TNM, using the Akaike information criteria, the Bayesian information criteria, and the receiver operating characteristic (ROC) curve graphs. Further validation on an independent sample of 251 patients was carried out. Results The univariable and multivariable analyses and the ROC curves detected an advantage of the TLNR and TLODDS systems over the TNM. The TLNR and TLODDS showed the best accuracy both in the subgroup of patients with ≥16 nodes examined. The results were confirmed in the validation analysis. Conclusions TLNR and TLODDS staging systems should be considered a valid implementation of the TNM for the prognostic stratification of GC patients. If these results are confirmed in further studies, the future implementation of the TNM should consider the introduction of the LNR or the LODDS along with the number of metastatic nodes.

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Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study

Cited by 28 publications

References 19 publications

Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

Ratio‐based staging systems are better than the 7th and 8th editions of the TNM in stratifying the prognosis of gastric cancer patients: A multicenter retrospective study

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