Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer

Yamashita, Keishi; Hosoda, Kei; Ema, Akira; Watanabe, Masahiko

doi:10.1016/j.ejso.2016.03.001

Cited by 77 publications

(44 citation statements)

References 63 publications

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“…56% of patients in this study were stage III (Figure 3). 95.8% of patients had T3-T4 tumor versus 69% in INT-0116 trial, even in several Survival function obvious [22]. In our study, the pN influenced the OS and the DFS, and there was a negative correlation between the OS and the N ratio without reaching the threshold of significance ( Figure 5).…”

Section: Discussionmentioning

confidence: 44%

Adjuvant Chemoradiation for Localized Gastric Adenocarcinoma: An Institutional Experience

Touil¹,

Loughlimi²,

Abbassi³

et al. 2017

J Cancer Sci Ther

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BackgroundGastric cancer is the second leading cause of cancer related death among men and the fourth among women, and thus represents a significant global health concern [1]. The disease is commonly diagnosed at a locally advanced stage, and surgery remains the main treatment; The overall survival rate of patients who underwent surgery alone is about 45% at 5 years, that has undergone few changes over the last decades [2,3].The curative treatment of gastric cancer requires surgical resection in less than 40% of cases [2,3]. Independent risk factors in the literature are tumor size (>4 cm), age (>70 years), proximal location, diffuse type of Lauren classification, tumor residue, Deep invasion (T3-T4), and the ratio of involved lymph nodes/total number (>20%) [4,5]. Locoregional recurrences on the tumor bed, on the anastomosis or in lymph nodes occur in 40% to 65% of the patients after resection with curative intent [6,7]. The frequency of this relapse makes regional radiotherapy an attractive possibility for adjuvant therapy [8].Various chemotherapy regimens used to prevent relapse and improve the poor survival rates provide small but statistically significant clinical benefit [9,10]. Finally, the intergroup of gastrointestinal cancers was the first to demonstrate in a phase III trial that concomitant radio-chemotherapy after complete gastric resection improves median relapse-free survival (30 vs 19 months, p<0.0001) and overall survival (36 vs 27 months, p<0.01) [11]. Following these results, postoperative radio-chemotherapy according to the Macdonald protocol became the new standard of care [11]. However, much concern remains regarding the toxicity of the regimen. 41% of patients had grade 3 digestive toxicity and 32% grade 4 [11]. The objective of our AbstractBackground: Several studies have shown that surgery alone is not enough in the management of early gastric cancer with locoregional relapse in 40% to 60%. The frequency of relapses makes regional radiotherapy an attractive possibility for adjuvant therapy. The survival benefit of adjuvant chemoradiation over surgery alone was first established by the US Intergroup 0116 study.

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Section: Discussionmentioning

confidence: 44%

Adjuvant Chemoradiation for Localized Gastric Adenocarcinoma: An Institutional Experience

Touil¹,

Loughlimi²,

Abbassi³

et al. 2017

J Cancer Sci Ther

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“…Improved understanding of GC biology will successively favor tailored surgery. Further research could possibly introduce LNR as a new biomarker [39], since it is closely associated with epidermal growth factor receptor (EGFR) expression [40].…”

Section: Discussionmentioning

confidence: 99%

The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Rawicz‐Pruszyński

Ciseł

Mlak

et al. 2019

Cancers

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The ratio of positive lymph nodes (LNs) to the total LN harvest is called the LN ratio (LNR). It is an independent prognostic factor in gastric cancer (GC). The aim of the current study was to evaluate the impact of neoadjuvant chemotherapy (NAC) on the LNR (ypLNR) in patients with advanced GC. We retrospectively analyzed the data of patients with advanced GC, who underwent gastrectomy with N1 and N2 (D2) lymphadenectomy between August 2011 and January 2019 in the Department of Surgical Oncology at the Medical University of Lublin. The exclusion criteria were a lack of preoperative NAC administration, suboptimal lymphadenectomy (

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“…This is the first study to identify lateral LNR as a prognostic factor for PTC. Recently, the value of LNR as a more accurate prognostic factor than LN number has been shown in other cancers such as esophageal cancer , gastric cancer , colon cancer , head and neck cancer , and pancreatic cancer . Vincent et al.…”

Section: Discussionmentioning

confidence: 99%

“…As in previous studies, we found no association between the number of metastatic LNs and CSM of PTC in this study. The reason why LNR was a more accurate factor than simple number of metastatic LNs remains unclear, but it might reflect the completeness of LN dissection or potential immune responses in patients . Interestingly, advanced gastric cancer with strong expression of epidermal growth factor receptor (EGFR) is closely associated with high LNR, and EGFR signaling is known to affect immune response by activating regulatory T cells during human cancer development .…”

Section: Discussionmentioning

confidence: 99%

Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size

Kim

Choe

et al. 2017

Cancer Medicine

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The current 7th TNM staging stratifies N1b papillary thyroid cancer (PTC) patients without distant metastasis into either stage I or stage IV merely by an age threshold (45 years). To date, no studies have adequately quantified the mortality risk of PTC patients with N1b disease. We hypothesized that incorporating lymph node (LN) factors into the staging system would better predict cancer‐specific mortality (CSM). A total of 745 nonmetastatic PTC patients with N1b disease were enrolled. We identified factors related to LNs and cut‐points using Cox regression and time‐dependent ROC analysis. New prognostic groupings were derived based on minimal hazard differences for CSM among the groups stratified by LN risk and age, and prediction of CSM was assessed. Lateral lymph node ratio (LNR) and largest LN size were significant prognostic LN factors at cut‐points of 0.3 and 3 cm. Without LN risk (lateral LNR >0.3 or largest LN size >3 cm), stage IV patients had prognosis [adjusted HR 1.10 (98% CI 0.19–6.20); P = 0.906] similar to stage I patients with LN risk. Patients were restratified into three prognostic groups: Group 1, <45 years without LN risk; Group 2, <45 years with LN risk or ≥45 years without LN risk; and Group 3, ≥45 with LN risk. This system had a lower log‐rank P‐value (<0.001 vs. 0.002) and higher C‐statistics (0.80 vs. 0.71) than the 7th TNM. New prognostic grouping using lateral LNR and largest LN size predicts CSM accurately and distinguishes N1b patients with different prognosis.

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Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer

Cited by 77 publications

References 63 publications

Adjuvant Chemoradiation for Localized Gastric Adenocarcinoma: An Institutional Experience

Adjuvant Chemoradiation for Localized Gastric Adenocarcinoma: An Institutional Experience

The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size

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