Lymph node ratio is a prospective prognostic indicator for locally advanced gastric cancer patients after neoadjuvant chemotherapy

Abstract

Background The accuracy of lymph node ratio (LNR) as a prognostic index remains to be proven for gastric cancer patients after neoadjuvant chemotherapy (NACT). This study sought to investigate the prognostic value of LNR in locally advanced gastric cancer (LAGC) patients after NACT. Methods LAGC patients with clinical TNM stages 2–3, Her2(−), and Eastern Cooperative Oncology Group, scores 0–2 are routinely scheduled with NACT. Patients with LAGC after NACT and surgical operation between January 2012 and October 2020 were retrospectively reviewed. The correlation between LNR and survival was investigated. Results Overall, 148 patients were enrolled: 103 with low-LNR (LNR ≤ 30%) and 45 with high-LNR (LNR > 30%). Approximately, 50.5% and 24.4% patients responded to NACT at the primary site in the low-LNR and high-LNR groups, respectively. The overall survival (OS) and progression-free survival (PFS) of low-LNR group were considerably better than those of high-LNR group (3-year OS: 81.9% vs 18.5%, P < 0.001; 3-year PFS: 72.6% vs 13.5%, P < 0.001). In the low-LNR group, OS and PFS were superior in patients with tumor regression grade (TRG) 0–2 than in those with TRG 3 (3-year OS: 89.2% vs 73.2%, P = 0.086; 3-year PFS: 80.3% vs 66.5%, P = 0.036). In association with OS and PFS, the degree of tumor differentiation, TRG, and LNR were identified as predictive factors, and LNR was identified as the independent prognostic factor in univariate and multivariate analyses, respectively. Conclusions LNR is a prospective index of prognosis in patients with LAGC after NACT.

Area of residual tumor measurement after preoperative chemotherapy as an objective and quantitative method for predicting prognosis of gastric cancer: a single-center retrospective study

“…Of the 11 cases, who were ART-0 treated with NAC, 6 were pCR, 5 were non-pCR, and 3 were ypN positive, all receiving postoperative adjuvant chemotherapy. Several studies have demonstrated that lymph node metastasis in GC is a prognostic factor after surgical resection alone (Baiocchi et al 2010;Siewert et al 1998) and NAC followed by curative surgery (Jiang et al 2022;Fukagawa et al 2018). Although the number of cases was small, the prognosis would likely be highly favorable if ART was 0 after NAC, even if ypN-positive or non-pCR.…”

Safety and efficacy of tislelizumab plus chemotherapy versus chemotherapy alone as neoadjuvant treatment for patients with locally advanced gastric cancer: real-world experience with a consecutive patient cohort

“…Therefore, NACT combined with radical gastrectomy has become a standard treatment for LAGC ( 3 – 6 ). However, approximately 40% of gastric cancer patients treated with NACT experience recurrence and metastasis within 3 years after surgery ( 3 – 5 , 7 , 8 ). Therefore, exploring new models of neoadjuvant therapy for LAGC is essential.…”