Positive node‐ratio in curative‐intent treatment for gastric cancer is a strong independent prognostic factor for 5‐year overall survival

Abstract

Introduction This study addressed whether the positive node‐ratio (N‐ratio) for patients who underwent curative‐intent treatment was an independent prognostic factor of overall survival (OS) for gastric adenocarcinoma (GA). Methods Consecutive patients who underwent gastrectomy for GA with at least 15 harvested nodes were evaluated for 5‐year OS. The best threshold was determined using the area under an receiver operating characteristic (ROC) curve. Univariate and multivariate models were assessed looking for independent prognostic factors for OS. Results From 1994 to 2015, 398 consecutive patients were evaluated. The N‐ratio ≥11% had an accuracy of 0.764, the sensitivity of 71.1%, the specificity of 81.7%, positive predictive value (PPV) of 91.7%, and odds ratio (OR) of 11. After multivariate analysis for OS, age ≥70 years (HR 1.44), need for total gastrectomy (HR 1.45), need for extended resection (HR 1.7), and N‐ratio ≥11% (HR 3.7) were unfavorable prognostic factors. D2 lymphadenectomy (HR 0.53) was a protective factor. The median OS according to N‐ratio was 14 months for N‐ratio >11 vs 58 months for N‐ratio <11%. Conclusion The N‐ratio ≥11% was an independent negative prognostic factor for patients who underwent treatment for GA with curative intent. The N‐ratio ≥11% presented high specificity, high PPV and high OR for risk of death for 5 years after surgery.

Retrieval of 30 Lymph Nodes Is Mandatory for Selected Stage II Gastric Cancer Patients

“…As depicted in our data, approximately half of the stage II patients are with pN0 stage and a NR of 0%, thus, the prognosis predictive value of NR is limited. But for the pN+ patients with insufficient LNRs, introducing an index of positive lymph node ratio (NR) could potentially overcome the bias of inaccurate N staging, which is in concordance with the previous reports (17,18). Nevertheless, the efforts by the surgeons and pathologists to retrieve more lymph nodes were important for avoiding false pN staging (19).…”

Design and Development of an Intelligent System for Predicting 5-Year Survival in Gastric Cancer

“…6,7 The 5-year relative survival rate is up to 70% for lesions in the early stages and 4% for lesions in the advanced stages. 6,8,9 Survival often refers to the likelihood, by which a patient will live 60 months after being diagnosed with cancer. This index is commonly used in medical science to evaluate the effects of surgical and treatment plans.…”