Prognostic Significance of the Metastatic Lymph Node Ratio in Patients with Gastric Cancer

Lee, Sung Ryol; Kim, Hyung Ook; Son, Byung Ho; Shin, Jun Ho; Yoo, Chai H.

doi:10.1007/s00268-012-1520-5

Cited by 62 publications

(54 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The LNR has been calculated as the ratio of the number of metastatic lymph nodes and the number of lymph nodes examined in the surgical specimens, and patients were stratified into six subgroups in accordance with the criteria used by Lee et al [16]: LNR0, LNR1 (0.01-0.05), LNR2 (0.06-0.1), LNR3 (0.11-0.2), LNR4 (0.21-0.3), and LNR5 (>0.3). …”

Section: Methodsmentioning

confidence: 99%

Lymph-Node Ratio Classification Strongly Correlates with Cancer Survivals of Patients Who Underwent R0 Resection for Gastric Cancer with More than 15 Nodes Harvested

Lorenzon¹,

Mercantini²,

Ferri³

et al. 2014

Eur Surg Res

View full text Add to dashboard Cite

Background: During the last few years, the gastric cancer nodal staging has been extensively revised. Lately, a new system emerged in this field with the purpose of implementing the prognostic stratification: the lymph-node ratio (LNR). The aim of this study was to investigate the prognostic value of the LNR in relation to cancer survivors undergoing resection for gastric adenocarcinoma. Methods: Off 227 patients undergoing surgical resection for gastric cancer at our Department, 129 curative gastric resections with more than 15 nodes harvested were selected. The LNR was calculated and patients were stratified into 6 subgroups based on the ratio values. The subgroups were compared for data analysis. Survivals were calculated by the Kaplan-Meier method, and the mean follow-up period was 40 months. ROC curves were calculated in order to analyze the performance of the LNR system. Results: LNR stratification correlated with the stage of the disease, with the rate of patients undergoing chemotherapy and patients presenting with a relapse of disease at follow-up. Moreover, an increased ratio correlated with a worse overall, a disease-free and a disease-specific survival of the patients. The ROC curves documented a significant performance of the stratification system with the endpoints of disease-free and disease-specific survivals. Conclusion: LNR stratification correlated with cancer-related survivals in our case series. It is a reliable system that might improve current nodal staging and thereby the identification of patients with a higher risk of recurrence or cancer-related mortality.

show abstract

Section: Methodsmentioning

confidence: 99%

Lymph-Node Ratio Classification Strongly Correlates with Cancer Survivals of Patients Who Underwent R0 Resection for Gastric Cancer with More than 15 Nodes Harvested

Lorenzon¹,

Mercantini²,

Ferri³

et al. 2014

Eur Surg Res

View full text Add to dashboard Cite

show abstract

“…Complete surgical removal of the involved LN may lead to clearly better prognosis even with the large number of involved LNs (5,6,7). In breast cancers, LN size is also an important prognostic factor.…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma

Jeon

Yoon

Han

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: The presence of central neck lymph node (LN) metastases (defined as pN1a according to Tumor Node Metastasis classification) in papillary thyroid cancer (PTC) is known as an independent risk factor for recurrence. Extent of LN metastasis and the completeness of removal of metastatic LN must have an impact on prognosis but they are not easy to measure. Moreover, the significance of the size of metastatic tumors in LNs has not been clarified. This study was to evaluate the impact of the extent of LN metastasis and size of metastatic tumors on the recurrence in pathological N1a PTC. Design: This retrospective observational cohort study enrolled 292 PTC patients who underwent total thyroidectomy with central neck dissection from 1999 to 2005. LN ratio was defined as the number of metastatic LNs divided by the number of removed LNs, which was regarded as variable reflecting both extent of LN metastasis and completeness of resection, and LN size as the maximal diameter of tumor in metastatic LN. Results: The significant risk factors for recurrence in univariate analysis were large primary tumor size (defined as larger than 2 cm), high LN ratio (defined as higher than 0.4), and presence of macrometastasis (defined as larger than 0.2 cm). Age, sex, clinical node status, and microscopic perithyroidal extension had no effect on recurrence. In multivariate analysis, high LN ratio and presence of macrometastasis were independent risk factors for recurrence. Conclusion: LN ratio and size of metastatic nodes had a significant prognostic value in pathological N1a PTC. We suggest that risk stratification of pathological N1a PTC according to the pattern of LN metastasis such as LN ratio and size would give valuable information to clinicians.

show abstract

“…An LN ratio (LNR) has also been proposed and many international groups have examined the utility of an LNR for the prognosis of GC, finding this more predictive than simple analysis of the number of positive LNs [26][27][28]. However, most studies have excluded patients with fewer than 15 LNs examined, and no uniform cut-off points have been identified to date.…”

Section: Introductionmentioning

confidence: 99%

How many lymph nodes should be assessed in patients with gastric cancer? A systematic review

et al. 2012

View full text Add to dashboard Cite

Background Nodal status is one of the most important prognostic factors in gastric adenocarcinoma (GC). As such, it is important to assess an appropriate number of lymph nodes (LNs) in order to accurately stage patients. However, the number of LNs assessed in each GC case varies, and in many cases the number examined per gastric specimen is less than current recommendations. Purpose We aimed to identify and synthesize findings from all articles evaluating the association of clinicopathological features and long-term outcomes with the number of LNs assessed among GC patients. Methods Systematic electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1998 to 2009.Results Twenty-five articles were included in this review. Extensive resection, increased tumor size, and greater TNM staging were all associated with a greater number of LNs assessed. The disease-free survival was longer and recurrence rate was lower in patients with more LNs assessed. Overall survival, as well as survival by TNM and clinical stage, was improved among patients with an increased number of LNs assessed, but much of this appears to be due to stage migration, with the effect more pronounced in more advanced disease. Conclusion More LNs assessed resulted in less stage migration and possibly better long-term outcomes. Although current guidelines suggest 16 LNs to be assessed, especially in advanced GC, a higher number of LNs should be assessed.

show abstract

Prognostic Significance of the Metastatic Lymph Node Ratio in Patients with Gastric Cancer

Abstract: MLR can be a prognostic factor in patients who undergo radical resection for gastric cancer and can overcome the limitations of existing prognostic factors.

Cited by 62 publications

References 29 publications

Lymph-Node Ratio Classification Strongly Correlates with Cancer Survivals of Patients Who Underwent R0 Resection for Gastric Cancer with More than 15 Nodes Harvested

Lymph-Node Ratio Classification Strongly Correlates with Cancer Survivals of Patients Who Underwent R0 Resection for Gastric Cancer with More than 15 Nodes Harvested

The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma

How many lymph nodes should be assessed in patients with gastric cancer? A systematic review

Contact Info

Product

Resources

About