The Prognostic Value of Lymph Node Ratio after Neoadjuvant Chemotherapy in Patients with Locally Advanced Gastric Adenocarcinoma

Abstract

Purpose This study aimed to investigate the prognostic value of lymph node ratio (LNR) in patients with locally advanced gastric cancer who received neoadjuvant chemotherapy. Materials and Methods We retrospectively enrolled gastric cancer patients treated with neoadjuvant chemotherapy and curative surgery at the First Affiliated Hospital of Zhejiang University from 2004 to 2015 as the study cohort. Patients with the same inclusion criteria treated in 2016–2017 were enrolled as the validation cohort. Kaplan-Meier curves were assessed using the log-rank test to analyze the differences in overall survival (OS). Multivariate survival analysis was performed using the Cox proportional hazards model. The areas under the receiver operating characteristic curve of ypN and LNR categories for predicting the actual 3-year OS were compared. Results A total of 265 patients were included in the proposal cohort. The median number of retrieved lymph nodes (rLNs) was 32. The number of positive lymph nodes (pLNs) increased as rLN increased (P=0.037), but the LNR remained relatively constant (P=0.462). The LNR was categorized into 4 groups according to the prognosis: ypNr0, node-negative with rLN>25; ypNr1, node-negative with rLN≤25 or 0<LNR≤0.1; ypNr2, 0.1<LNR≤0.3; and ypNr3, LNR>0.3. In the validation cohort of 43 enrolled patients, there was a clear distinction in OS that significantly (P<0.001) varied depending on the LNR values and LNR was the only independent prognostic factor in multivariate analysis (P<0.001). Conclusions LNR was an independent prognostic factor for survival of patients with gastric cancer after preoperative chemotherapy and might be an alternative predictor for ypN stage.

Short- and long-term outcomes of laparoscopic surgery for locally advanced gastric cancer after neoadjuvant chemotherapy: A propensity score matching analysis

“…The lymph node ratio (LNR) has been proven to be a more stable and accurate prognostic indicator than N staging in previous studies, and it is usually unaffected by the number of DLN in predicting the prognosis of gastric cancer patients. Therefore, LNR is a promising prognostic indicator to replace the ypTNM staging system for LAGC after NC [30,31]. In addition, several large RCTs con rmed that the number of DLN by laparoscopic surgery was similar to open surgery for LAGC [3,6,32].…”

Survival Based On The Pathologic Lymph Node Ratio For Local Advanced Gastric Cancer; Elderly Patients Versus Non Elderly Patients

“…Recently, many investigations have emphasized the clinical importance of a new quantitative classi cation, which is the rate of metastatic lymph nodes and is a signi cant prognostic factor of gastric cancer following curative resection (26,27). It is reported to be an applicable prognostic factor even if the number of lymph nodes resected is less than 15 (28).…”

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

“…However, this system is complicated and inconvenient for clinical use. Compared with ypN staging, LNR is almost not affected by the number of lymph nodes dissected when judging the prognosis for gastric carcinoma patients after NACT and has been proved to be a more stable and accurate prognostic indicator in previous studies [13,29,30]. In the study by Chen et al (1791), patients obtained from the SEER database were enrolled, and the stratification of LNR instead of ypN staging was used to form a new ypT-NrM staging system [12].…”

“…Lymph node ratio (LNR, the proportion of metastasized lymph nodes to the dissected lymph nodes) has been confirmed to be a more accurate predictor of prognosis in gastric cancer patients undergoing initial gastrectomy [9][10][11]. However, there are limited literature on the predictive value of LNR in LAGC patients after NACT [12,13]. The accuracy of LNR remains to be explored for the patients who underwent NACT.…”