Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study

Abstract Purpose The purpose of this study is to evaluate the correlation between lymph node count (LNC) and survival and to evaluate whether lymph node ratio (LNR) which is related to LNC is a better predictor of survival for gastric cancer than the N category of UICC/AJCC through a multi-instituti...

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Published in:European journal of surgical oncology 2017-02, Vol.43 (2), p.432-439
Main Authors: Lee, J.H, Kang, J.-W, Nam, B.-H, Cho, G.S, Hyung, W.J, Kim, M.C, Lee, H.-J, Ryu, K.W, Ryu, S.W, Shin, D.W, Kim, C.-Y
Format: Article
Language:English
Subjects:
Female
Hematology, Oncology and Palliative Medicine
Humans
Lymph Node Excision
Lymph nodes
Lymphatic Metastasis - pathology
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Metastasis
Neoplasm Staging
Predictive Value of Tests
Stomach neoplasm
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Surgery
Survival
Survival Rate
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Summary:Abstract Purpose The purpose of this study is to evaluate the correlation between lymph node count (LNC) and survival and to evaluate whether lymph node ratio (LNR) which is related to LNC is a better predictor of survival for gastric cancer than the N category of UICC/AJCC through a multi-institutional cohort study. Methods The study cohort included 3284 patients from eight institutions. Lower and upper quartiles of LNC were used for comparisons. The cut-off values (0, 0.06, 0.27, and 0.49) for the LNR categories were based on Classification and Regression Trees techniques. Akaike information criteria (AIC) for Cox regression models was used to evaluate goodness of fit between competing predictor variables (LNR vs. N category). Results The 5-year disease-specific survival (DSS) rates of lower and upper quartiles of LNC were 82.2% and 84.8%. In the subgroup analysis of pN category, the upper quartile of LNC showed better survival than the lower quartile in pN2, pN3a, and pN3b subgroups. Regarding LNR, 5-year DSS of LNR 0, 0–0.06, 0.06–0.27, 0.27–0.49, and >0.49 was 95.3%, 88.7%, 70.6%, 42.7%, and 17.2% respectively. Multivariate analysis showed that pT, pN, LNR, residual tumor status, distant metastasis, and tumor differentiation significantly affected survival. The analysis also confirmed superiority of LNR compared with N category in the AIC analysis. Conclusion Higher LNC correlated with better survival in patients with pN2, pN3a, and pN3b gastric cancer. Our data indicate that LNR is a better predictor of survival than N category of UICC/AJCC.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2016.09.007