The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer

The metastatic status of the regional node is the most significant prognostic factor for early gastric cancer (EGC). However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study was to evaluate the prognostic signific...

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Bibliographic Details
Published in:Annals of surgical oncology 2006-03, Vol.13 (3), p.377-385
Main Authors: Cheong, Jae-Ho, Hyung, Woo Jin, Shen, Jian Guo, Song, Changsoo, Kim, Junuk, Choi, Seung Ho, Noh, Sung Hoon
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Follow-Up Studies
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging - methods
Prognosis
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Survival Analysis
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Summary:The metastatic status of the regional node is the most significant prognostic factor for early gastric cancer (EGC). However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study was to evaluate the prognostic significance of the ratio of metastatic to retrieved lymph nodes (N ratio) in identifying a high-risk subgroup with node-positive EGC. From a prospective database of 1264 EGC patients between 1987 and 1997, 156 (12.4%) were found to have histologically confirmed node metastasis. A number of prognostic factors, including the N ratio, were evaluated by univariate and multivariate analysis. The recurrence rate of node-positive EGC was 16.7% (n = 26). The overall 5-year survival rate of all patients was 84.0%. It was 26.9% and 95.4% in patients with and without recurrence, respectively (P < .0001; log-rank test). The cutoff value of the N ratio was set at .07. The 5-year survival rate of patients with an N ratio .07 (P < .0001; log-rank test). Both univariate and multivariate analysis identified the N ratio as the most significant predictive factor for recurrence and overall survival. Regarding stage migration, it shows superiority in comparison to the number-based N classification. The N ratio is a more effective and rational indicator for prognostic stratification of patients with lymph node-positive EGC than the current N classification of the tumor-node-metastasis system.
ISSN:1068-9265
1534-4681
DOI:10.1245/ASO.2006.04.018