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. 2010 May;17(5):1267-77.
doi: 10.1245/s10434-010-0914-6. Epub 2010 Jan 23.

New metastatic lymph node ratio system reduces stage migration in patients undergoing D1 lymphadenectomy for gastric adenocarcinoma

Ugwuji N Maduekwe  1 , Gregory Y Lauwers, Carlos Fernandez-Del-Castillo, David L Berger, Charles M Ferguson, David W Rattner, Sam S Yoon
Affiliations

New metastatic lymph node ratio system reduces stage migration in patients undergoing D1 lymphadenectomy for gastric adenocarcinoma

Ugwuji N Maduekwe et al. Ann Surg Oncol. 2010 May.

Abstract

Background: The American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system for gastric cancer incorporates the absolute number of metastatic lymph nodes (N status) and is optimally used when >or=15 nodes are examined. The ratio of metastatic to examined nodes (N ratio) is an effective prognostic tool, but has not been examined in Western patients undergoing primarily D1 lymphadenectomy.

Methods: Two hundred and fifty seven patients with gastric adenocarcinoma who underwent gastric resection between 1995 and 2005 at our institution were examined. Novel N ratio intervals were determined using the best cutoff approach (Nr0: N ratio = 0 and >or=15 nodes examined; Nr1: 0 <or= N ratio <or= 0.3; Nr2: 0.3 < N ratio <or= 0.7; and Nr3: N ratio > 0.7). Overall survival was examined according to N status and N ratio.

Results: 83% of patients underwent D1 lymphadenectomy with a median of 14 lymph nodes examined. Overall survival stratified by N status was significantly different in patients with <15 nodes examined compared with those with >or=15 nodes examined. When we stratified by N ratio intervals, there was no significant difference in overall survival in patients with <15 versus >or= 15 nodes examined. On multivariate analysis, N ratio but not N status was retained as an independent prognostic factor.

Conclusions: The use of N status for staging patients undergoing primarily D1 lymphadenectomy results in significant stage migration due to varying numbers of nodes examined. Use of N ratio reduces stage migration and may be a more reliable method of staging these patients.

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Conflict of interest statement

Disclosures: None

Figures

Figure 1
Figure 1
(A) Overall survival of patients based on 2002 AJCC/UICC N status. (B) Overall survival of patients with <15 nodes examined and ≥15 nodes examined based on 2002 AJCC/UICC N status.
Figure 2
Figure 2
(A) Overall survival of patients based on N ratio intervals. (B) Overall survival of patients with <15 nodes examined and ≥15 nodes examined based on N ratio intervals.
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