| Objective:The UICC/AJCC TNM system redefined the N categoriesbased on the number of metastatic lymph nodes.Although this is a simple method for staging,it needs the examination of at least 15 lymph nodes and the variety of lymphadenectomy score may also cause a stage shift.This study was to investigate the relationship between the lymph nodes ratio(LNR)and the clinical pathologic data and to evaluate the prognostic significance of metastatic lymph nodes ratio(LNR)in patients with advanced stage gastric cancer through analysing the total retrieved and positive lympn nodes.To provide the new method for accurate stage and prognosis prediction of gastric cancer.Methods:The clinicopathological data of 119 patients,who received radical resection for primary tumor of advanced gastric cancer between November 2006 and December2010 in The Second People’s Hospitalof Wuhu,were reviewed retrospectively.Spearman correlation analysis was used to determine the correlation coefficient.The clinicopathological factors influencing LNR and pN were analyzed.The Kappa and Chi-squared tests were employed to compare the clinicopathological variables with LNR.In addition,survival was determined by the Kaplan-Meier method and differences were assessed by the Log-rank test.Multivariate analysis was performed using the Cox proportional hazard regression model.Receiver operator characteristic curve was used to compare the accuracy of the number of metastatic lymph nodes to that of metastatic lymph node ratio.Results:In the trial,total number of lymph nodes harvested was 1556,545 were metastastic lymph nodes.The metastatic lymph node ratio did not correlate with the total number of lymph nodes when more than 15 lymph nodes were dissected(r=0.068,P>0.05),whereas the number of metastatic lymph nodes did(r=0.5677,P<0.01).,Univariate analysis showed that differentiation degree,vascular invasion,tumor diameter,gross type and invasion depth were significantly associated with r N or pN(all P<0.05).Histological type was significantlyassociated with LNR(P<0.05),but not with pN.Logistic regression analysis revealed that vascular invasion,tumor diameter≥4 em and invasion depth were independent risk factors for lymph node distant metastasis in AGC(all P<0.05).Conlusion: Of the 119 surgical patients enrolled,61 were free of distant metastasis and58 had distant metastasis involving the liver(35 cases),lungs(10 cases),and multiple organs(13 cases).Vascular invasion,differentiation and LNR of the tumors differed significantly between the two groups.Logistic regression analysis showed that LNR was an independent factor correlating to distant metastasis of advanced gastric cancer The LNR was assessed in 4 categories:0,0.01—0.3,0.3-0.6,>0.6.Kaplan-Meier survival analysis showed that LNR significantly influenced the postoperative survival time and Cox proportional hazard regression model analysis showed LNR was an independent poor prognostic factor.Conclusions: LNR is independently correlated with distant organ metastasis of gastric cancer and serves as an important predicative factor for estimating the prognosis of gastric cancer.The staging system based on metastatic lymph node ratio(LNR)is more reliable than the system based on the number of metastatic lymph nodes without the restriction of the number of harvesting lymph node. |
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