Preoperative Lymph Node Size Is Helpful To Predict The Prognosis Of Patients With Stage ? Gastric Cancer After Radical Resection

Background and Objective There are few reports on the relationship between preoperative lymph node size(Ns)and long-term prognosis after radical gastrectomy.To investigate the association between preoperative Ns and prognosis of radical gastrectomy for gastric cancer.Methods The clinical and pathological data of 970 patients undergoing radical gastrectomy for gastric cancer from December 2009 to May 2012 were retrospectively analyzed to investigate the effect of NS on long-term prognosis.The Ns is the maximum diameter of the largest LN measured by MDCT within 1 week before surgery.X-tile software was used to choose the optimal cutoff value of preoperative Ns and to group.The Kaplan–Meier method and Cox proportional hazards regression model were used to estimate association between preoperative Ns and the long-term outcome after radical gastric cancer surgery.A nomogram was built based on the Cox proportional hazards regression model for predicting 3-year disease-free survival and calibration plot was built as well.Results Overall,900(92.8%)patients completed a postoperative follow-up,and the median follow-up period was 51(range 2-76)months.Whereas the median disease-free survival time was 50 months.331(34.1%)of 970 patients developed a recurrence,which was most common at local lymph node.The average length of Ns was 1.52 cm in patients with recurrent,which was significantly higher than 1.14 cm that in patients without recurrence(p<0.001).Patients were categorized into three groups as follows(Ns category): Ns0: ?1.10 cm,Ns1:1.10-1.70 cm,Ns2:>1.70 cm,according to LN count cutoff values determined by X-tile program in terms of disease-free survival.On univariate and multivariate analysis,the significant factors were age,tumor size,lymph node dissection,whether to received adjuvant chemotherapy and TNM stages for overall survival.Ns category and above ingredients were independent prognostic factors in terms of disease-free survival.More than,the disease-free survival curve showed that Ns category could distinguish the patients with different age,tumor size,lymph node dissection,and whether or not received adjuvant chemotherapy,and the difference was statistically significant.However,it was only in stage ? that there was significant difference in the different Ns category in TNM stratification.Furthermore,in stage ? subgroup,the univariate and multivariate analysis of the disease-free survival revealed that Ns category,lymph node dissection,and TNM stages were independent prognostic factors for disease-free survival.The nomogram and calibration plot we developed,to predict 3-year disease-free survival rate.Conclusions: Preoperative Ns was an independent prognostic factor for disease-free survival after gastric cancer radical surgery.The nomogram combined with Ns could be simple and effective to predict 3 years disease-free survival of patients in stage ?.