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World J Gastroenterol. Jul 21, 2008; 14(27): 4383-4388
Published online Jul 21, 2008. doi: 10.3748/wjg.14.4383
Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus
Chang-Ming Huang, Bi-Juan Lin, Hui-Shan Lu, Xiang-Fu Zhang, Ping Li, Jian-Wei Xie
Chang-Ming Huang, Bi-Juan Lin, Hui-Shan Lu, Xiang-Fu Zhang, Ping Li, Jian-Wei Xie, Department of Oncology, Affiliated Union Hospital of Fujian Medical University, Fuzhou 350001, Fujian Province, China
Author contributions: Huang CM and Lin BJ conceived of the study, analyzed the data, and drafted the manuscript; Lu HS and Zhang XF helped revise the manuscript critically for important intellectual content; Li P and Xie JW helped collect data and design the study; all authors read and approved the final manuscript.
Correspondence to: Chang-Ming Huang, Department of Oncology, Affiliated Union Hospital, Fujian Medical University, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. hcmlr253@sohu.com
Telephone: +86-591-87118266
Fax: +86-591-83320319
Received: April 10, 2008
Revised: June 2, 2008
Accepted: June 9, 2008
Published online: July 21, 2008
Abstract

AIM: To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus.

METHODS: Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients.

RESULTS: The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (χ2 = 4.26, P = 0.0389), tumor size (χ2 = 18.48, P < 0.001), Borrmann type (χ2 = 7.41, P = 0.0065), histological grade (χ2 = 5.07, P = 0.0243), pT category (χ2 = 49.42, P < 0.001), pN category (χ2 = 87.7, P < 0.001), total number of retrieved lymph nodes (χ2 = 8.22, P = 0.0042) and MLR (χ2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (χ2 = 7.985, P = 0.018), pT category (χ2 = 30.82, P < 0.001) and MLR (χ2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple linear regression (β = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%.

CONCLUSION: The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.

Keywords: Stomach neoplasms, Lymph node metastasis, Metastatic lymph node ratio, Lymphadenectomy, Prognosis