Oncotarget

Research Papers:

Prognostic and predictive value of metastatic lymph node ratio in stage III gastric cancer after D2 nodal dissection

Yinbo Chen, Cong Li, Yian Du, Qi Xu, Jieer Ying and Cong Luo _

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Oncotarget. 2017; 8:70841-70846. https://doi.org/10.18632/oncotarget.19998

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Abstract

Yinbo Chen1,*, Cong Li2,*, Yian Du3, Qi Xu4, Jieer Ying4 and Cong Luo4

1Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China

2Department of Lymphoma Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China

3Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China

4Department of Abdominal Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China

*These authors have contributed equally to this work and so served both as the first author

Correspondence to:

Cong Luo, email: [email protected]

Jieer Ying, email: [email protected]

Keywords: adjuvant chemotherapy, gastric cancer, lymph node ratio

Received: February 21, 2017     Accepted: July 18, 2017     Published: August 07, 2017

ABSTRACT

Introduction: This study is to evaluate the prognostic and predictive value of metastatic lymph node ratio (MLR) in stage III gastric cancer following radical D2 dissection.

Methods: 87 patients who underwent radical resection with D2 lymphadenectomy were retrospectively evaluated. The median age was 60 with a 2:1 ratio of male/female. Of these 87 patients, 83 underwent total gastrectomy, the remaining 4 underwent subtotal gastrectomy and 57 patients received adjuvant chemotherapy with fluoropyrimidines. Indexes of lymph node involvement and other clinicopathological data were analyzed. Survival was determined by the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox proportional hazards model.

Results: Median total retrieved lymph node number was 35 (range: 10-104) with median metastatic lymph node amount of eight (range: 0-71). Median survival time was 31.7 months with a 3-year survival rate of 36.4%. Patients were divided into four groups according to MLR: MLR0, 0; MLR1, <0.1; MLR2, 0.1-0.25; MLR3, >0.25. After median follow-up of 31 months, median OS rates of MLR0 to MLR3 were 37.1m, 35.9m, 31.5m and 20.8m, respectively (p=0.013). Median OS rates were significantly different among subgroups: 39.3m and 36.5m were obtained for low subgroups (MLR<0.24) with or without adjuvant chemotherapy, respectively; 22.9m and 12.2m were found in high subgroups (MLR>0.24) with and without chemotherapy, respectively (p=0.002). Finally, MLR constituted an independent prognostic factor in multivariable analysis.

Conclusions: After R0 resection with D2 lymphadenectomy for stage III gastric cancer, MLR constitutes an effective prognostic indicator. Patients with high MLR may benefit the most from adjuvant chemotherapy.


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