Oncotarget

Research Papers:

Superiority of lymph node ratio-based staging system for prognostic prediction in 2575 patients with gastric cancer: validation analysis in a large single center

Lin-Yong Zhao _, Chang-Chun Li, Lu-Yu Jia, Xiao-Long Chen, Wei-Han Zhang, Xin-Zu Chen, Kun Yang, Kai Liu, Yi-Gao Wang, Lian Xue, Bo Zhang, Zhi-Xin Chen, Jia-Ping Chen, Zong-Guang Zhou and Jian-Kun Hu

PDF  |  HTML  |  How to cite

Oncotarget. 2016; 7:51069-51081. https://doi.org/10.18632/oncotarget.9714

Metrics: PDF 1624 views  |   HTML 2320 views  |   ?  


Abstract

Lin-Yong Zhao1,2,*, Chang-Chun Li1,2,*, Lu-Yu Jia3, Xiao-Long Chen1,2, Wei-Han Zhang1,2, Xin-Zu Chen1,2, Kun Yang1,2, Kai Liu1,2, Yi-Gao Wang1,2, Lian Xue1,2, Bo Zhang1, Zhi-Xin Chen1, Jia-Ping Chen1, Zong-Guang Zhou1, Jian-Kun Hu1,2

1Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China

2Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China

3West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China

*These authors contributed equally to this work

Correspondence to:

Jian-Kun Hu, email: [email protected]

Keywords: gastric cancer, lymph node ratio, staging, prediction

Received: March 19, 2016     Accepted: May 17, 2016     Published: May 30, 2016

ABSTRACT

This study aimed to evaluate the prognostic significance of node ratio (Nr), the ratio of metastatic to retrieved lymph nodes, and to investigate whether a modified staging system based on Nr can improve prognostic ability for gastric cancer patients following gastrectomy. A total of 2572 patients were randomly divided into training set and validation set, and the cutoff points for Nr were produced using X-tile. The relationships between Nr and other clinicopathologic factors were analyzed, while survival prognostic discriminatory ability and accuracy were compared among different staging systems by AIC and C-index in R program. Patients were categorized into four groups as follows: Nr0, Nr1: 0.00–0.15, Nr2: 0.15–0.40 and Nr3: > 0.40. Nr was significantly associated with clinicopathologic factors including macroscopic type, tumor differentiation, lymphovascular invasion, perineural invasion, tumor size, T stage, N stage and TNM stage. Besides, for all patients, Nr and TNrM staging system showed a smaller AIC and a larger C-index than that of N and TNM staging system, respectively. Moreover, in subgroup analysis for patients with retrieved lymph nodes < 15, Nr was demonstrated to have a smaller AIC and a larger C-index than N staging system. Furthermore, in validation analysis, Nr, categorized by our cutoff points, showed a larger C-index and a smaller AIC value than those produced in previous studies. Nr could be considered as a reliable prognostic factor, even in patients with insufficient (< 15) retrieved lymph nodes, and TNrM staging system may improve the prognostic discriminatory ability and accuracy for gastric cancer patients undergoing radical gastrectomy.


Creative Commons License All site content, except where otherwise noted, is licensed under a Creative Commons Attribution 4.0 License.
PII: 9714