New metastatic lymph node ratio system reduces stage migration in patients undergoing D1 lymphadenectomy for gastric adenocarcinoma.

Abstract:

BACKGROUND:The American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system for gastric cancer incorporates the absolute number of metastatic lymph nodes (N status) and is optimally used when >or=15 nodes are examined. The ratio of metastatic to examined nodes (N ratio) is an effective prognostic tool, but has not been examined in Western patients undergoing primarily D1 lymphadenectomy. METHODS:Two hundred and fifty seven patients with gastric adenocarcinoma who underwent gastric resection between 1995 and 2005 at our institution were examined. Novel N ratio intervals were determined using the best cutoff approach (Nr0: N ratio = 0 and >or=15 nodes examined; Nr1: 0 0.7). Overall survival was examined according to N status and N ratio. RESULTS:83% of patients underwent D1 lymphadenectomy with a median of 14 lymph nodes examined. Overall survival stratified by N status was significantly different in patients with <15 nodes examined compared with those with >or=15 nodes examined. When we stratified by N ratio intervals, there was no significant difference in overall survival in patients with <15 versus >or= 15 nodes examined. On multivariate analysis, N ratio but not N status was retained as an independent prognostic factor. CONCLUSIONS:The use of N status for staging patients undergoing primarily D1 lymphadenectomy results in significant stage migration due to varying numbers of nodes examined. Use of N ratio reduces stage migration and may be a more reliable method of staging these patients.

journal_name

Ann Surg Oncol

authors

Maduekwe UN,Lauwers GY,Fernandez-Del-Castillo C,Berger DL,Ferguson CM,Rattner DW,Yoon SS

doi

10.1245/s10434-010-0914-6

subject

Has Abstract

pub_date

2010-05-01 00:00:00

pages

1267-77

issue

5

eissn

1068-9265

issn

1534-4681

journal_volume

17

pub_type

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