Ratio between metastatic and examined lymph nodes (N ratio) may have low clinical utility in gastric cancer patients treated by limited lymphadenectomy: Results from a single-center experience of 526 patients

Corrado Pedrazzani, Armands Sivins, Guntis Ancans, Daniele Marrelli, Giovanni Corso, Viesturs Krumins, Franco Roviello, Marcis Leja

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Abstract

Background: The aim of this study was to evaluate the prognostic value of the ratio of metastatic to examined lymph nodes (N ratio) in gastric cancer patients who underwent limited lymphadenectomy and had a small number (≤15) of analyzed nodes. Methods: The prognostic value of the actual AJCC/UICC pN staging system and the N ratio (0%, 1-25%, > 25%) were analyzed by means of univariate and multivariate analyses for 526 patients who underwent R0 resection for gastric adenocarcinoma at the Latvia Oncology Center. Results: The mean (SD) number of analyzed nodes was 5.6 (2.8). The number of positive nodes significantly increased with the number of analyzed nodes (p <0.001). No significant differences in survival (p = 0.508) and risk of death (p = 0.224) were observed between pN1 and pN2 subsets. When the N ratio (1-25% vs. > 25%) was taken into account, a significant difference was demonstrated between pNR1 and pNR2 with respect to survival (p = 0.017) and risk of death (p = 0.012). Nonetheless, the joint allocation of the two classifications demonstrated that only a minority of patients (28 cases) belonged to the pNR1 subset and none of these belonged to the AJCC/UICC pN2 subset. Conclusions: When a small number of lymph nodes are analyzed, the N ratio can discriminate patients better than TNM classification. However, because a small number of retrieved nodes produced only a small number of pNR1 patients, the N ratio classification cannot be justified for clinical use.

Original languageEnglish
Pages (from-to)85-91
Number of pages7
JournalWorld Journal of Surgery
Volume34
Issue number1
DOIs
Publication statusPublished - Jan 2010

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Lymph Node Excision
Stomach Neoplasms
Lymph Nodes
Latvia
Neoplasm Staging
Stomach
Adenocarcinoma
Multivariate Analysis
Joints
Survival

ASJC Scopus subject areas

  • Surgery

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Ratio between metastatic and examined lymph nodes (N ratio) may have low clinical utility in gastric cancer patients treated by limited lymphadenectomy : Results from a single-center experience of 526 patients. / Pedrazzani, Corrado; Sivins, Armands; Ancans, Guntis; Marrelli, Daniele; Corso, Giovanni; Krumins, Viesturs; Roviello, Franco; Leja, Marcis.

In: World Journal of Surgery, Vol. 34, No. 1, 01.2010, p. 85-91.

Research output: Contribution to journalArticle

Pedrazzani, Corrado ; Sivins, Armands ; Ancans, Guntis ; Marrelli, Daniele ; Corso, Giovanni ; Krumins, Viesturs ; Roviello, Franco ; Leja, Marcis. / Ratio between metastatic and examined lymph nodes (N ratio) may have low clinical utility in gastric cancer patients treated by limited lymphadenectomy : Results from a single-center experience of 526 patients. In: World Journal of Surgery. 2010 ; Vol. 34, No. 1. pp. 85-91.
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abstract = "Background: The aim of this study was to evaluate the prognostic value of the ratio of metastatic to examined lymph nodes (N ratio) in gastric cancer patients who underwent limited lymphadenectomy and had a small number (≤15) of analyzed nodes. Methods: The prognostic value of the actual AJCC/UICC pN staging system and the N ratio (0{\%}, 1-25{\%}, > 25{\%}) were analyzed by means of univariate and multivariate analyses for 526 patients who underwent R0 resection for gastric adenocarcinoma at the Latvia Oncology Center. Results: The mean (SD) number of analyzed nodes was 5.6 (2.8). The number of positive nodes significantly increased with the number of analyzed nodes (p <0.001). No significant differences in survival (p = 0.508) and risk of death (p = 0.224) were observed between pN1 and pN2 subsets. When the N ratio (1-25{\%} vs. > 25{\%}) was taken into account, a significant difference was demonstrated between pNR1 and pNR2 with respect to survival (p = 0.017) and risk of death (p = 0.012). Nonetheless, the joint allocation of the two classifications demonstrated that only a minority of patients (28 cases) belonged to the pNR1 subset and none of these belonged to the AJCC/UICC pN2 subset. Conclusions: When a small number of lymph nodes are analyzed, the N ratio can discriminate patients better than TNM classification. However, because a small number of retrieved nodes produced only a small number of pNR1 patients, the N ratio classification cannot be justified for clinical use.",
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AU - Ancans, Guntis

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AU - Krumins, Viesturs

AU - Roviello, Franco

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