Background: Lymphadenectomy is a fundamental part of surgical strategy in patients with gastric cancer. Lymph node (LN) status is a key point in assessment of prognosis in gastric cancer. The LN ratio (LNR)—number of positive LNs/number of sampled LNs—offers a new approach for predicting survival. The aim of the study was to find factors affecting LN yield and the impact of LNR on 5-year survival. Methods: Prospective multicenter quality assurance study. Only LN-positive patients were included in the LNR calculations. Results: 4946 patients from 149 hospitals were enrolled. The inclusion criteria were met by 1884 patients. Patients were divided into two groups: Group 1 (<16 LN), 456 patients and Group 2 (≥16 LN), 1428 patients. The multivariate analysis found G2 (OR 1.98; 95%CI 1.11–3.54), G3 (OR 2.15; 95%CI 1.212–3.829), UICC-stage II (OR 1.44; 95%CI 1.01–2.06) and III (OR 1.71; 95%CI 1.14–2.57), age < 70 (OR 1.818 95%CI 1.19–2.78) and female gender (OR 1.37; 95%CI 1.00–1.86) as independent factors of ≥16 LN yield. Patients with a LNR ≥ 0.4 have a lower probability of survival (p= 0.039 and <0.001) than patients with a LNR = 0.1. Patients with UICC-II have a lower probability of survival than UICC-I (p= 0.023). Age 70–80 (p= 0.045) and > 80 years (p= 0.003) were negative prognostic factors for long-term survival. Conclusion: Long-term survival is directly related to adequate lymphadenectomy. LNR could be superior to pN-stage for estimating survival and adds remarkable nuances in prognosis compared to UICC-stage. LNR also appears valid, even in the case of insufficient LN yield.
背景：淋巴结清扫术是胃癌患者手术策略的基本组成部分。淋巴结状态是评估胃癌预后的关键点。淋巴结比率（阳性淋巴结数/采样淋巴结数）为预测生存提供了新方法。本研究旨在探讨影响淋巴结检出数量的因素及淋巴结比率对五年生存率的影响。方法：前瞻性多中心质量保证研究。仅淋巴结阳性患者纳入淋巴结比率计算。结果：纳入来自149家医院的4946例患者，其中1884例符合纳入标准。患者分为两组：第一组（检出淋巴结<16枚）456例，第二组（检出淋巴结≥16枚）1428例。多变量分析显示G2级（OR 1.98；95%CI 1.11-3.54）、G3级（OR 2.15；95%CI 1.212-3.829）、UICC II期（OR 1.44；95%CI 1.01-2.06）和III期（OR 1.71；95%CI 1.14-2.57）、年龄<70岁（OR 1.818；95%CI 1.19-2.78）及女性（OR 1.37；95%CI 1.00-1.86）是获得≥16枚淋巴结的独立影响因素。淋巴结比率≥0.4的患者生存概率显著低于淋巴结比率=0.1的患者（p=0.039和<0.001）。UICC II期患者生存概率低于UICC I期（p=0.023）。70-80岁（p=0.045）及>80岁（p=0.003）是长期生存的负面预后因素。结论：长期生存与充分的淋巴结清扫直接相关。在评估生存预后方面，淋巴结比率可能优于pN分期，且较UICC分期能提供更精细的预后分层。即使在淋巴结检出不足的情况下，淋巴结比率仍具有重要临床价值。
Lymph Node Yield and Lymph Node Ratio for Prognosis of Long-Term Survival in Gastric Carcinoma
肿瘤(癌症)患者之家