ASO Author Reflections: Comparison of Three Lymph Node Staging Systems for Prognostic Evaluation of Resected Gastric Adenocarcinoma

Excerpt

Gastric adenocarcinoma (GAC) is frequently diagnosed at an advanced stage and exhibits heterogeneity in molecular biology, histopathology, and survival prognosis.1 The optimal lymph node classification system for prognostic assessment in GAC patients who undergo lymph node dissection remains unclear. The accuracy of N stage was questioned because this staging system only evaluates the absolute number of regional node metastases and ignores the total number of lymph nodes examined.2 Recognizing the restrictions of current algorithms, several studies have suggested that evaluation of prognosis by lymph node ratio (LNR) and log of the odds of metastatic lymph nodes (LODDS) is related to the relationship between metastatic and examined lymph nodes.3,4 In the current study, we aimed to develop and validate reliable and practical survival-predicting nomograms by incorporating N stage, LNR or LODDS classification with other prognostic variables to predict overall survival in two independent cohorts. Furthermore, the possible benefit of postoperative radiotherapy was evaluated by comparing the prognostic performance of different lymph node staging schemes to identify which nodal classification was more accurate for prognosis assessment.5 …