Published in:
01-03-2006 | Original Article
The N Ratio Predicts Recurrence and Poor Prognosis in Patients With Node-Positive Early Gastric Cancer
Authors:
Jae-Ho Cheong, MD, Woo Jin Hyung, MD, Jian Guo Shen, MD, Changsoo Song, MD, Junuk Kim, MD, Seung Ho Choi, MD, Sung Hoon Noh, MD, PhD
Published in:
Annals of Surgical Oncology
|
Issue 3/2006
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Abstract
Background
The metastatic status of the regional node is the most significant prognostic factor for early gastric cancer (EGC). However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study was to evaluate the prognostic significance of the ratio of metastatic to retrieved lymph nodes (N ratio) in identifying a high-risk subgroup with node-positive EGC.
Methods
From a prospective database of 1264 EGC patients between 1987 and 1997, 156 (12.4%) were found to have histologically confirmed node metastasis. A number of prognostic factors, including the N ratio, were evaluated by univariate and multivariate analysis.
Results
The recurrence rate of node-positive EGC was 16.7% (n = 26). The overall 5-year survival rate of all patients was 84.0%. It was 26.9% and 95.4% in patients with and without recurrence, respectively (P < .0001; log-rank test). The cutoff value of the N ratio was set at .07. The 5-year survival rate of patients with an N ratio <.07 was 94.0%; this was significantly higher than the rate (72.6%) for those with a ratio >.07 (P < .0001; log-rank test). Both univariate and multivariate analysis identified the N ratio as the most significant predictive factor for recurrence and overall survival. Regarding stage migration, it shows superiority in comparison to the number-based N classification.
Conclusions
The N ratio is a more effective and rational indicator for prognostic stratification of patients with lymph node–positive EGC than the current N classification of the tumor-node-metastasis system.