Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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A Novel Approach for Gastric Cancer Staging in Elderly Patients Based on the Lymph Node Ratio

  • Park, Joonseon (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeon, Chul Hyo (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, So Jung (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Seo, Ho Seok (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Song, Kyo Young (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Han Hong (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2021.03.11
  • Accepted : 2021.03.22
  • Published : 2021.03.31
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Abstract

Purpose: To date, no studies have been performed on staging based on the lymph node ratio (LNR) in elderly patients with gastric cancer who may require limited lymph node (LN) dissection due to morbidity and tissue fragility. We aimed to develop a new N staging system using the LNR in elderly patients with gastric cancer. Materials and Methods: The present study included patients aged over 75 years who underwent curative gastrectomy between January 1989 and December 2018. Clinicopathological data including the number of retrieved and metastatic LNs were collected and the LNR values were obtained (LNR = the number of metastatic LNs/the number of retrieved LNs). Eleven LNR groups with intervals of 0.1 were divided into four stages based on the inflection points at which the hazard ratio (HR) increased. Survival analysis was performed to evaluate the prognostic value of the LNR. Results: The four LNR stages included LNR0 (n=364), LNR1 (n=128), LNR2 (n=103), and LNR3 (n=10). In the multivariate analysis, both N staging and LNR staging exhibited significant prognostic values for predicting survival outcomes. However, the incremental change in the hazard ratio (HR) between consecutive stages was greater for the LNR staging than for the N staging (HRs: 1.607, 2.758, and 3.675 for N staging; 1.583, 3.514, and 10.261 for LNR staging). Conclusions: LNR staging is more useful than N staging in predicting the prognosis in elderly patients with gastric cancer and may be used as a complement or alternative to N staging.

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References

  1. Orsenigo E, Tomajer V, Palo SD, Carlucci M, Vignali A, Tamburini A, et al. Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer 2007;10:39-44. https://doi.org/10.1007/s10120-006-0409-0
  2. Jun JK, Choi KS, Lee HY, Suh M, Park B, Song SH, et al. Effectiveness of the Korean National Cancer Screening Program in reducing gastric cancer mortality. Gastroenterology 2017;152:1319-1328.e7. https://doi.org/10.1053/j.gastro.2017.01.029
  3. Hwang SH, Park DJ, Jee YS, Kim HH, Lee HJ, Yang HK, et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg 2009;208:186-192. https://doi.org/10.1016/j.jamcollsurg.2008.10.023
  4. Seo HS, Jung YJ, Kim JH, Park CH, Lee HH. Necessity of D2 lymph node dissection in older patients ≥80 years with gastric cancer. J Geriatr Oncol 2018;9:115-119. https://doi.org/10.1016/j.jgo.2017.09.006
  5. Bouliaris K, Rachiotis G, Diamantis A, Christodoulidis G, Polychronopoulou E, Tepetes K. Lymph node ratio as a prognostic factor in gastric cancer patients following D1 resection. Comparison with the current TNM staging system. Eur J Surg Oncol 2017;43:1350-1356. https://doi.org/10.1016/j.ejso.2017.03.013
  6. Kim Y, Squires MH, Poultsides GA, Fields RC, Weber SM, Votanopoulos KI, et al. Impact of lymph node ratio in selecting patients with resected gastric cancer for adjuvant therapy. Surgery 2017;162:285-294. https://doi.org/10.1016/j.surg.2017.03.023
  7. Komatsu S, Ichikawa D, Miyamae M, Kosuga T, Okamoto K, Arita T, et al. Positive lymph node ratio as an indicator of prognosis and local tumor clearance in N3 gastric cancer. J Gastrointest Surg 2016;20:1565-1571. https://doi.org/10.1007/s11605-016-3197-9
  8. Nelen SD, van Steenbergen LN, Dassen AE, van der Wurff AA, Lemmens VE, Bosscha K. The lymph node ratio as a prognostic factor for gastric cancer. Acta Oncol 2013;52:1751-1759. https://doi.org/10.3109/0284186X.2012.754991
  9. Yamashita H, Deng J, Liang H, Seto Y. Re-evaluating the prognostic validity of the negative to positive lymph node ratio in node-positive gastric cancer patients. Surgery 2017;161:1588-1596. https://doi.org/10.1016/j.surg.2016.12.018
  10. Yamashita K, Hosoda K, Ema A, Watanabe M. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol 2016;42:1253-1260. https://doi.org/10.1016/j.ejso.2016.03.001
  11. Zhu J, Xue Z, Zhang S, Guo X, Zhai L, Shang S, et al. Integrated analysis of the prognostic role of the lymph node ratio in node-positive gastric cancer: a meta-analysis. Int J Surg 2018;57:76-83. https://doi.org/10.1016/j.ijsu.2018.08.002
  12. Wohnrath DR, Araujo RL. Positive node-ratio in curative-intent treatment for gastric cancer is a strong independent prognostic factor for 5-year overall survival. J Surg Oncol 2020;121:777-783. https://doi.org/10.1002/jso.25755
  13. Hwang JE, Kim H, Shim HJ, Bae WK, Hwang EC, Jeong O, et al. Lymph-node ratio is an important clinical determinant for selecting the appropriate adjuvant chemotherapy regimen for curative D2-resected gastric cancer. J Cancer Res Clin Oncol 2019;145:2157-2166. https://doi.org/10.1007/s00432-019-02963-7
  14. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean Practice Guideline for Gastric Cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer 2019;19:1-48. https://doi.org/10.5230/jgc.2019.19.e8
  15. Lee YC, Yang PJ, Zhong Y, Clancy TE, Lin MT, Wang J. Lymph node ratio-based staging system outperforms the seventh AJCC system for gastric cancer: validation analysis with National Taiwan University Hospital Cancer Registry. Am J Clin Oncol 2017;40:35-41. https://doi.org/10.1097/COC.0000000000000110
  16. Yoshikawa K, Shimada M, Higashijima J, Nakao T, Nishi M, Kashihara H, et al. Limited lymph node dissection in elderly patients with gastric cancer. J Med Invest 2016;63:91-95. https://doi.org/10.2152/jmi.63.91
  17. Bilici A, Selcukbiricik F, Seker M, Oven BB, Olmez OF, Yildiz O, et al. Prognostic significance of metastatic lymph node ratio in patients with pN3 gastric cancer who underwent curative gastrectomy. Oncol Res Treat 2019;42:209-216. https://doi.org/10.1159/000496746

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