Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer

A multi-institutional cohort study

J. H. Lee, J. W. Kang, B. H. Nam, G. S. Cho, WooJin Hyung, M. C. Kim, H. J. Lee, K. W. Ryu, S. W. Ryu, D. W. Shin, C. Y. Kim

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose The purpose of this study is to evaluate the correlation between lymph node count (LNC) and survival and to evaluate whether lymph node ratio (LNR) which is related to LNC is a better predictor of survival for gastric cancer than the N category of UICC/AJCC through a multi-institutional cohort study. Methods The study cohort included 3284 patients from eight institutions. Lower and upper quartiles of LNC were used for comparisons. The cut-off values (0, 0.06, 0.27, and 0.49) for the LNR categories were based on Classification and Regression Trees techniques. Akaike information criteria (AIC) for Cox regression models was used to evaluate goodness of fit between competing predictor variables (LNR vs. N category). Results The 5-year disease-specific survival (DSS) rates of lower and upper quartiles of LNC were 82.2% and 84.8%. In the subgroup analysis of pN category, the upper quartile of LNC showed better survival than the lower quartile in pN2, pN3a, and pN3b subgroups. Regarding LNR, 5-year DSS of LNR 0, 0–0.06, 0.06–0.27, 0.27–0.49, and >0.49 was 95.3%, 88.7%, 70.6%, 42.7%, and 17.2% respectively. Multivariate analysis showed that pT, pN, LNR, residual tumor status, distant metastasis, and tumor differentiation significantly affected survival. The analysis also confirmed superiority of LNR compared with N category in the AIC analysis. Conclusion Higher LNC correlated with better survival in patients with pN2, pN3a, and pN3b gastric cancer. Our data indicate that LNR is a better predictor of survival than N category of UICC/AJCC.

Original languageEnglish
Pages (from-to)432-439
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume43
Issue number2
DOIs
Publication statusPublished - 2017 Feb 1

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Stomach Neoplasms
Cohort Studies
Lymph Nodes
Survival
Residual Neoplasm
Proportional Hazards Models
Multivariate Analysis
Survival Rate
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Lee, J. H. ; Kang, J. W. ; Nam, B. H. ; Cho, G. S. ; Hyung, WooJin ; Kim, M. C. ; Lee, H. J. ; Ryu, K. W. ; Ryu, S. W. ; Shin, D. W. ; Kim, C. Y. / Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer : A multi-institutional cohort study. In: European Journal of Surgical Oncology. 2017 ; Vol. 43, No. 2. pp. 432-439.
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title = "Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: A multi-institutional cohort study",
abstract = "Purpose The purpose of this study is to evaluate the correlation between lymph node count (LNC) and survival and to evaluate whether lymph node ratio (LNR) which is related to LNC is a better predictor of survival for gastric cancer than the N category of UICC/AJCC through a multi-institutional cohort study. Methods The study cohort included 3284 patients from eight institutions. Lower and upper quartiles of LNC were used for comparisons. The cut-off values (0, 0.06, 0.27, and 0.49) for the LNR categories were based on Classification and Regression Trees techniques. Akaike information criteria (AIC) for Cox regression models was used to evaluate goodness of fit between competing predictor variables (LNR vs. N category). Results The 5-year disease-specific survival (DSS) rates of lower and upper quartiles of LNC were 82.2{\%} and 84.8{\%}. In the subgroup analysis of pN category, the upper quartile of LNC showed better survival than the lower quartile in pN2, pN3a, and pN3b subgroups. Regarding LNR, 5-year DSS of LNR 0, 0–0.06, 0.06–0.27, 0.27–0.49, and >0.49 was 95.3{\%}, 88.7{\%}, 70.6{\%}, 42.7{\%}, and 17.2{\%} respectively. Multivariate analysis showed that pT, pN, LNR, residual tumor status, distant metastasis, and tumor differentiation significantly affected survival. The analysis also confirmed superiority of LNR compared with N category in the AIC analysis. Conclusion Higher LNC correlated with better survival in patients with pN2, pN3a, and pN3b gastric cancer. Our data indicate that LNR is a better predictor of survival than N category of UICC/AJCC.",
author = "Lee, {J. H.} and Kang, {J. W.} and Nam, {B. H.} and Cho, {G. S.} and WooJin Hyung and Kim, {M. C.} and Lee, {H. J.} and Ryu, {K. W.} and Ryu, {S. W.} and Shin, {D. W.} and Kim, {C. Y.}",
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Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer : A multi-institutional cohort study. / Lee, J. H.; Kang, J. W.; Nam, B. H.; Cho, G. S.; Hyung, WooJin; Kim, M. C.; Lee, H. J.; Ryu, K. W.; Ryu, S. W.; Shin, D. W.; Kim, C. Y.

In: European Journal of Surgical Oncology, Vol. 43, No. 2, 01.02.2017, p. 432-439.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer

T2 - A multi-institutional cohort study

AU - Lee, J. H.

AU - Kang, J. W.

AU - Nam, B. H.

AU - Cho, G. S.

AU - Hyung, WooJin

AU - Kim, M. C.

AU - Lee, H. J.

AU - Ryu, K. W.

AU - Ryu, S. W.

AU - Shin, D. W.

AU - Kim, C. Y.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Purpose The purpose of this study is to evaluate the correlation between lymph node count (LNC) and survival and to evaluate whether lymph node ratio (LNR) which is related to LNC is a better predictor of survival for gastric cancer than the N category of UICC/AJCC through a multi-institutional cohort study. Methods The study cohort included 3284 patients from eight institutions. Lower and upper quartiles of LNC were used for comparisons. The cut-off values (0, 0.06, 0.27, and 0.49) for the LNR categories were based on Classification and Regression Trees techniques. Akaike information criteria (AIC) for Cox regression models was used to evaluate goodness of fit between competing predictor variables (LNR vs. N category). Results The 5-year disease-specific survival (DSS) rates of lower and upper quartiles of LNC were 82.2% and 84.8%. In the subgroup analysis of pN category, the upper quartile of LNC showed better survival than the lower quartile in pN2, pN3a, and pN3b subgroups. Regarding LNR, 5-year DSS of LNR 0, 0–0.06, 0.06–0.27, 0.27–0.49, and >0.49 was 95.3%, 88.7%, 70.6%, 42.7%, and 17.2% respectively. Multivariate analysis showed that pT, pN, LNR, residual tumor status, distant metastasis, and tumor differentiation significantly affected survival. The analysis also confirmed superiority of LNR compared with N category in the AIC analysis. Conclusion Higher LNC correlated with better survival in patients with pN2, pN3a, and pN3b gastric cancer. Our data indicate that LNR is a better predictor of survival than N category of UICC/AJCC.

AB - Purpose The purpose of this study is to evaluate the correlation between lymph node count (LNC) and survival and to evaluate whether lymph node ratio (LNR) which is related to LNC is a better predictor of survival for gastric cancer than the N category of UICC/AJCC through a multi-institutional cohort study. Methods The study cohort included 3284 patients from eight institutions. Lower and upper quartiles of LNC were used for comparisons. The cut-off values (0, 0.06, 0.27, and 0.49) for the LNR categories were based on Classification and Regression Trees techniques. Akaike information criteria (AIC) for Cox regression models was used to evaluate goodness of fit between competing predictor variables (LNR vs. N category). Results The 5-year disease-specific survival (DSS) rates of lower and upper quartiles of LNC were 82.2% and 84.8%. In the subgroup analysis of pN category, the upper quartile of LNC showed better survival than the lower quartile in pN2, pN3a, and pN3b subgroups. Regarding LNR, 5-year DSS of LNR 0, 0–0.06, 0.06–0.27, 0.27–0.49, and >0.49 was 95.3%, 88.7%, 70.6%, 42.7%, and 17.2% respectively. Multivariate analysis showed that pT, pN, LNR, residual tumor status, distant metastasis, and tumor differentiation significantly affected survival. The analysis also confirmed superiority of LNR compared with N category in the AIC analysis. Conclusion Higher LNC correlated with better survival in patients with pN2, pN3a, and pN3b gastric cancer. Our data indicate that LNR is a better predictor of survival than N category of UICC/AJCC.

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