br Table Basic characteristics of patients
Table 1 Basic characteristics of patients.
Variable Category Overall, Adjuvant group, Non-adjuvant group, P value
OPD, outpatient department; ER, emergency room; CEA, carcinoembryonic antigen; CA19-9, cancer antigen 19-9; ECOG, Eastern
Cooperative Oncology Group; ASA, American Society of Anesthesiologists.
In this study, LNR was shown to be an independent prog-nostic factor of OS and DFS after D2 surgery in gastric cancer patients with metastasis to more than 15 regional Amiloride HCL nodes. We developed an LNR-based prognostic model for predicting survival outcomes in patients with locally advanced gastric cancer. The model accurately predicted survival outcome and was internally validated with a bootstrapped corrected c-index of 0.79. All the five inde-pendent variables of this prognostic model are accessible and are available during preparation for adjuvant chemo-therapy. Therefore, this model is widely applicable. This study showed that the LNR-based model might enable prognostic stratification of locally advanced gastric cancer patients after surgical resection and might assist clinicians in counseling patients appropriately.
High numbers of metastatic regional lymph nodes imply a poor prognosis.13 Unfortunately, no prognostic stratifica-tion model that considers the number of metastatic lymph nodes in patients with metastases to more than 15 regional lymph nodes is available in literature. The LNR, calculated by dividing the number of metastatic lymph nodes with the total number of retrieved lymph nodes, might replace the number of metastatic lymph nodes as a prognostic factor in such circumstance. High LNR denotes either extensive metastases of regional lymph nodes or few numbers of lymph node retrieved, thus indicating either more locally advanced tumor stage or less extensive lymph node dissection. LNR is consistently associated with poor prog-nosis in several types of gastrointestinal cancers, including gastric cancer,12e16 colorectal cancer,23 pancreatic can-cer,24 and ampulla of Vater cancer,25 as well as in other non-gastrointestinal tract malignancies.26 Komatsu
LNR-based prognostic model for gastric cancer 89
Table 2 Univariate analysis for overall survival and disease-free survival.
Variable Category No (%)
Median survival Univariate p
Median survival Univariate p
Lymphatic invasion No 8 n/a
OPD, outpatient department; ER, emergency room; CEA, carcinoembryonic antigen; CA19-9, cancer antigen 19-9; ECOG PS, Eastern
Cooperative Oncology Group performance status; ASA, American Society of Anesthesiologists.
Figure 1 Multivariate analysis for overall survival.
Table 3 Prognostic score.
Variable b-Coefficients SE Point
SE, standard error; CEA, carcinoembryonic antigen; ECOG PS,
Eastern Cooperative Oncology Group performance status; ASA, American Society of Anesthesiologists; LNR, ratio of metastaticlymph nodes to total retrieved lymph nodes.
et al conducted a study that included 1069 consecutive gastric cancer patients and reported that high LNR is a significant factor for high lymphatic invasion, vascular in-vasion, and undifferentiated cancer.27 In the molecular
level, high LNR was closely associated with epidermal growth factor receptor expression,28 which was associated with poor patient outcomes after curative resection of gastric cancer.29,30 However, the optimal cutoff value of LNR as a prognostic factor for gastric cancer has not been established. Kilic et al identified LNR 0.75 as a prognostic factor for DFS based on 71 gastric cancer patients with metastases to more than 15 regional lymph nodes who un-derwent D2 lymph node dissection.31 Similarly, our study identified LNR 0.80 as a prognostic factor for both DFS and OS. The high cutoff value of LNR as the prognostic factor for survival outcome indicates the severity of this disease entity. In line with previous studies, we identified the prognostic value of LNR in gastric cancer patients with metastasis to more than 15 regional lymph nodes after D2 surgery. As an essential result in pathological reports, we recommend the incorporation of LNR as a prognostic tool in clinical practice for patients with gastric cancer with metastasis to more than 15 lymph nodes.