scholarly journals Lymph node staging systems in patients with gastric cancer treated with D2 resection plus adjuvant chemotherapy

2018 ◽  
Vol 9 (4) ◽  
pp. 660-666 ◽  
Author(s):  
Yi-Xin Zhou ◽  
Lu-Ping Yang ◽  
Zi-Xian Wang ◽  
Ming-Ming He ◽  
Jing-Ping Yun ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Staging ◽  
Staging Systems

Comparison of lymph node staging system in gastric cancer using time-dependent ROC analysis with Harrell’s concordance index.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 12-12
Author(s):  
Etsuro Bando ◽  
Norihiko Sugisawa ◽  
Masanori Tokunaga ◽  
Yutaka Tanizawa ◽  
Taiichi Kawamura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Roc Analysis ◽  
Staging System ◽  
Time Dependent ◽  
Lymph Node Staging ◽  
Anatomical Location ◽  
Node Negative ◽  
Staging Systems

12 Background: The aim this study was to clarify what the most informative pathologic lymph node staging system in gastric cancer is, by using time-dependent receiver operating characteristic (ROC) analysis with Harrell’s concordance (c) index. Methods: This study enrolled 2747 primary gastric cancer patients, without prior chemotherapy, who underwent R0 or R1 macroscopically curative resection. We calculated concordance indices of different 3 nodal staging systems (anatomical level based on JPN 13th edition vs. numbers of metastatic nodes based upon TNM 7th edition vs. ratio of metastatic nodes; derived from Yu’s definition {Yu et al. Br J Surg;1997,N0:0, N1;0-0.1, N2;0.1-0.25, N3;0.25-}) for survival. Results: (Anatomical level) Harrell’s c-index was 0.754 with 5-year survival rate of N0; 93%, N1; 73%, N2; 51%, N3; 19%. C-index without node-negative patients was 0.628. (Numbers of positive nodes) C-index was 0.767 with 5-year survival rate of N0; 93%, N1; 81%, N2; 68%, N3; 37%. C-index without node-negative patients was 0.669. (Ratio of nodal involvement) C-index was 0.770 with 5-year survival rate of N0; 93%, N1; 80%, N2; 63%, N3; 29%. C-index without node-negative patients was 0.691, which is significantly larger than those in anatomical level or numbers of positive nodes (p<0.001, p=0.014, respectively). (Comparison of Staging System) If combined pT category with ratio grading system without pStage IA, new staging system is the significantly most informative (c-index; 0.760) than JPN 13th (c-index; 0.735) or TNM 7th (c-index; 0.742) (p=0.009, p=0.023, respectively). Conclusions: Lymph node staging system based on the conception of ratio of metastatic nodes is the most informative staging system than those with anatomical location or numbers of metastatic nodes. These results suggested that in gastric cancer pathologic staging system in next TNM classification should include the ratio of metastatic nodes.

A novel simplified approach to incorporating lymph node ratio into gastric cancer staging.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 24-24
Author(s):  
Sarah B. Fisher ◽  
Malcolm Hart Squires ◽  
Sameer H. Patel ◽  
David A. Kooby ◽  
Kenneth Cardona ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Ratio ◽  
Staging System ◽  
Cancer Staging ◽  
Lymph Node Staging ◽  
Cox Regression Analysis ◽  
Simplified Approach ◽  
Staging Systems ◽  
Node Ratio

24 Background: Previous investigators have reported on the value of lymph node ratio (LNR, defined as the number of positive nodes divided by the total number of nodes assessed) in gastric adenocarcinoma (GAC) staging. Given the complexity of previously proposed staging systems, it has not gained widespread acceptance. The aim of our study was to offer a novel simplified approach to incorporating LNR into gastric cancer staging. Methods: 131 patients who underwent curative intent resection with lymphadenectomy for GAC between 1/00-6/11 were identified. Clinicopathologic factors were assessed. Primary outcome was overall survival (OS). Results: Median age was 64 yrs, 51% were male. Median tumor size was 3.5 cm, 67% were poorly differentiated, 20% had perineural invasion, 31% had lymphovascular invasion, and 6% had a positive margin. Locoregional nodal metastases were present in 59% (n=77, N0: 41%, N1: 18%, N2: 22%, N3a: 14%, N3b: 5%). Median number of lymph nodes (LN) assessed was 15.5. Mean FU was 27.3 mos, median OS was 29.3 mos. Median LNR was 0.4 (.04-1). Patients with LNR ≥0.4 had decreased OS as compared to patients with LNR <0.4 (15.1 vs 41.5 mos, p<0.0001); the survival of patients with LNR <0.4 was similar to that of node negative pts (48 mos, p=0.882). On Cox regression analysis, LNR ≥0.4 was more strongly associated with decreased OS (HR 3.09, 95%CI: 1.81-5.26; p<0.0001) compared to the AJCC 7th edition N stage (HR 1.36, 95%CI: 1.11-1.68; p=0.004). In the subset of patients who were inadequately staged and had <16 nodes examined, a LNR ≥0.4 was associated with reduced survival compared to a LNR <0.4 (17.3 vs 41.5 mos, p=.04). Conclusions: Compared to the current lymph node staging system, a lymph node ratio using 0.4 as the cutoff may more accurately predict survival outcomes. It seems to be particularly useful in patients who have inadequate nodal assessment. This simplified approach to lymph node ratio may be a more valuable staging tool than the current AJCC nodal staging system for gastric cancer and needs to be validated.

scholarly journals Comparison of different lymph node staging systems in prognosis of gastric cancer: a bi-institutional study from Hungary

2017 ◽  
Vol 29 (4) ◽  
pp. 323-332 ◽  
Author(s):  
Dezső Tóth ◽  
◽  
Adrienn Bíró ◽  
Zsolt Varga ◽  
Miklós Török ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Staging ◽  
Staging Systems

scholarly journals Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy

Tumor Biology ◽  
2016 ◽  
Vol 37 (8) ◽  
pp. 11105-11113 ◽  
Author(s):  
Chen Jian-hui ◽  
Cai Shi-rong ◽  
Wu Hui ◽  
Chen Si-le ◽  
Xu Jian-bo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Prognostic Value ◽  
Lymph Node Staging ◽  
D2 Lymphadenectomy ◽  
Staging Systems

scholarly journals Different lymph node staging systems in patients with gastric cancer from Korean

Medicine ◽  
2016 ◽  
Vol 95 (25) ◽  
pp. e3860 ◽  
Author(s):  
Jin Won Lee ◽  
Bandar Ali ◽  
Cho Hyun Park ◽  
Kyo Young Song
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Staging ◽  
Staging Systems

scholarly journals Prognostic performance of three lymph node staging systems in patients after D2 lymphadenectomy for gastric cancer

2020 ◽  
Author(s):  
Ze-ping Huang ◽  
Wen-jun Zhang ◽  
Zi-xian Wang ◽  
Hai-peng Liu ◽  
Xiang-Ting Zeng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Optimal System ◽  
Ca 125 ◽  
D2 Lymphadenectomy ◽  
Concordance Index ◽  
Internal Validation ◽  
Preoperative Serum ◽  
Staging Systems ◽  
Resectable Gastric Cancer

Background: Accurate staging of lymph node (LN) status is essential for predicting prognosis in patients with gastric cancer. Recent proposals suggest that lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) may have superior accuracy in predicting survival by minimizing stage migration. The aim of the present study was to compare the prognostic performances of the UICC (pN), LNR and LODDS staging systems and incorporate the optimal system into a nomogram for predicting individual survival in patients with resectable gastric cancer. Methods: The study cohort comprised of 423 patients who had undergone D2 lymphadenectomy. The discriminatory powers of the different LN staging systems were compared using the concordance index (C-index). The optimal system was incorporated into a prognostic nomogram with other independent prognosticators, and bootstrap validation was performed. Results: When LN status was assessed as a continuous variable, the LNR system (C-index: 0.712) was superior to pN (C-index: 0.695) and LODDS (C-index: 0.704). Age, LNR, and preoperative serum CA 19-9 and CA 125 were incorporated into a nomogram for predicting 2-year overall survival. Internal validation of the nomogram revealed good predictive abilities, with a bootstrap-corrected concordance index of 0.704. Conclusion: Overall, LNR was the optimum predicator of survival in patients with resectable gastric cancer on the basis of LN status. LNR was incorporated into a nomogram along with age and preoperative serum CA 19-9 and CA 125. Internal validation confirmed the predictive ability of this nomogram.

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