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Annals of Oncology Advance Access originally published online on January 29, 2009
Annals of Oncology 2009 20(5):897-905; doi:10.1093/annonc/mdn707
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

gastrointestinal tumors

The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients

Z. Sun{dagger}, G.-L. Zhu{dagger}, C. Lu, P.-T. Guo, B.-J. Huang, K. Li, Y. Xu, De-Ming Li, Z.-N. Wang and H.-M. Xu*

Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China

* Correspondence to: Dr H.-M. Xu, Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China. Tel: +86-13998303068; Fax: +86-24-22834060; E-mail: xuhuimian{at}126.com

Background: Previous studies indicate that N-ratio has significant superiority in minimizing ‘stage migration’ for patients with >15 lymph nodes retrieved. Whether the result is applicable to patients with ≤15 lymph nodes retrieved is still in question.

Patients and methods: Overall survival rates of 2159 gastric cancer patients who underwent radical resection were compared between patients with different number and level of lymph nodes retrieved according to pN [International Union Against Cancer (Union Internationale Contre le Cancer)/AJCC N stage], n (JGCA N stage) and rN (N-ratio) staging system.

Results: Patient number was significantly different between insufficient and sufficient number or level retrieved group in pN and n system, respectively, but not in rN system, while overall survival rates were not significantly different between those groups. The 5-year survival rates of patients with insufficient nodes retrieved were significantly lower than those with sufficient nodes retrieved in pN and n system, but not in rN system. The hazard risk for patients with insufficient nodes retrieved was significantly higher than that for patients with sufficient nodes retrieved in pN and n system, but not in rN system.

Conclusion: The rN stage has more potential advantages in minimizing stage migration phenomenon for patients with insufficient number or level of lymph nodes retrieved.

Key words: gastric cancer, lymph node metastasis, metastatic lymph node ratio, prognosis, stage migration

{dagger} Sun and Zhu contributed equally to this work.

Received for publication July 22, 2008. Revision received October 9, 2008. Accepted for publication October 10, 2008.


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