Metastatic lymph node ratio to evaluate prognosis of patients with stage Ⅱ-Ⅲ gastric cancer after radical gastrectomy

doi:10.16139/j.1007-9610.2022.05.010

Abstract

Abstract: Objective To study the metastatic lymph node ratio for grouping of gastric cancer patients and evaluate the prognosis. Methods A total of 392 patients of gastric cancer who underwent radical gastrectomy with stage Ⅱ-Ⅲ according to the American Joint Committee on Cancer (AJCC) 8th in Zhongshan Hospital of Fudan University from January 2004 to July 2018 were retrospectively analyzed. X-tile software was used to group patients based on the metastatic lymph node ratio. The correlation between metastatic lymph node ratio and other clinicopathological factors was made, and the evaluation of prognosis of patients was assessed. The nomogram model of prediction was established. Calibration curves were drawn, and comparison between the curves and data of patients was performed. Internal validation was done by the Bootstrap method. Concordance index (C-index) was calculated to test the accuracy of model. Results X-tile analysis showed that the best cut-off values were 0.20 (20%) and 0.70 (70%) of metastatic lymph node ratio. According to the cut-off values, the patients in this study were divided into 3 subgroups at metastatic lymph node ratio 1(0-20%), metastatic lymph node ratio 2 (21%-69%), and metastatic lymph node ratio 3 (70%-100%) with significant difference in survival statistically(P<0.001). Univariate analysis showed that metastatic lymph node ratio, TNM stage, T stage, N stage, lymphatic invasion, and age were related factors affecting prognosis. Multivariate analysis showed that metastatic lymph node ratio, T stage, N stage, lymphatic invasion, and age were independent factors affecting prognosis. Receiver operator characteristic curve of postoperative overall survival rates of patients were drawn using metastatic lymph node ratio, TNM stage, lympha-tic invasion and age, of which area under the curve were 0.699, 0.667, 0.587 and 0.561. The independent 4 risk factors were taken into account to construct nomogram prediction models. C-index was 0.707 (95% CI: 0.705-0.708). The 1-, 3- and 5- year survival rate predicted by the nomogram were consistent with the actual data. Conclusions Metastatic lymph node ratio is an independent factor affecting the prognosis of radical gastrectomy for stage Ⅱ-Ⅲ gastric cancer. Metastatic lymph node ratio is an effective supplement to pathological N stage, which can direct reasonable treatment.

Key words: Gastric cancer, Metastatic lymph node ratio, Lymphatic invasion

CLC Number:

R735.2

DAI Zhiqiang, ZHENG Jinxin, TANG Zhaoqing, ZHANG Qi, GU Yuan, SHI Zhongyi, HU Guohua, SUN Yihong. Metastatic lymph node ratio to evaluate prognosis of patients with stage Ⅱ-Ⅲ gastric cancer after radical gastrectomy[J]. Journal of Surgery Concepts & Practice, 2022, 27(05): 429-434.

Figures/Tables 8

References 17

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临床病理因素	总体(n=392)	rN			统计值	P值
临床病理因素	总体(n=392)	rN1(n=193)	rN2(n=127)	rN3(n=72)	统计值	P值
年龄(岁)	61.3±11.6	61.8±11.3	60.5±11.5	61.6±12.4	0.473	0.624
性别[n(%)]					2.149	0.341
男	269(68.6)	83(71.5)	81(68.5)	30(69.4)
女	123(31.4)	55(28.5)	46(31.5)	22(30.6)
肿瘤部位[n(%)]					11.331	0.023
贲门	63(16.1)	35(18.1)	21(16.5)	7(9.7)
胃体	88(22.4)	32(16.6)	31(24.4)	25(34.7)
胃窦	241(61.5)	126(65.3)	75 (59.1)	40(55.6)
分化程度[n(%)]					9.948	0.090
Ⅰ	1(0.3)	1(0.5)	0(0)	0(0)
Ⅱ	70(17.9)	45(23.3)	18(14.2)	7(9.7)
Ⅱ~Ⅲ	25(6.4)	12(6.2)	9(7.1)	4(5.6)
Ⅲ	296(75.5)	135(69.9)	100(78.7)	61(84.7)
T分期[n(%)]					33.385	<0.001
T₁	8(2.0)	1(0.5)	6(4.7)	1(1.4)
T₂	28(7.1)	19(9.8)	8 (6.3)	1(1.4)
T₃	150(38.3)	89(46.1)	46(36.2)	15(20.8)
T₄	206(52.6)	84(43.5)	67(52.8)	55(76.4)
N分期[n(%)]					290.735	<0.001
N₀	60(15.5)	56(33.2)	3(2.4)	1(1.4)
N₁	73(18.5)	73(40.1)	0(0)	0(0)
N₂	92(23.4)	59(27.2)	32(25.2)	1(1.4)
N₃	167(27.2)	5(1.1)	92(72.4)	70(97.2)
TNM分期[n(%)]					107.082	<0.001
Ⅱ	115 (29.3)	103(53.4)	11(68.7)	1(1.4)
Ⅲ	277 (70.7)	90(46.6)	116(91.3)	71(98.6)
淋巴管浸润[n(%)]					34.792	<0.001
有	98(25.0)	23(11.9)	47(37.0)	28(38.9)
无	294(75.0)	170(88.1)	80(63.0)	44(61.1)
神经侵犯[n(%)]					2.215	0.344
有	92(23.5)	49(25.4)	24(18.9)	19(26.4)
无	300(76.5)	144(74.6)	103(81.1)	53(73.6)
癌结节[n(%)]					46.626	0.036
有	67(17.1)	35(18.1)	14(11.0)	18(25.0)
无	325(82.9)	158(81.9)	113(89.0)	54(75.0)

临床病理因素	β值	标准误	Wald值	风险比	95%CI	P值
淋巴管浸润	0.693	0.139	24.747	2.000	1.522~2.629	<0.001
rN	0.768	0.083	84.722	2.155	1.830~2.538	<0.001
肿瘤部位	-0.124	0.082	2.311	0.883	0.753~1.037	0.128
分化程度	-0.084	0.079	1.137	0.919	0.787~1.073	0.286
TNM分期	1.210	0.176	47.365	3.355	2.377~4.735	<0.001
T分期	0.347	0.098	12.466	1.414	1.167~1.715	<0.001
N分期	0.581	0.071	67.912	1.789	1.558~2.054	<0.001
性别	-0.049	0.138	0.124	0.952	0.727~0.248	0.724
癌结节	0.052	0.172	0.091	1.053	0.752~1.474	0.763
神经侵犯	-0.044	0.154	0.083	0.957	0.708~1.293	0.774
年龄	0.298	0.131	5.214	1.347	1.043~1.740	0.022

临床病理因素	β值	标准误	Wald值	风险比	95%CI	P值
淋巴管浸润	0.322	0.146	4.851	1.380	1.036~1.838	0.028
rN	0.474	0.123	14.951	1.606	1.263~2.042	<0.001
T分期	0.200	0.093	4.661	1.222	1.019~1.466	0.031
N分期	0.291	0.095	9.300	1.338	1.110~1.613	0.002
肿瘤部位	-0.062	0.083	0.570	0.939	0.799~1.105	0.450
年龄	0.384	0.133	8.357	1.467	1.131~1.903	0.004