This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cheong, J.-H. Articles by Noh, S. H. Search for Related Content PubMed PubMed Citation Articles by Cheong, J.-H. Articles by Noh, S. H.

The N Ratio Predicts Recurrence and Poor Prognosis in Patients With Node-Positive Early Gastric Cancer

¹ Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul 120-752, Korea
² Cancer Metastasis Research Center, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul 120-752, Korea
³ Department of Surgical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, China
⁴ Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul 120-752, Korea

Correspondence: Address correspondence and reprint requests to: Sung Hoon Noh, MD, PhD; E-mail: sunghoonn{at}yumc.yonsei.ac.kr.

Background: The metastatic status of the regional node is the most significant prognostic factor for early gastric cancer (EGC). However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study was to evaluate the prognostic significance of the ratio of metastatic to retrieved lymph nodes (N ratio) in identifying a high-risk subgroup with node-positive EGC.

Methods: From a prospective database of 1264 EGC patients between 1987 and 1997, 156 (12.4%) were found to have histologically confirmed node metastasis. A number of prognostic factors, including the N ratio, were evaluated by univariate and multivariate analysis.

Results: The recurrence rate of node-positive EGC was 16.7% (n = 26). The overall 5-year survival rate of all patients was 84.0%. It was 26.9% and 95.4% in patients with and without recurrence, respectively (P < .0001; log-rank test). The cutoff value of the N ratio was set at .07. The 5-year survival rate of patients with an N ratio <.07 was 94.0%; this was significantly higher than the rate (72.6%) for those with a ratio >.07 (P < .0001; log-rank test). Both univariate and multivariate analysis identified the N ratio as the most significant predictive factor for recurrence and overall survival. Regarding stage migration, it shows superiority in comparison to the number-based N classification.

Conclusions: The N ratio is a more effective and rational indicator for prognostic stratification of patients with lymph node–positive EGC than the current N classification of the tumor-node-metastasis system.

Key Words: Early gastric cancer • Lymph node metastasis • Metastatic lymph node ratio • Prognosis • Recurrence

This article has been cited by other articles:

				Z. Sun, G.-L. Zhu, C. Lu, P.-T. Guo, B.-J. Huang, K. Li, Y. Xu, D.-M. Li, Z.-N. Wang, and H.-M. Xu 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 Ann. Onc., May 1, 2009; 20(5): 897 - 905. [Abstract] [Full Text] [PDF]

				X. Wang, J.-J. Wang, and F. Wan A Common Misuse of Stepwise Regression in Studies of Ratio of Metastatic Lymph Nodes for Gastric Cancer Ann. Surg. Oncol., June 1, 2008; 15(6): 1805 - 1806. [Full Text] [PDF]