Anticancer research · 2026
Prognostic Impact of Lymph Node Ratio in Patients With Gastric Cancer Undergoing Curative Gastrectomy Post Neoadjuvant Chemotherapy.
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Komori Keisuke, Akimoto Norihiro, Nakayama Yuta, Nagasawa Shinsuke, Kanematsu Kyohei, Yamada Takanobu, Ogata Takashi, Saito Aya, Oshima Takashi
Аннотация
BACKGROUND/AIM: The lymph node ratio (LNR), defined as the ratio of metastatic to examined lymph nodes, is a prognostic indicator in gastric cancer after curative gastrectomy. However, in response to neoadjuvant chemotherapy (NAC), the absolute number of metastatic lymph nodes may decrease. Moreover, the N-stage classification after this (ypN) alone may not fully reflect residual nodal disease. We evaluated whether LNR-based stratification offers improved prognostic discrimination compared with ypN classification, using survival analysis together with time-dependent receiver operating characteristics analysis.
PATIENTS AND METHODS: We retrospectively analyzed 201 patients with gastric adenocarcinoma who underwent post-NAC curative (R0) gastrectomy with D2 lymphadenectomy at Kanagawa Cancer Center (March 1992 to November 2019). Patients were classified using commonly reported LNR cutoffs: low (<0.10), intermediate (0.10-0.25), and high (>0.25). Recurrence-free (RFS) and overall survival (OS) were evaluated. The prognostic performance of the LNR and the ypN classification was compared using multivariate Cox proportional hazards models.
RESULTS: The median follow-up period was 37.6 months. Higher LNR was associated with worse RFS and OS (p<0.001, global log-rank test). Unlike yPN, LNR remained an independent adverse prognostic factor for RFS [hazard ratio (95% confidence interval) vs. low LNR: intermediate: 3.622 (1.302-10.08), p=0.017; high: 3.923 (1.154-13.34), p=0.029] and OS [vs. low LNR: intermediate: 3.590 (1.341-9.606), p=0.011; high: 4.057 (1.230-13.38), p=0.021] in multivariate analysis.
CONCLUSION: The LNR may serve as a practical postoperative risk stratification metric for recurrence and survival after NAC in patients with gastric cancer, complementing the limitations of the ypN classification.
PATIENTS AND METHODS: We retrospectively analyzed 201 patients with gastric adenocarcinoma who underwent post-NAC curative (R0) gastrectomy with D2 lymphadenectomy at Kanagawa Cancer Center (March 1992 to November 2019). Patients were classified using commonly reported LNR cutoffs: low (<0.10), intermediate (0.10-0.25), and high (>0.25). Recurrence-free (RFS) and overall survival (OS) were evaluated. The prognostic performance of the LNR and the ypN classification was compared using multivariate Cox proportional hazards models.
RESULTS: The median follow-up period was 37.6 months. Higher LNR was associated with worse RFS and OS (p<0.001, global log-rank test). Unlike yPN, LNR remained an independent adverse prognostic factor for RFS [hazard ratio (95% confidence interval) vs. low LNR: intermediate: 3.622 (1.302-10.08), p=0.017; high: 3.923 (1.154-13.34), p=0.029] and OS [vs. low LNR: intermediate: 3.590 (1.341-9.606), p=0.011; high: 4.057 (1.230-13.38), p=0.021] in multivariate analysis.
CONCLUSION: The LNR may serve as a practical postoperative risk stratification metric for recurrence and survival after NAC in patients with gastric cancer, complementing the limitations of the ypN classification.