European Journal of Surgical Oncology
Volume 34, Issue 2 , Pages 159-165 , February 2008

The prognostic value of N-ratio in patients with gastric cancer: Validation in a large, multicenter series

  • A. Marchet

      Affiliations

    • Clinica Chirurgica II, University of Padova, Padova, Italy
  • ,
  • S. Mocellin

      Affiliations

    • Clinica Chirurgica II, University of Padova, Padova, Italy
  • ,
  • A. Ambrosi

      Affiliations

    • Clinica Chirurgica II, University of Padova, Padova, Italy
    • Statistics Center for Biomedical Sciences, San Raffaele University, Milan, Italy
  • ,
  • G. de Manzoni

      Affiliations

    • First Division of General Surgery, University of Verona, Verona, Italy
  • ,
  • A. Di Leo

      Affiliations

    • First Division of General Surgery, University of Verona, Verona, Italy
  • ,
  • D. Marrelli

      Affiliations

    • Surgical Oncology Unit, University of Siena, Siena, Italy
  • ,
  • F. Roviello

      Affiliations

    • Surgical Oncology Unit, University of Siena, Siena, Italy
  • ,
  • P. Morgagni

      Affiliations

    • Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
  • ,
  • L. Saragoni

      Affiliations

    • Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
  • ,
  • G. Natalini

      Affiliations

    • General Surgery Unit, General Hospital of Perugia, Perugia, Italy
  • ,
  • F. De Santis

      Affiliations

    • Department of Surgery, Todi-Marsciano General Hospital, Todi, Italy
  • ,
  • L. Baiocchi

      Affiliations

    • Institute of Clinica Chirurgica, University of Brescia, Brescia, Italy
  • ,
  • A. Coniglio

      Affiliations

    • Institute of Clinica Chirurgica, University of Brescia, Brescia, Italy
  • ,
  • D. Nitti

      Affiliations

    • Clinica Chirurgica II, University of Padova, Padova, Italy
    • Corresponding Author InformationCorresponding author. Address: Clinica Chirurgica II, Dipartimento di Scienze Oncologiche e Chirurgiche, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy. Tel.: +39 049 8212055; fax: +39 049 651891.
  • ,
  • on behalf of the Italian Research Group for Gastric Cancer Study (GIRCG)

,Accepted 28 April 2007.

References 

  1. Siewert JR, Bittcher K, Stein HJ, Roder J. Relevant prognostic factors in gastric cancer. Ten-year results of the German Gastric Cancer Study. Ann Surg. 1998;228:449–461
  2. Bozzetti F, Bonfanti G, Morabito A, et al. A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection. Surg Gynecol Obstet. 1986;162:229–234
  3. Hohenberger P, Gretschel S. Gastric Cancer. Lancet. 2003;362:305–315
  4. Dicken BJ, Bigam DL, Cass C, et al. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg. 2005;241:27–39
  5. Japanese Research Society for Gastric Cancer . The general rules for the gastric cancer study in surgery and pathology. Part 1. Jpn J Surg. 1981;11:127–139
  6. Japanese Gastric Cancer Association . Japanese classification of gastric carcinoma-2nd English Edition. Gastric Cancer. 1981;1:10–24
  7. Sobin LH, Wittekind CH. International Union Against Cancer (UICC). TNM classification of malignant tumors. 5th ed.. New York: John Wiley & Sons; 1997;
  8. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed.. New York: Springer-Verlag; 2002;
  9. Bouvier AM, Haas O, Piard F, et al. How many nodes must be examined to accurately stage gastric adenocarcinomas? Results from a population based study. Cancer. 2002;94:2862–2866
  10. Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the stomach – a patient care evaluation study by the American College of Surgeons. Ann Surg. 1993;218:583–592
  11. Hundahl SA, Macdonald JS, Benedetti J, Fitzsimmons T for the Southwest Oncology Group and the Gastric Intergroup. Surgical treatment variation in a prospective, randomized trial of chemoradiotherapy in gastric cancer: the effect of undertreatment. Ann Surg Oncol. 2002;9:278–286
  12. Wanebo HJ, Kennedy BJ, Winchester DP, et al. Gastric carcinoma: does lymph node dissection alter the survival?. J Am Coll Surg. 1996;183:616–624
  13. Bonekamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–914
  14. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer. Long term results of the MRC randomised surgical trial. Br J Cancer. 1999;79:1522–1530
  15. Jansen EP, Boot H, Verheij M, et al. Optimal locoregional treatment in gastric cancer. J Clin Oncol. 2005;23:4509–4517
  16. Feinstein AR, Sosin DM, Wells CK, The Will Rogers phenomenon . Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985;312:1604–1608
  17. Bonder BE. Will Rogers and gastric carcinoma (letter). Arch Surg. 1988;123:1023–1024
  18. de Manzoni G, Verlato G, Roviello F, et al. The new TNM classification of lymph node metastasis minimises stage migration problems in gastric cancer patients. Br J Cancer. 2002;87:171–174
  19. Bunt AMG, Hermans J, Smit VTHBM, et al. Surgical/pathologic-stage migration confronts comparisons of gastric cancer survival rate between Japan and Western countries. J Clin Oncol. 1995;13:19–25
  20. Bando E, Yonemura Y, Taniguchi K, et al. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002;9:775–784
  21. Inoue K, Nakane Y, Iiyama H, et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol. 2002;9:27–34
  22. Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol. 2003;10:1077–1085
  23. Hyung WJ, Noh SH, Yoo CH, et al. Prognostic significance of metastatic lymph node ratio in T3 gastric cancer. World J Surg. 2002;26:323–329
  24. Kodera Y, Yamamura Y, Shimizu Y, et al. Lymph node status assessment for gastric carcinoma: is the number of metastatic lymph nodes really practical as a parameter for N categories in the TNM classification?. J Surg Oncol. 1998;69:15–20
  25. Therneau TM, Grambsh PM, Flemming TR. Martingale based residuals for survival models. Biometrika. 1990;77:147–160
  26. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481
  27. Cox DR. Regression models and life-tables. J R Stat Soc B. 1972;34:187–220
  28. Grambsch P, Therneau T. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika. 1994;81:515–526
  29. Vinh-Hung V, Vershraegen C, Promish DI, et al. Ratios of involved nodes in early breast cancer. Breast Cancer Res. 2004;6:680–688
  30. Truong PT, Berthelet E, Lee L, et al. The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph. Cancer. 2005;103:2006–2014
  31. Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23:8706–8712
  32. Cheong JH, Hyung WJ, Shen JG, et al. The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer. Ann Surg Oncol. 2006;13:377–385
  33. Kunisaki C, Shimada H, Nomura M, et al. Clinical impact of metastatic lymph node ratio in advanced gastric cancer. Anticancer Res. 2005;25:1369–1376

PII: S0748-7983(07)00207-7

doi: 10.1016/j.ejso.2007.04.018

European Journal of Surgical Oncology
Volume 34, Issue 2 , Pages 159-165 , February 2008