Development of a simplified tumor-lymph node ratio classification system for patients with resected gastric cancer: A western study
| Autor: | Luis Ortega Medina, Lourdes Estrada Muñoz, Soledad García Gómez de Las Heras, Ricardo García Martínez, Cristina Díaz del Arco, Andrés Sánchez Pernaute, Mª Jesús Fernández Aceñero |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Pathology Lymphovascular invasion TNM staging system Gastroenterology Disease-Free Survival Pathology and Forensic Medicine 03 medical and health sciences 0302 clinical medicine Stomach Neoplasms Internal medicine Medicine Humans Neoplasm Invasiveness Lymph node Aged Neoplasm Staging Retrospective Studies Aged 80 and over Tumor size Signet ring cell business.industry Mortality rate Retrospective cohort study Mean age General Medicine Middle Aged Prognosis Survival Analysis 030104 developmental biology medicine.anatomical_structure Spain 030220 oncology & carcinogenesis Disease Progression Lymph Node Excision Female Lymph Nodes business Lymph Node Ratio |
| Zdroj: | Annals of diagnostic pathology. 50 |
| ISSN: | 1532-8198 |
| Popis: | Introduction Gastric cancer (GC) shows high recurrence and mortality rates. The AJCC TNM staging system is the best prognostic predictor, but lymph node assessment is a major source of controversy. Recent studies have found that lymph node ratio (LNR) may overcome TNM limitations. Our aim is to develop a simplified tumor-LNR (T-LNR) classification for predicting prognosis of resected GC. Methods Retrospective study of all GC resected in a tertiary center in Spain (N = 377). Clinicopathological features were assessed, LNR was classified into N0:0%, N1:1–25%, N2:>25%, and a T-LNR classification was developed. Statistical analyses were performed. Results 317 patients were finally included. Most patients were male (54.6%) and mean age was 72 years. Tumors were intestinal (61%), diffuse (30.8%) or mixed (8.1%). During follow-up, 36.7% and 27.4% of patients progressed and died, respectively. T-LNR classification divided patients into five prognostic categories (S1-S5). Most cases were S1-S4 (26.2%, 19.9%, 22.6% and 23.6%, respectively). 7.6% of tumors were S5. T-LNR classification was significantly associated with tumor size, depth, macroscopical type, Lauren subtype, signet ring cells, histologic grade, lymphovascular invasion, perineural infiltration, infiltrative growth, patient progression and death. Kaplan-Meier curves for OS showed an excellent patient stratification with evenly spaced curves. As for DFS, T-LNR classification also showed good discriminatory ability with non-overlapping curves. T-LNR classification was independently related to both OS and DFS. Conclusions T-LNR classifications can successfully predict prognosis of GC patients. Larger studies in other geographic regions should be performed to refine this classification and to validate its prognostic relevance. |
| Databáze: | OpenAIRE |
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