Taghizadeh-Kermani Ali, Yahouiyan Seyede Zeinab, AliAkbarian Mohsen, Seilanian Toussi Mehdi
Cancer Research Center, Omid Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran ; Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Cancer Prev. 2014 Spring;7(2):73-9.
In this study we have evaluated the prognostic impact of Metastatic Lymph node Ratio (MLR) in gastric cancer patients whose have undergone curative surgical resection.
A total of 121 patients with gastric adenocarcinoma undergoing curative surgical resection (R0) in our institutions between 2003 and 2010 have been included in this study. MLR has classified into 3 groups as follows: MLR0; 0, MLR1; >0-0.33 and MLR2; 0.34-1. We have used Kaplan-Meier method to calculate survival rates and log rank test to compare survival curves between groups. Cox proportional hazards model has utilized for multivariate analysis.
The median age of patients was 65 (range; 32 to 89) with a male to female ratio of 91/30 (3.03). 88 patients have undergone total gastrectomy (72.5%) and 33 subtotal gastrectomy (27.5%). With a median total retrieved lymph node of 11 (range; 6 to 44), the MLR0 to MLR2 has calculated in 28(23.1%), 31(25.6%) and 62 (51.2%) patients respectively. MLR2 (>0.33) has significantly associated with higher Tumor stage (T1-T2: 18.7% vs. T3: 56.2%, p=0.002). With a median follow up time of 12 months (range; 2-88), the 3-year survival in patients with MLR0, MLR1 and MLR2 was 75.1%, 54.8% and 9.5% respectively (p value<0.001). Tumor location (p<0.01), tumor stage (p<0.01) and lymph node stage (p<0.001) were also significant predictor of survival. MLR has also significant correlated with survival in 91 patients with less than 15 obtained lymph nodes (p<0.001). Cox-regression multivariate analysis has shown MLR as the most important and independent predictor of survival (p<0.001).
MLR with cutoff point of 0.33 could be used as an independent prognostic factor in gastric cancer patients whose have undergone curative surgical resection. This factor could effectively predict survival even in cases with insufficient (<15) retrieved lymph nodes.
在本研究中，我们评估了转移性淋巴结比率（MLR）对接受根治性手术切除的胃癌患者的预后影响。
本研究纳入了2003年至2010年间在我们机构接受根治性手术切除（R0）的121例胃腺癌患者。MLR分为以下3组：MLR0；0，MLR1；>0至0.33，MLR2；0.34至1。我们使用Kaplan-Meier方法计算生存率，并使用对数秩检验比较组间生存曲线。Cox比例风险模型用于多变量分析。
患者的中位年龄为65岁（范围：32至89岁），男女比例为91/30（3.03）。88例患者接受了全胃切除术（72.5%），33例接受了胃次全切除术（27.5%）。中位总切除淋巴结数为11个（范围：6至44个），MLR0至MLR2的患者分别为28例（23.1%）、31例（25.6%）和62例（51.2%）。MLR2（>0.33）与更高的肿瘤分期显著相关（T1-T2：18.7%对T3：56.2%，p=0.002）。中位随访时间为12个月（范围：2至88个月），MLR0、MLR1和MLR2患者的3年生存率分别为75.1%、54.8%和9.5%（p值<0.001）。肿瘤位置（p<0.01）、肿瘤分期（p<0.01）和淋巴结分期（p<0.001）也是生存的重要预测因素。MLR在91例切除淋巴结少于15个的患者中也与生存显著相关（p<0.001）。Cox回归多变量分析显示MLR是最重要的独立生存预测因素（p<0.001）。
截断点为0.33的MLR可作为接受根治性手术切除的胃癌患者的独立预后因素。即使在切除淋巴结不足（<15个）的情况下，该因素也能有效预测生存。
