Complutense University of Madrid.
Departments of Pathology.
Am J Clin Oncol. 2021 Jan 1;44(1):1-9. doi: 10.1097/COC.0000000000000770.
Gastric cancer (GC) is an aggressive disease with high mortality rates. Lymph node (LN) staging of GC is a major source of controversy. The aim of this study is to compare the prognostic value of 3 different LN classifications for patients with resected GC: the eighth TNM staging system, lymph node ratio (LNR, ratio between positive and total LN) and a new anatomic-based classification (Choi classification).
A retrospective study of all cases of GC resected in a tertiary hospital in Spain (n=377). Clinical data were collected; histologic slides were reviewed; and univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed.
In all, 315 patients fulfilled inclusion criteria. Univariate analysis showed that all classifications were significantly associated with tumor death and progression (P<0.001). All staging systems were independent prognostic factors for DFS. Area under the curve ratios for Choi, N stage, and LNR classifications were 0.738, 0.730, and 0.735, respectively. TNM and LNR classifications were independent prognosticators for OS, while Choi classification was an independent factor only in patients with ≥16 LN resected. Area under the curve ratios for Choi, N stage, and LNR classifications were 0.707, 0.728, and 0.732, respectively. Kaplan-Meier curves depending on LNR classification showed the best patient stratification for both OS and DFS.
The 3-staging systems had similar prognostic performance, but LNR-based classification stratified patients better. Further studies are needed to evaluate the impact of the number of LN examined, cutoff values, and anatomic extent of LN disease in GC.
胃癌（GC）是一种死亡率很高的侵袭性疾病。GC 的淋巴结（LN）分期是一个主要的争议来源。本研究的目的是比较 3 种不同 LN 分类对接受 GC 切除的患者的预后价值：第八版 TNM 分期系统、淋巴结比率（LN 比，阳性和总 LN 之间的比值）和新的基于解剖的分类（Choi 分类）。
对西班牙一家三级医院接受 GC 切除的所有病例进行回顾性研究（n=377）。收集临床数据；复查组织切片；并对无病生存率（DFS）和总生存率（OS）进行单因素和多因素分析。
共有 315 例患者符合纳入标准。单因素分析显示，所有分类均与肿瘤死亡和进展显著相关（P<0.001）。所有分期系统均为 DFS 的独立预后因素。Choi、N 分期和 LNR 分类的曲线下面积比分别为 0.738、0.730 和 0.735。TNM 和 LNR 分类是 OS 的独立预后因素，而 Choi 分类仅在切除≥16 个 LN 的患者中是独立因素。Choi、N 分期和 LNR 分类的曲线下面积比分别为 0.707、0.728 和 0.732。根据 LNR 分类绘制的 Kaplan-Meier 曲线在 OS 和 DFS 方面对患者的分层最佳。
这 3 种分期系统具有相似的预后性能，但基于 LN 比的分类对患者的分层更好。需要进一步研究以评估检查的 LN 数量、截断值和 GC 中 LN 疾病的解剖范围对预后的影响。
