Complutense University of Madrid, Av. Séneca 2, 28040 Madrid, Spain; Hospital Clínico San Carlos, c/Profesor Martín Lagos s/n, 28040 Madrid, Spain.
Rey Juan Carlos University of Madrid, Av. De Atenas s/n, 28922 Alcorcón, Madrid, Spain; Rey Juan Carlos Hospital, c/ Gladiolo s/n, 28933 Móstoles, Madrid, Spain.
Ann Diagn Pathol. 2021 Jun;52:151738. doi: 10.1016/j.anndiagpath.2021.151738. Epub 2021 Mar 31.
The TNM staging system is the main prognostic tool for GC, but the number of metastatic lymph nodes (LN) can be affected by surgical, pathological, tumor or host factors. Several authors have shown that lymph node ratio (LNR) may be superior to TNM staging in GC. However, cut-off values vary between studies and LNR assessment is not standardized.
Retrospective study of all GC resected in a western tertiary center (N = 377). Clinical features were collected and pathological features were assessed by two independent pathologists. Eight LNR classifications were selected and applied to our patients. Statistical analyses were performed.
315 patients were included. Most tumors were T3 (49.2%) N+ (59.3%). During follow-up, 36.7% of patients progressed and 27.4% died due to tumor. All LNR classifications were significantly associated with clinicopathological features such as Laurén subtype, lymphovascular invasion, perineural infiltration, T stage, tumor progression or death. All LNR classifications were independent prognostic factors for OS and DFS, and ROC analyses calculated similar AUC values for all staging systems. Kaplan-Meier curves showed that Pedrazzani, Wang, Liu and Huang classifications stratified patients better into three (Pedrazzani) or four categories. These classifications tended to downstage TNM N2 and N3 tumors. In cases with less than 16 LNs resected, Pedrazzani and Wang classifications showed the best prognostic performance.
Pedrazzani, Wang, Liu and Huang classifications showed good prognostic performance in western GC patients. Larger studies in other cohorts are needed to identify the most consistent LNR classification for GC.
TNM 分期系统是 GC 的主要预后工具，但转移淋巴结（LN）的数量可能受到手术、病理、肿瘤或宿主因素的影响。一些作者已经表明，淋巴结比率（LNR）可能优于 GC 的 TNM 分期。然而，不同研究之间的截断值不同，且 LNR 评估尚未标准化。
回顾性分析了在一家西部三级中心接受 GC 切除术的所有患者（N=377）。收集了临床特征，并由两名独立的病理学家评估了病理特征。选择了 8 种 LNR 分类并应用于我们的患者。进行了统计学分析。
纳入了 315 名患者。大多数肿瘤为 T3（49.2%）N+（59.3%）。在随访期间，36.7%的患者肿瘤进展，27.4%的患者因肿瘤死亡。所有 LNR 分类均与临床病理特征显著相关，如Laurén 亚型、淋巴血管侵犯、神经周围浸润、T 分期、肿瘤进展或死亡。所有 LNR 分类均是 OS 和 DFS 的独立预后因素，ROC 分析计算出所有分期系统的 AUC 值相似。Kaplan-Meier 曲线表明，Pedrazzani、Wang、Liu 和 Huang 分类将患者更好地分为三组（Pedrazzani）或四组。这些分类倾向于下调 TNM N2 和 N3 肿瘤的分期。在切除 LN 少于 16 个的情况下，Pedrazzani 和 Wang 分类显示出最佳的预后表现。
在西方 GC 患者中，Pedrazzani、Wang、Liu 和 Huang 分类显示出良好的预后性能。需要在其他队列中进行更大规模的研究，以确定最一致的 GC LNR 分类。
