Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Scand J Gastroenterol. 2022 Jul;57(7):832-841. doi: 10.1080/00365521.2022.2036807. Epub 2022 Mar 16.
The objective of this study was to evaluate the prognostic value of Metastatic lymph node ratio (MLNR) after curative gastrectomy in patients with gastric cancer (GC) and the potential for new indicators to strengthen the current guidelines.
We retrospectively researched 3864 GC patients with curative gastrectomy between February 2011 and February 2016. The following clinical data were collected from the included patients: gender, type of gastrectomy, tumor location, T stage, N stage, ELN, tumor size, age at surgery, perineural invasion, vascular invasion, TNM stage, survival time and survival status. Patients were divided into low-MLNR (L-MLNR), and high-MLNR (H-MLNR) groups based on adjusted the X-tile cutoff-value of 0.25 for MLNR, the survival rates and clinicopathological characteristics of each group were compared. For the assessment of significant associations between clinicopathological characteristics and patients' survival, univariate and multivariate analyses were performed using the Kaplan-Meier method and Cox proportional hazards analysis. The log-rank test was used to examine the statistical significance of differences among different survival curves. Clinicopathological features significantly associated with MLNR were assessed by the Chi-square test and multinomial logistic regression. The discriminative ability was measured by calculating the Bayesian Information Criterion (BIC) values for each category. Assessment of the effect of clinicopathological features on MLNR for predicting prognosis of GC patients used stratum analysis through Kaplan-Meier analysis and Cox proportional risk Analysis.
Survival analysis indicated that MLNR was negatively associated with overall survival (OS) ( < .001) and was an independent prognostic predictor in 3864 GC patients ( < .001). MLNR had significant prognostic significance in various subgroups with clinicopathological characteristics (gender, type of gastrectomy, tumor location, T stage, N stage, ELN, tumor size, age at surgery, perineural invasion, vascular invasion, and TNM stage) ( < .001).
The MLNR may become a new indicator to assess the prognosis of GC patients who underwent curative gastrectomy. The results may have potential clinical implications that should be considered when developing clinical practice guidelines or the design of the future investigation.
本研究旨在评估胃癌（GC）根治性胃切除术后转移淋巴结比率（MLNR）的预后价值，并寻找新的指标来加强现行指南。
我们回顾性研究了 2011 年 2 月至 2016 年 2 月期间接受根治性胃切除术的 3864 例 GC 患者。从纳入的患者中收集以下临床数据：性别、胃切除术类型、肿瘤位置、T 分期、N 分期、淋巴结清除范围、肿瘤大小、手术年龄、神经侵犯、血管侵犯、TNM 分期、生存时间和生存状态。根据 MLNR 的 X-tile 截断值 0.25 调整后，将患者分为低 MLNR（L-MLNR）和高 MLNR（H-MLNR）组，比较各组的生存率和临床病理特征。采用 Kaplan-Meier 法和 Cox 比例风险分析进行单因素和多因素分析，评估临床病理特征与患者生存之间的显著相关性。对数秩检验用于检验不同生存曲线之间的统计学差异。采用卡方检验和多项逻辑回归评估与 MLNR 显著相关的临床病理特征。通过计算每个分类的贝叶斯信息准则（BIC）值来衡量判别能力。通过 Kaplan-Meier 分析和 Cox 比例风险分析进行分层分析，评估临床病理特征对 GC 患者 MLNR 预测预后的影响。
生存分析表明，MLNR 与总生存（OS）呈负相关（ < .001），是 3864 例 GC 患者的独立预后预测因子（ < .001）。MLNR 在具有临床病理特征的各种亚组中具有显著的预后意义（性别、胃切除术类型、肿瘤位置、T 分期、N 分期、淋巴结清除范围、肿瘤大小、手术年龄、神经侵犯、血管侵犯和 TNM 分期）（ < .001）。
MLNR 可能成为评估接受根治性胃切除术的 GC 患者预后的新指标。研究结果可能具有潜在的临床意义，在制定临床实践指南或未来研究设计时应予以考虑。
