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Vol. 100. Issue 5.
Pages 266-273 (May 2022)
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Vol. 100. Issue 5.
Pages 266-273 (May 2022)
Original article
Prognostic value of the nodal ratio in gastric cancer: unicentric analysis of 199 patients
Valor pronóstico del ratio nodal en el cáncer gástrico: análisis unicéntrico de 199 pacientes
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Ibabe Villalabeitia Atecaa,
Corresponding author
, Arkaitz Perfecto Valeroa, Clara Serrano Hermosillaa, Ainhoa Marcaida Salazara,c, Silvia Pérez Fernándezb, Aingeru Sarriugarte Lasartea,b,c
a Cirugía General y Aparato Digestivo, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
b Instituto de Investigación Sanitaria Biocruces, Barakaldo, Vizcaya, Spain
c UPV/EHU Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Vizcaya, Spain
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Tables (4)
Table 1. Demographic data and pathologic factors.
Table 2. Univariate study of survival of the lymphatic dissemination classification systems.
Table 3. Multivariate study of overall survival of lymph node staging systems.
Table 4. Comparison of the prognostic value of the different staging systems and comparison among the 3 systems using Δ AUC.
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Abstract
Introduction

In the gastric cancer the most widely used classification is the AJCC TNM system. However, it presents limitations, such as staging migration in cases with suboptimal lymphadenectomies. The nodal ratio has been proposed as an alternative system, proving to be a good prognostic predictor of survival. The aim was to assess the influence of the nodal ratio measured in tertiles [tNR] as a prognostic factor and compare with the TNM systems (7th ed.) and log odds of positive lymph nodes [LODDS].

Material and methods

Retrospective and single-center study on 199 patients operated on with curative intent between 2010 and 2014. For each system an univariate and multivariate analysis was performed and the overall survival rates [OS] were compared by the ROC test.

Results

The prognostic factors that showed statistical significance in the multivariate analysis were: tRN2 (HR2.87) and tRN3 (HR7.29); LODDS 2 (HR1.55), LODDS3 (HR2.6) and LODDS4 (HR4.9); pN2 (HR1.84) and pN3 (HR2.91). The 5-year OS was 75.8%, 61.4%, 25.8%, and 3.84% for tRN0, tRN1, tRN2 and tRN3; 72.4%, 60%, 29.1% and 13.9% for LODDS1, LODDS2, LODDS3 and LODDS4; and 77.6%, 59.4%, 28.8% and 25.5% for pN0, pN1, pN2 and pN3, respectively. The three systems behaved as good predictors, with areas under the curve >0.75.

Conclusion

tNR was an independent prognostic factor for estimating survival in gastric cancer. Furthermore, the ease of its calculation in clinical practice could reduce the effect of staging migration.

Keywords:
Lymph node ratio
Lymph node metastasis
Gastric cancer
Prognostic factor
Resumen
Introducción

El sistema de clasificación ganglionar gástrico más utilizado en el cáncer gástrico es el TNM. No obstante presenta limitaciones, como la “migración de estadiaje” en los casos con linfadenectomías subóptimas, por ello se han planteado distintos sistemas. Asimismo, el objetivo fue valorar la influencia del ratio nodal medido en terciles [RNt] como factor pronóstico, y compararlo con los sistemas TNM (7ª ed.) y log odds of positive lymph nodes [LODDS].

Material y métodos

Se trata de un estudio retrospectivo y unicéntrico sobre 199 pacientes con neoplasia gástrica intervenidos con intención curativa entre 2010 y 2014. Se realizó un análisis univariante y multivariante de cada sistema, y se compararon las tasas de supervivencia global [SG] obtenidas mediante test ROC.

Resultados

Los factores pronóstico que mostraron significación estadística en el análisis multivariante fueron: RNt2 (HR2,87) y RNt3 (HR7,29); LODDS 2 (HR1,55), LODDS3 (HR2,6) y LODDS4 (HR4,9); pN2 (HR1.84) y pN3 (HR2.91). La SG a 5 años fue del 75,8%, 61,4%, 25,8% y 3,84% para RNt0, RNt1, RNt2 y RNt3; 72,4%, 60%, 29,1% y 13,9% para LODDS1, LODDS2, LODDS3 y LODDS4; y 77,6%, 59,4%, 28,8% y 25,5% para pN0, pN1, pN2 y pN3, respectivamente. Los tres sistemas se comportaron como buenos predictores, con áreas bajo la curva >0,75.

Conclusión

El RNt fue un factor pronóstico independiente para la estimación de la supervivencia en el cáncer gástrico. Además, la facilidad de su cálculo en la práctica clínica podría disminuir el efecto de migración de estadificación.

Palabras clave:
Ratio nodal
Afectación ganglionar
Cáncer gástrico
Factor pronóstico

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