title: The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer.
abstract: BACKGROUND
  The metastatic status of the regional node is the most significant prognostic factor for early gastric cancer (EGC). However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study was to evaluate the prognostic significance of the ratio of metastatic to retrieved lymph nodes (N ratio) in identifying a high-risk subgroup with node-positive EGC.
  
  
  METHODS
  From a prospective database of 1264 EGC patients between 1987 and 1997, 156 (12.4%) were found to have histologically confirmed node metastasis. A number of prognostic factors, including the N ratio, were evaluated by univariate and multivariate analysis.
  
  
  RESULTS
  The recurrence rate of node-positive EGC was 16.7% (n = 26). The overall 5-year survival rate of all patients was 84.0%. It was 26.9% and 95.4% in patients with and without recurrence, respectively (P < .0001; log-rank test). The cutoff value of the N ratio was set at .07. The 5-year survival rate of patients with an N ratio <.07 was 94.0%; this was significantly higher than the rate (72.6%) for those with a ratio >.07 (P < .0001; log-rank test). Both univariate and multivariate analysis identified the N ratio as the most significant predictive factor for recurrence and overall survival. Regarding stage migration, it shows superiority in comparison to the number-based N classification.
  
  
  CONCLUSIONS
  The N ratio is a more effective and rational indicator for prognostic stratification of patients with lymph node-positive EGC than the current N classification of the tumor-node-metastasis system.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul 120-752, Korea.
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Cheong
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Jian Guo
authors.initials: JG
authors.lastname: Shen
authors.forename: Changsoo
authors.initials: C
authors.lastname: Song
authors.forename: Junuk
authors.initials: J
authors.lastname: Kim
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis