title: Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus.
abstract: OBJECTIVE
  To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus.
  
  
  METHODS
  Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients.
  
  
  RESULTS
  The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (c2 = 4.26, P = 0.0389), tumor size (c2 = 18.48, P < 0.001), Borrmann type (c2 = 7.41, P = 0.0065), histological grade (c2 = 5.07, P = 0.0243), pT category (c2 = 49.42, P < 0.001), pN category (c2 = 87.7, P < 0.001), total number of retrieved lymph nodes (c2 = 8.22, P = 0.0042) and MLR (c2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (c2 = 7.985, P = 0.018), pT category (c2 = 30.82, P < 0.001) and MLR (c2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple linear regression (beta = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%.
  
  
  CONCLUSIONS
  The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.
authors.affiliation: Department of Oncology, Affiliated Union Hospital, Fujian Medical University, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. hcmlr253@sohu.com
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Huang
authors.forename: Bi-Juan
authors.initials: BJ
authors.lastname: Lin
authors.forename: Hui-Shan
authors.initials: HS
authors.lastname: Lu
authors.forename: Xiang-Fu
authors.initials: XF
authors.lastname: Zhang
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*