Influencing factors and clinical significance of the metastatic lymph nodes ratio in gastric adenocarcinoma.
BACKGROUND
To investigate influencing factors of the metastatic lymph nodes ratio (MLR) and whether it is related to survival in patients with gastric adenocarcinoma.


METHODS
We retrospectively evaluated the clinical features of 121 patients with gastric adenocarcinoma enrolled in our hospital between 2000 and 2007. The receiver operating characteristic (ROC) curve was used to determine the cutoff of the MLR, and CK20 immunohistochemical staining was used to detect micrometastasis of the lymph nodes.


RESULTS
The areas under the ROC curve of MLR used to predict the death of 3-year and 5-year postoperative patients were 0.826 +/- 0.053 and 0.896 +/- 0.046. Thus MLR = 30.95% and MLR = 3.15% were designated as cutoffs. The MLR was then classified into three groups: MLR1 (MLR<3.15%); MLR2(3.15% < or = MLR < or = 30.95%); and MLR3 (MLR>30.95%). We found that patients with a higher MLR demonstrated a much poorer survival period after radical operation than those patients with a lower MLR (P = 0.000). The COX model showed that MLR was an independent prognostic factor (P = 0.000). The MLR could also discriminate between subsets of patients with different 5-year survival periods within the same N stage (P < 0.05). The MLR has been shown to be 34.7% (242/697) by HE staining and 43.5% (303/697) by CK staining (P = 0.001). The clinicopathological characteristics of lymph vessel invasion and the depth of invasion could significantly affect the MLR.


CONCLUSIONS
MLR is an independent prognostic factor in gastric cancer. The combined ROC curve with MLR is an effective strategy to produce a curve to predict the 3-year and 5-year survival rates.
Yu
Ji-wei
JW
Department of General Surgery, No 3 People's Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 201900, PR China. jiweiyu919@hotmail.com
Wu
Ju-gang
JG
Zheng
Lin-hai
LH
Zhang
Biao
B
Ni
Xiao-chun
XC
Li
Xiao-qiang
XQ
Jiang
Bo-jian
BJ
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate