title: Influencing factors and clinical significance of the metastatic lymph nodes ratio in gastric adenocarcinoma.
abstract: 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.
authors.affiliation: Department of General Surgery, No 3 People's Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 201900, PR China. jiweiyu919@hotmail.com
authors.forename: Ji-wei
authors.initials: JW
authors.lastname: Yu
authors.forename: Ju-gang
authors.initials: JG
authors.lastname: Wu
authors.forename: Lin-hai
authors.initials: LH
authors.lastname: Zheng
authors.forename: Biao
authors.initials: B
authors.lastname: Zhang
authors.forename: Xiao-chun
authors.initials: XC
authors.lastname: Ni
authors.forename: Xiao-qiang
authors.initials: XQ
authors.lastname: Li
authors.forename: Bo-jian
authors.initials: BJ
authors.lastname: Jiang
mesh_terms: 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