title: The RML of lymph node metastasis was superior to the LODDS for evaluating the prognosis of gastric cancer.
abstract: OBJECTIVE
  The aim of the study was to investigate the most appropriate system for categorization of metastatic lymph nodes among N staging (according to the 7th edition UICC/AJCC TNM Classification for Gastric Cancer), ratio between metastatic and examined lymph nodes (RML) staging, negative lymph nodes (NLN) staging and log odds of positive lymph nodes (LODDS) staging for evaluation the overall survival (OS) of gastric cancer.
  
  
  METHODS
  We reviewed clinicopathological data of 372 gastric cancer patients who underwent radical gastrectomy plus extended lymphadenectomy with the purpose of evaluating the differences in the OS according to different categories of metastatic lymph nodes.
  
  
  RESULTS
  Univariate and multivariate analysis of data significantly identified the degree of differentiation (HR = 1.404, p = 0.015), T staging (according to the 7th edition UICC/AJCC TNM Classification for Gastric Cancer) (HR = 1.568, p = 0.024) and the RML staging (HR = 1.479, p = 0.030) as independent predictors of the OS. However, RML staging was identified as the most appropriate for evaluating the OS of gastric cancer patients following radical gastrectomy plus extended lymphadenectomy rather than N staging, NLN staging and LODDS staging by using the case-control matched analysis. With the further stratified analysis, we demonstrated that RML staging had the best prognostic homogeneity than LODDS staging, NLN staging or N staging.
  
  
  CONCLUSIONS
  RML staging was the best system for prediction the OS of the gastric cancer patients following radical gastrectomy plus extended lymphadenectomy, rather than LODDS staging, NLN staging or N staging.
authors.affiliation: Department of Gastrointestinal Oncology, Key Lab of Cancer Treatment and Prevention, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Honggen
authors.initials: H
authors.lastname: Liu
authors.forename: Jingyu
authors.initials: J
authors.lastname: Deng
authors.forename: Rupeng
authors.initials: R
authors.lastname: Zhang
authors.forename: Xishan
authors.initials: X
authors.lastname: Hao
authors.forename: Xuguan
authors.initials: X
authors.lastname: Jiao
authors.forename: Han
authors.initials: H
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery