title: Prognostic impact of lymph node retrieval and ratio in gastric cancer: a U.S. single center experience.
abstract: BACKGROUND
  Increased lymph node (LN) retrieval for gastric cancer has been associated with improved overall survival (OS). This study examines the impact of number of examined LN (eLN) and lymph node ratio.
  
  
  METHODS
  Patients referred for surgical care of gastric cancer were stratified by number of eLN, positive LNs (LN+), and lymph node ratio (LN+/eLN). Clinicopathologic factors were compared; OS and disease-free survival (DFS) were the primary endpoints.
  
  
  RESULTS
  From 1997 to 2012, 222 patients, median age 67 (range, 17-92) years, were analyzed. Of 220 (99 %) explored, 164 (74 %) underwent resection. Median OS was 22 (range, 0.3-140) months. Perineural and lymphovascular invasion and poor differentiation adversely affected OS, p < 0.05. A median 14 eLN (range, 0-45), with median 1 LN+ (range, 0-31), was observed. There were no OS or DFS differences when comparing the eLN groups. Both OS and DFS were impacted by LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months (0) to 37 months (0.01-0.2), 27 months (0.21-0.5), and 12 months (>0.5), p < 0.0001. DFS was similar: 35 months (0), decreasing to 22 months (0.01-0.2), 13 months (0.21-0.5), and 7 months (>0.5), p < 0.0001.
  
  
  CONCLUSIONS
  Number of eLN did not impact survival, while LN+ adversely affected survival. Lymph node ratio may predict prognosis better than number of eLN or LN+ in gastric cancer.
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA, joyce.wong02@gmail.com.
authors.forename: Joyce
authors.initials: J
authors.lastname: Wong
authors.forename: Shams
authors.initials: S
authors.lastname: Rahman
authors.forename: Nadia
authors.initials: N
authors.lastname: Saeed
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoffe
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D055815:Young Adult