title: Prognostic Performance of Different Lymph Node Staging Systems After Curative Intent Resection for Gastric Adenocarcinoma.
abstract: OBJECTIVE
  To compare the prognostic performance of American Joint Committee on Cancer/International Union Against Cancer seventh N stage relative to lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS), and N score in gastric adenocarcinoma.
  
  
  BACKGROUND
  Metastatic disease to the regional LN basin is a strong predictor of worse long-term outcome following curative intent resection of gastric adenocarcinoma.
  
  
  METHODS
  A total of 804 patients who underwent surgical resection of gastric adenocarcinoma were identified from a multi-institutional database. The relative discriminative abilities of the different LN staging/scoring systems were assessed using the Akaike's Information Criterion (AIC) and the Harrell's concordance index (c statistic).
  
  
  RESULTS
  Of the 804 patients, 333 (41.4%) had no lymph node metastasis, whereas 471 (58.6%) had lymph node metastasis. Patients with ≥N1 disease had an increased risk of death (hazards ratio = 2.09, 95% confidence interval: 1.68-2.61; P < 0.001]. When assessed using categorical cutoff values, LNR had a somewhat better prognostic performance (C index: 0.630; AIC: 4321.9) than the American Joint Committee on Cancer seventh edition (C index: 0.615; AIC: 4341.9), LODDS (C index: 0.615; AIC: 4323.4), or N score (C index: 0.620; AIC: 4324.6). When LN status was modeled as a continuous variable, the LODDS staging system (C index: 0.636; AIC: 4304.0) outperformed other staging/scoring systems including the N score (C index: 0.632; AIC: 4308.4) and LNR (C index: 0.631; AIC: 4225.8). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that was better stratified and characterized by the LODDS.
  
  
  CONCLUSIONS
  When assessed as a categorical variable, LNR was the most powerful manner to stratify patients on the basis of LN status. LODDS was a better predicator of survival when LN status was modeled as a continuous variable, especially among those patients with either very low or high LNR.
authors.affiliation: *Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD †Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA ‡Department of Surgery, Stanford University, Palo Alto, CA §Department of Surgery, Washington University School of Medicine, St. Louis, MO ¶Department of Surgery, The Ohio State University, Columbus, OH ||Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI **Department of Surgery, Wake Forest University, Winston-Salem, NC.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.forename: George
authors.initials: G
authors.lastname: Poultsides
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Votanopoulos
authors.forename: Alexandra W
authors.initials: AW
authors.lastname: Acher
authors.forename: Linda X
authors.initials: LX
authors.lastname: Jin
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: David
authors.initials: D
authors.lastname: Worhunsky
authors.forename: Neil
authors.initials: N
authors.lastname: Saunders
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; 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 / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis