| Background and objective: lymph node metastasis is an important factor to assess the prognosis of gastric cancer. Accurate evaluation of the metastatic lymph node status is vital to assess the prognosis. So far, the most commonly used lymph node staging system p N category exists the shortage of stage migration, which lead to under-diagnosis To solve this problem, MLR have been put forward to assess the prognosis of gastric cancer,but the conclusions were not the same. The main purpose of this study is to combine our data center to investigating the prognostic significance of MLR in gastric cancer patients undergoing radical resection.Methods: Retrospectively analysis the Clinical and pathology data of the 477 patients who undergone radical resection were diagnosed with gastric adenocarcinoma by postoperative pathology with more than 15 lymph nodes dissected in our hospital during January 2010 to December 2011, to investigate the relationship between the MLR staging and p N staging in assessing the prognosis of patients with gastric cancer.Result: This research includes 477 gastric adenocarcinoma participants with only 444 patients had been followed-up. The median follow-up time is 55 months. All patients' postoperative survival time is 45.5 months on average. The 1, 3 and 5 year overall survival rates are 89.94%, 64.0% and 52.1% respectively. Spearman correlation analysis showed that MLR did not correlate with the inspected number of lymph nodes(p=0.657), whereas p N did(p=0.001). Univariate analysis showed that tumor sites, tumor size, gross type, histological type, differentiation degree, invasion depth, pathological stage, vascular cancer embolus, nerve invasion, lymphatic vessel invasion, MLR stage and p N stage were risky factor for prognosis of patients with gastric cancer(P <0.05), but differences in Gender and age did not have statistical significance effect on prognosis(p>0.05). In subgroup analysis,as the subgroup with the same MLR stage but different p N stage, we found only MLR1 stage had statistically different overall survival rate among subgroups(P=0.000). Then the same p N category was stratified into difference subgroups by the MLR stage, The patients within p N3 stage was found to contain subgroups of patients with statistical significance overall survival(P=0.002). Cox multivariate regression analysis showed MLR stage, histological type, tumor sites, vascular cancer embolus, lymphatic vessel invasion, pathological stage and tumor size were Independent prognostic factors of patients with gastric cancer(p<0.05), while invasion depth, p N category, differentiation degree, nerve invasion, gross type were not independent, significant prognostic parameters( p>0.05)? ROC curves analysis displayed whether classified by MLR or not, it was consistent with p N on evaluating the diagnostic value of prognosis in patients with gastric cancer(p>0.05).Conclusions: MLR stage, histological type, tumor sites, vascular cancer embolus, lymphatic vessel invasion, pathological stage and tumor size were Independent prognostic factors in patients with gastric cancer. MLR stage is one of the Independent prognostic factors in patients with gastric cancer, which is slightly affected by the number of examined nodes, and it can make up for the deficiencies of stage migration of the p N category in judging the prognosis of patients with gastric cancer on p N3 stage. Whether classified by MLR or not, its diagnosis value of judging the prognosis of patients with gastric cancer is equal to p N,but not superior to the latter. MLR stage can be regarded as an important supplement of p N category, the conjunction of MLR and p N will greatly improve gastric lymph stage system. |
PDF Full Text Request