Metastatic Lymph Node Ratio And Lauren Classification Are Independent Prognostic Factors For Survival In Patients With Curative Gastric Cancer Resection

Background: The long-term prognosis of gastric cancer patients after radical resection remains poor,and therefore,it is important to identify the prognostic markers to predict survival.In this retrospective study,we investigated the prognostic value of metastatic lymph node ratio(r N)and Lauren classification on predicting OS,and further conducted the subgroup analysis of Lauren classification using r N as an independent predictor.Methods:The data of 261 pathologically-confirmed gastric cancer patients were retrospectively reviewed.Kaplan-Meier estimates and Cox proportional hazards modeling were performed for the analysis of patients' overall survival.Receiver operating characteristic(ROC)curve was used to compare the accuracy of prognosis between metastatic lymph node ratio(r N)and Lymph node staging(N stage).Kaplan-Meier curve and Cox proportional hazard regression models were utilized to investigate the prognostic relevance of r N categories in each Lauren classification.The chi-square test was conducted to evaluate the association between r N and the diffuse type subgroup.Results:Univariate survival analysis showed that the significant prognostic factors included tumor diameter(P<0.001),lymph node metastasis status(node status)(P=0.004),r N(P<0.001),Lauren classification(P<0.001),N stage(p=0.001)and tumor node metastasis stage(TNM)(P<0.001).Multivariate analysis showed that tumor diameter(P=0.03),r N(P<0.001)and Lauren classification(P<0.001)were independent prognostic factors for overall survival.The higher r N was related to shorter survival,and the diffuse type of Lauren classification had the worst prognosis.The ROC analysis confirmed that r N was better than N stage for survival prediction.Subgroup analysis indicated that r N could further predict survival in patients with diffuse type gastric cancer.Conclusions: Metastatic lymph node ratio and Lauren classification were both independent prognostic factors for overall survival of gastric cancer patients after radical resection,and r N was more accurate than N stage for prognosis.r N could be used as an independent predictor of survival in patients with diffuse type gastric cancer..