Brief Article
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World J Gastroenterol. Dec 14, 2011; 17(46): 5123-5130
Published online Dec 14, 2011. doi: 10.3748/wjg.v17.i46.5123
Superiority of metastatic lymph node ratio to the 7th edition UICC N staging in gastric cancer
Long-Bin Xiao, Jian-Xing Yu, Wen-Hui Wu, Feng-Feng Xu, Shi-Bin Yang
Long-Bin Xiao, Jian-Xing Yu, Wen-Hui Wu, Feng-Feng Xu, Shi-Bin Yang, Department of Gastrointestinal-pancreatic Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
Author contributions: Xiao LB and Yu JX contributed equally to this work; Yu JX and Wu WH performed the majority of data collection and wrote the manuscript; Xu FF and Yang SB performed the statistical analysis; Xiao LB designed the study and provided financial support for this work.
Supported by The Science and Technology Program of Guangdong Province (2009B030801112), the Natural Science Foundation of Guangdong Province, China, No. 9151008901000119; the Science and Technology Program of Huangpu District, Guangdong Province (031)
Correspondence to: Long-Bin Xiao, MD, Department of Gastrointestinal-pancreatic Surgery, the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road II, Guangzhou 510080, Guangdong Province, China. longbinxiao@yahoo.cn
Telephone: +86-20-82379585 Fax: +86-20-82379495
Received: December 26, 2010
Revised: March 29, 2011
Accepted: April 5, 2011
Published online: December 14, 2011
Abstract

AIM: To compare and evaluate the appropriate prognostic indicators of lymph node basic staging in gastric cancer patients who underwent radical resection.

METHODS: A total of 1042 gastric cancer patients who underwent radical resection and D2 lymphadenectomy were staged using the 6th and 7th edition International Union Against Cancer (UICC) N staging methods and the metastatic lymph node ratio (MLNR) staging. Homogeneity, discriminatory ability, and gradient monotonicity of the various staging methods were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations. The area under the curve (AUC) was calculated to compare the predictive ability of the aforementioned three staging methods.

RESULTS: Optimal cut-points of the MLNR were calculated as MLNR0 (0), MLNR1 (0.01-0.30), MLNR2 (0.31-0.50), and MLNR3 (0.51-1.00). In univariate, multivariate, and stratified analyses, MLNR staging was superior to the 6th and 7th edition UICC N staging methods. MLNR staging had a higher AUC, higher linear trend and likelihood ratio χ2 scores and lower AIC values than the other two staging methods.

CONCLUSION: MLNR staging predicts survival after gastric cancer more precisely than the 6th and 7th edition UICC N classifications and should be considered as an alternative to current pathological N staging.

Keywords: Gastric cancer; Metastatic lymph node ratio; Prognosis