Cheng M, Yu Y, Watanabe T, Yoshimoto Y, Kaji S, Yube Y, Kaneda M, Orita H, Mine S, Wu YY, Fukunaga T. Evaluation of three lymph node staging systems for prognostic prediction in gastric cancer: A systematic review and meta-analysis. World J Gastrointest Oncol 2025; 17(3): 98103 [DOI: 10.4251/wjgo.v17.i3.98103]
Corresponding Author of This Article
Tetsu Fukunaga, MD, PhD, Chief Doctor, Department of Upper Gastroenterological Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo Ward, Tokyo 113-8431, Japan. t2fukunaga@juntendo.ac.jp
Research Domain of This Article
Oncology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ming Cheng, Yang Yu, Takehiro Watanabe, Yutaro Yoshimoto, Sanae Kaji, Yukinori Yube, Munehisa Kaneda, Hajime Orita, Shinji Mine, You-Yong Wu, Tetsu Fukunaga, Department of Upper Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo 113-8431, Japan
Ming Cheng, You-Yong Wu, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Yang Yu, Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing 100142, China
Co-first authors: Ming Cheng and Yang Yu.
Co-corresponding authors: You-Yong Wu and Tetsu Fukunaga.
Author contributions: Cheng M and Yu Y acquired, analyzed, and interpreted the data, drafted the manuscript, and approved the final manuscript; Watanabe T, Yoshimoto Y, and Kaji S revised the manuscript and approved the final manuscript; Kaneda M provided guidance on statistical analysis and support for the article’s publication fees; Mine S, Yube Y, and Orita H interpreted the data, revised the manuscript, and approved the final manuscript; Wu YY acquired and interpreted the data, and approved the final manuscript; Fukunaga T conceptualized and designed the study, critically revised the manuscript, and approved the final manuscript.
Supported by the Clinical Medical Team Introduction Program of Suzhou, No. SZYJTD201804.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tetsu Fukunaga, MD, PhD, Chief Doctor, Department of Upper Gastroenterological Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo Ward, Tokyo 113-8431, Japan. t2fukunaga@juntendo.ac.jp
Received: June 18, 2024 Revised: November 8, 2024 Accepted: December 25, 2024 Published online: March 15, 2025 Processing time: 241 Days and 8.1 Hours
Abstract
BACKGROUND
Lymph node status is a critical prognostic factor in gastric cancer (GC), but stage migration may occur in pathological lymph nodes (pN) staging. To address this, alternative staging systems such as the positive lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) were introduced.
AIM
To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.
METHODS
A systematic review identified 12 studies, from which hazard ratios (HRs) for overall survival (OS) were summarized. Sensitivity analyses, subgroup analyses, publication bias assessments, and quality evaluations were conducted. To enhance comparability, data from studies with identical cutoff values for pN, LNR, and LODDS were pooled. Homogeneous stratification was then applied to generate Kaplan-Meier (KM) survival curves, assessing the stratification efficacy of three staging systems.
RESULTS
The HRs and 95% confidence intervals for pN, LNR, and LODDS were 2.16 (1.72-2.73), 2.05 (1.65-2.55), and 3.15 (2.15-4.37), respectively, confirming all three as independent prognostic risk factors for OS. Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN. KM curves for pN (N0, N1, N2, N3a, N3b), LNR (0.1/0.2/0.5), and LODDS (-1.5/-1.0/-0.5/0) revealed significant differences (P < 0.001) among all prognostic stratifications. Mean differences and standard deviations in 60-month relative survival were 27.93% ± 0.29%, 41.70% ± 0.30%, and 26.60% ± 0.28% for pN, LNR, and LODDS, respectively.
CONCLUSION
All three staging systems are independent prognostic factors for OS. LODDS demonstrated the highest specificity, making it especially useful for predicting outcomes, while pN was the most effective in homogeneous stratification, offering better patient differentiation. These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.
Core Tip: In our study, the strength of our study lies in the simultaneous inclusion of lymph nodes stage, positive lymph node ratio, and log odds of positive lymph nodes, summarizing the hazard ratios for gastric cancer prognosis after surgery, and comparing the hazard ratios to evaluate their prognostic prediction ability. We combined data from studies with the same cutoff values and plotted Kaplan-Meier survival curves for overall survival. Comparing the relative survival differentiation rates within the stratifications of the three nodal systems.
