Is the metastatic lymph node ratio can predict the survival rate in gastric cancer patients?

Previous studies have proven that the MLR is an excellent predictor for survival outcome in patients with colon cancer, pancreatic cancer, breast cancer and other carcinomas. Some related studies on gastric cancer also found the potential of the MLR on prognostic evaluation. However, there is no consensus on MLR stratification cutoffs for lymph node staging, especially a lack of data for advanced gastric cancer located in the cardia and fundus.

A research article to be published on July 21, 2008 of the World Journal of Gastroenterology addresses this question. In this study, two hundred and 36 patients with advanced gastric cancer located in the cardia and fundus were analyzed retrospectively. As some researches revealed the correlation between MLR and survival by deviding the MLR into three or four different categories, this article made further step to investigate the prognostic impact of the MLR by setting up a regression model besides survival analysis.

The MLR can reflect the extent and the efficiency of lymphadenectomy. The MLR value did not fluctuate with the variation of the resected number of lymph nodes when the dissected number was more than 20. There was a significant correlation between five-year survival and the MLR, as well as with seven additional factors. The study also found a linear relationship between the MLR and survival rate, which the survival rate can be projected according to a regression equation.

Based on the statistical results, the authors suggest that the MLR can provide more reliable and accurate information on the extent of LN metastasis and lymphadenectomy for advanced gastric cancer located in cardia and fundus. Moreover, it is an important prognostic factor and can provide further evidence for rational lymphadenectomy. Therefore, this is an interesting and well done study investigating the prognostic role of MLR in cancer of gastric cardia and fundus.

Further studies are needed to know whether the MLR can predict the survival and help evaluate the lymph node dissection.

Reference: Huang CM, Lin BJ, Lu HS, Zhang XF, Li P, Xie JW. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus. World J Gastroenterol 2008; 14(27): 4383-4388
http://www.wjgnet.com/1007-9327/14/4383.asp

Correspondence to: Chang-Ming Huang, Department of Oncology,Affiliated Union Hospital, Fujian Medical University, Xinquan Road No.29, Fuzhou 350001, Fujian Province, China. hcmlr253@sohu.com
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