prognostic significance of metastatic lymph node ratio in patients with gastric cancer: an evaluation in north-east of iran

background: in this study we evaluated the prognostic impact of metastatic lymph node ratio (mlr) in patients with gastric cancer undergoing curative surgical resection. methods: a total of 121 patients with gastric adenocarcinoma undergoing curative r0 surgical resection in our institutions between 2003 and 2010 were included in this study.  mlr was classified into 3 groups as follows: mlr0; 0, mlr1; >0-0.33 and mlr2; 0.34-1. we used kaplan-meier method to calculate survival rates and log rank test to compare survival curves between groups. cox proportional hazards model was utilized for multivariate analysis. results: the median age of patients was 65 (range; 32 to 89) with a male to female ratio of 91/30 (3.03). 88 patients underwent total gastrectomy (72.5%) and 33 subtotal gastrectomy (27.5%). with a median total retrieved lymph node of 11 (range; 6 to 44), the mlr0 to mlr2 was calculated in 28(23.1%), 31(25.6%) and 62 (51.2%) patients respectively. mlr2 (>0.33) was significantly associated with higher tumor stage (t1-t2: 18.7% vs. t3: 56.2%, p=0.002). with a median follow up time of 12 months (range; 2-88), the 3-year survival in patients with mlr0, mlr1 and mlr2 was 75.1%, 54.8% and 9.5% respectively (p value<0.001). tumor location (p<0.01), tumor stage (p<0.01) and lymph node stage (p<0.001) were also significant predictor of survival. mlr was also significant correlated with survival in 91 patients with less than 15 obtained lymph nodes (p<0.001). cox-regression multivariate analysis showed mlr as being the most important and independent predictor of survival (p<0.001). conclusion: mlr with cutoff point of 0.33 can be used as an independent prognostic factor in gastric cancer patients undergoing curative surgical resection. this factor can effectively predict survival even in cases with insufficient (<15) retrieved lymph nodes. keywords: gastric cancer; lymph node; prognosis; metastatic lymph node ratio   please cite this article as: taghizadeh-kermani a, yahouiyan sz, aliakbarian m, seilanian toussi m. prognostic significance of metastatic lymph node ratio in patients with gastric cancer: an evaluation in north-east of iran. iran j cancer prev. 2014; 7(2):73-9.   references yu w, choi gs, whang i, suh is. comparison of five systems for staging lymph node metastasis in gastric cancer. br j surg. 1997; 84(9):1305-9. zhang m, zhu g, ma y, xue y. comparison of four staging systems of lymph node metastasis in gastric cancer. world j surg. 2009; 33(11):2383-8. rodriguez santiago jm, munoz e, marti m, quintana s, veloso e, marco c. metastatic lymph node ratio as a prognostic factor in gastric cancer. eur j surg oncol. 2005; 31(1):59-66. nitti d, marchet a, olivieri m, ambrosi a, mencarelli r, belluco c, et al. ratio between metastatic and examined lymph nodes is an independent prognostic factor after d2 resection for gastric cancer: analysis of a large european monoinstitutional experience. ann surg oncol. 2003; 10(9):1077-85. yu jw, wu jg, zheng lh, zhang b, ni xc, li xq, et al. influencing factors and clinical significance of the metastatic lymph nodes ratio in gastric adenocarcinoma. j exp clin cancer res. 2009; 28:55. lee sy, hwang i, park ys, gardner j, ro jy. metastatic lymph node ratio in advanced gastric carcinoma: a better prognostic factor than number of metastatic lymph nodes? int j oncol. 2010; 36(6):1461-7. lee sr, kim ho, son bh, shin jh, yoo ch. prognostic significance of the metastatic lymph node ratio in patients with gastric cancer. world j surg. 2012; 36(5):1096-101. inoue k, nakane y, iiyama h, sato m, kanbara t, nakai k, et al. the superiority of ratio-based lymph node staging in gastric carcinoma. ann surg oncol. 2002; 9(1):27-34. bilici a, seker m, ustaalioglu bb, yilmaz b, doventas a, salepci t, et al. determining of metastatic lymph node ratio in patients who underwent d2 dissection for gastric cancer. med oncol. 2010; 27(3):975-84. ding yb, chen gy, xia jg, zang xw, yang hy, yang l, et al. correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of patients with surgically-removed gastric carcinoma. world j gastroenterol. 2004; 10(2):182-5. fukuda n, sugiyama y, midorikawa a, mushiake h. prognostic significance of the metastatic lymph node ratio in gastric cancer patients. world j surg. 2009; 33(11):2378-82.