Background/aims: Gastric cancer staging based on the number of positive lymph nodes is not reliable in patients undergoing limited lymphadenectomies. The aim of the present study was to determine the prognostic influence of lymph node ratio (LR)--defined as the number of metastatic nodes divided by total of obtained nodes--in patients with less than 16 analyzed lymph nodes.
Methodology: Seventy-two gastric cancer patients underwent surgery with a curative intention, obtaining less than <16 nodes. The pN (TNM 5th Ed) and LR were studied in a multivariate analysis (Cox regression). LR was classified in four groups: 0, <40%, 40-79%, and >80%, according to a previous study carried out by the authors.
Results: Neither the number of affected lymph nodes nor LR behaved as independent prognostic factors. Nevertheless, when locally advanced tumors were studied separately, the lymph node ratio gave more precise prognostic information, resulting in the identification a group of patients with the same pN stage who presented with different prognoses.
Conclusions: LR offers better prognostic information than the number of affected lymph nodes in patients with locally advanced gastric tumors undergoing limited lymphadenectomies. Further studies are needed to confirm these results and standardize the stratification of LR.