Clinical Influence of the Lymph Node Ratio on Lymph Node Metastasis-positive Gastric Cancer Patients Who Receive Curative Treatment

Aim: The present study investigated the clinical impact of the lymph node ratio (LNR) on overall survival (OS) and recurrence-free survival (RFS) in cancer patients with lymph node metastasis who received curative treatment. Patients and Methods: Eighty-six patients who received curative surgery for gastric cancer between 2000 and 2015, and in whom lymph node metastasis was pathologically confirmed, were included in this study. The LNR was defined as the ratio of the number of metastatic lymph nodes to the total number of harvested lymph nodes. Results: A lymph node ratio of 0.23 was considered the optimal cutoff point for classification according to OS. Statistically significant differences were observed in the 3- and 5-year OS rates and 3- and 5-year RFS rates. The 3-year and 5-year OS rates in the LNR less than 0.23 group were 57.6% and 57.6%, respectively, whereas those in the LNR more than 0.23 group were 33.0% and 0% (p=0.001). The 3-year and 5-year RFS rates in the LNR less than 0.23 group were 45.9% and 43.6%, respectively, whereas those in the LNR more than 0.23 group were 25.2% and 0% (p=0.002). Regarding the site of first relapse, the incidence rates of peritoneal and lymph node metastasis in the LNR more than 0.23 group were significantly different in comparison to the LNR less than 0.23 group. Conclusion: High LNR was associated with significantly worse OS and RFS in patients who received curative treatment for gastric cancer. The lymph node metastasis status should be utilized in the development of treatment strategies for gastric cancer.