Background: Lymph node ratio (LNR) has been considered as a prognostic factor for survival in gastric cancer patients. To date, the best cutoff value with its impact on recurrence has not been identified. Materials and Methods: A total of 100 patients with adenocarcinoma of stomach who underwent curative gastrectomy with lymphadenectomy during 2016–2023 were included in this quaternary care cohort study. The receiver operating characteristic curve followed by calculation of the Youden’s index was used to determine the appropriate LNR. Recurrence-free survival analysis was compared using the cutoff LNR. Cox regression analysis was carried out to identify associating factors. Results: Majority of tumors were poorly differentiated (66%) with 22% of signet ring cell. Pathological stages were T1 21%, T2 14%, T3 34%, and T4 31% with N0 35%, N1 15%, N2 17%, and N3 33%. The median number of total harvested lymph nodes was 41.5 (16–109) with three (0–52) metastatic nodes. A LNR of 0.2 yielded a sensitivity of 83.3% (95%CI 62.6–95.3), a specificity of 82.9% (95%CI 72.5–90.6), and an accuracy of 83% on recurrence. Three-year disease-free survival (DFS) was significantly worse in LNR≥0.2 (32.6% vs 92.8%, P < 0.001) with a median time to recurrence of 18.9 months. Subgroup analysis without N0 cases provided the same sensitivity with a specificity of 68.29% (95%CI 51.91–81.92) and significantly worse 3-year DFS (32.6% vs 83.3%, P < 0.001). From multivariate analysis, pathological N3 stage and LNR≥0.2 were independent factors for recurrence. Conclusion: An LNR of 0.2 may offer the optimal cutoff point to predict gastric cancer recurrence after surgery.
Nampoolsuksan et al. (Wed,) studied this question.