Which lymph node staging system best predicts prognosis in gastric carcinoma?

The three lymph node (LN) staging systems assessed in a recent study—the eighth TNM staging system, lymph node ratio (LNR, ratio between positive and total LN), and a new anatomic-based classification (Choi classification)—show comparable prognostic performance, but LNR-based classification better stratifies patients with resected gastric carcinoma (GC).

LN staging of GC remains controversial. To address this, the researchers conducted this retrospective study of 377 GC patients in a tertiary hospital in Spain. They collected clinical data, reviewed histologic slides, and performed univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS).

Of the patients identified, 315 met the eligibility criteria. On univariate analysis, all LN classifications significantly correlated with tumour death and progression (p<0.001).

The three staging systems were independent prognostic factors for DFS, with area under the curve ratios of 0.738 for Choi, 0.730 for N stage, and 0.735 for LNR classification.

Additionally, TNM and LNR classifications were independent prognostic factors for OS, while Choi classification was an independent factor only in patients with ≥16 LN resected. Area under the curve ratios were 0.707, 0.728, and 0.732 for Choi, N stage, and LNR classifications, respectively.

Of note, Kaplan-Meier curves depending on LNR classification demonstrated the best stratification of patients for both OS and DFS.

“GC is an aggressive disease with high mortality rates,” the researchers said.