Improving Prognostic Stratification in Gastric Cancer: The Role of Lymph Node Staging Systems

Area of Science:

• Oncology
• Surgical Oncology
• Pathology

Background:

• The Tumor-Node-Metastasis (TNM) classification is standard for gastric cancer staging and survival prediction.
• Accuracy of TNM staging can be limited by insufficient lymph node (LN) dissection or pathologic examination.
• Alternative staging systems like lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) may offer better prognostic value, especially with suboptimal LN examination.

Purpose of the Study:

• To assess the prognostic impact of LNR and LODDS on overall survival (OS) in gastric cancer patients undergoing radical gastrectomy.
• To evaluate if LNR and LODDS provide improved prognostic stratification compared to the current N staging system.

Main Methods:

• Retrospective analysis of 75 gastric cancer patients who underwent curative gastrectomy between March 2005 and June 2025.
• Evaluation of potential prognostic factors including age, sex, tumor location, T stage, N stage, TNM stage, LNR, and LODDS using univariate and multivariate analysis.
• Utilized X-tile software to determine optimal cut-offs for LNR and LODDS for survival stratification.

Main Results:

• OS analysis included 71 patients surviving postoperatively.
• The N staging system did not accurately stratify patients by OS.
• Both LNR and LODDS, with identified cut-offs, significantly stratified patients into three distinct survival subgroups.
• Multivariate analysis confirmed LODDS and LNR as independent prognostic factors for OS.

Conclusions:

• LNR and LODDS provide more detailed insights into lymph node status and enhance prognostic accuracy compared to traditional N staging.
• These systems improve prognostic stratification even in patients undergoing curative gastrectomy with D2 lymphadenectomy and adequate lymph node retrieval (>15 LNs).
• Further validation in larger studies is recommended due to the small sample size and proposed cut-offs.