Negative-to-Positive Lymph Node Ratio as an Independent Prognostic Factor for Gastric Adenocarcinoma

Objective: To investigate the association between the ratio of negative/positive lymph nodes ( RNP) and other clinic pathological parameters. Study Design: Descriptive study. Place and Duration of Study: Faculty of Medicine, Cumhuriyet University, Sivas, Turkey, from February 2008 to December 2019. Methodology: Consecutive 119 patients with gastric adenocarcinoma, who underwent gastrectomy and D2 lymph node dissection, were included. RNP, other clinicopathological parameters such as tumour grade, type and lymphovascular invasion (LVI) were analysed, as their prognostic impact was investigated. Results: RNP was an independent prognostic factor for overall survival (p = 0.003) and was significantly associated with poor survival (p <0.001). Advanced pathologic T and N stage, presence of perineural invasion (PNI), presence of LVI, high tumour grade, and diffuse-type as per Louren's classification, and the number of the negative lymph nodes were also significantly associated with poor survival (all p <0.05). Although pathologic N stage (p <0.01), PNI (p <0.01), LVI (p <0.01), tumour type as per Louren's classification (p <0.01), tumour grade (p <0.01) and the number of negative lymph nodes (p <0.01) were significantly associated with overall survival in univariate analyses; only gender (p = 0.025), gastrectomy type (p = 0.037), PNI (p = 0.028), tumour type (p = 0.006), and number of negative lymph nodes (p = 0.003) were meaningfully associated with survival in a multivariate analysis. Conclusion: The ratio of negative/positive lymph nodes can be used as an independent prognostic marker in patients with gastric cancer, who undergo curative resection, as an alternative prognostic marker to the pathologic N stage.