Prognostic value of regional lymph node status in locally advanced gastric cancer after neoadjuvant treatment

Beliak N.P., Kutukova S.I., Smirnova N.V., Androsova A.V., Mgar E.A., Varankina A.A., Ksanaeva L.A., Pelipas Yu. V., Orlova R.V.

1) Saint Petersburg State University, St. Petersburg, Russia; 2) City Clinical Oncology Dispensary, St. Petersburg, Russia; 3) Pavlov First Saint Petersburg State Medical University (Pavlov University), St. Petersburg, Russia

Background: Gastric cancer (GC) remains one of the most commonly diagnosed malignancies. Nearly 70% of patients with gastric cancer are diagnosed at a locally advanced stage with a poor prognosis [1]. In recent years, a series of randomized clinical trials, such as MAGIC, FLOT, PRODIGY, and RESOLVE, have consistently confirmed the efficacy of neoadjuvant chemotherapy (NACT) in the treatment of locally advanced gastric cancer. Thus, NACT is the preferred option for patients with locally advanced disease [2–6]. Currently, the ypTNM staging system (AJCC) is the most widely used tool for assessing the prognosis of patients with gastric cancer after NACT [7]. The ypN stage depends on the number of metastatic lymph nodes, and the accuracy of its determination can be affected by dissection of an insufficient number of lymph nodes [8]. Furthermore, several studies have shown that an increased number of lymph nodes removed correlates with a better prognosis. Lymph node ratio (LNR, the proportion of metastatic lymph nodes to all lymph nodes removed) has also been shown to be a more accurate predictor of prognosis in patients with gastric cancer who have undergone radical gastrectomy [9–13]. However, there is limited data on the prognostic value of the LNR in patients with locally advanced gastric cancer after NACT.
Objective: Evaluation of the prognostic value of the LNR in patients with locally advanced gastric cancer after NACT
Materials and methods: Our retrospective study collected data from 210 patients with locally advanced gastric cancer who underwent radical surgery after NACT at the City Clinical Oncology Dispensary from 2020 to the present. Indications for perioperative therapy for gastric cancer include clinical stages cT3-4aN any M0 or cT3-4aN+M0, assessed using CT and endoscopic ultrasonography [14]. All patients underwent regional lymph node assessment based on morphological examination data: the number of examined lymph nodes and the number of affected lymph nodes were assessed, and the ratio of affected to examined lymph nodes was calculated, multiplied by 100 (the LNR index). The optimal cutoff value for the LNR index, which significantly impacts PFS, was determined; this value was >7.14.
Conclusion: Our study showed that a high LNR index (>7.14) was significantly associated with worse relapse-free and overall survival in patients who underwent perioperative chemotherapy and radical gastrectomy. The metastatic regional lymph node ratio (LNR) can be used as an independent prognostic factor in patients with resectable gastric cancer.

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About the Authors

Natalia P. Beliak, Cand. Sci. (Med.), Associate Professor at the Department of Oncology at the Medical Institute, Saint Petersburg State University; Head of Department № 10 (Chemotherapy), City Clinical Oncology Dispensary, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0003-0402-6067, SPIN-код: 2937-4858
Svetlana I. Kutukova, Dr. Sci. (Med.), Professor at the Department of Dentistry, Surgical and Maxillofacial Surgery, Pavlov First Saint Petersburg State Medical University (Pavlov University); Oncologist, Department № 10 (Chemotherapy), City Clinical Oncology Dispensary, St. Petersburg, Russia; dr.s.kutukova@gmail.com, ORCID: https://orcid.org/0000-0003-2221-4088, SPIN-код: 6735-6556 (corresponding author)
Natalia V. Smirnova, Oncologist, Department № 10 (Chemotherapy), City Clinical Oncology Dispensary, St. Petersburg, Russia; ORCID: https://orcid.org/0009-0006-3593-3646
Alexandra V. Androsova, Cand. Sci. (Med.), Assistant at the Department of Oncology at the Medical Institute, Saint Petersburg State University; Oncologist at the Department № 10 (Chemotherapy), City Clinical Oncology Dispensary, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0001-7111-1507, SPIN-код: 8552-6219
Ekaterina A. Mgar, Oncologist, Department № 10 (Chemotherapy), City Clinical Oncology Dispensary, St. Petersburg, Russia; ORCID: https://orcid.org/0009-0003-6646-9442
Anna A. Varankina, Oncologist, Department № 10 (Chemotherapy), City Clinical Oncology Dispensary, St. Petersburg, Russia; ORCID: https://orcid.org/0009-0007-2182-5684
Leylya A. Ksanaeva, Oncologist, Department № 10 (Chemotherapy), City Clinical Oncology Dispensary, St. Petersburg, Russia;
Yury V. Pelipas, Cand. Sci. (Med.), Head of Department № 4, City Clinical Oncology Dispensary, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0003-3647-0445, SPIN-код: 3549-5476
Rashida V. Orlova, Dr. Sci. (Med.), Head of the Department of Oncology at the Medical Institute, Saint Petersburg State University; Chief Specialist in Drug Treatment and Rehabilitation; City Clinical Oncology Dispensary, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0003-4447-9458, SPIN-код: 9932-6170

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