1. Patient characteristics
The information of all 211 patients was listed in Table 1. Of all patients, 142 (67.3%) were male and 69 (32.7%) were female. The median age was 59 (range 25 to 84) years. Most tumors (58.3%) were located in the lower third part of the stomach. Totally, 4611 slices were reviewed, including 3978 slices indicating lymph nodes. After reevaluation, 94 patients (44.5%) had no lymph node metastasis (pN0); 35 patients (16.6%) had one to two lymph node metastasis (pN1); 43 patients (20.4%) had three to six lymph node metastasis (pN2); 29 patients (13.7%) had seven to fifteen lymph node metastasis (pN3a); and 10 patients (4.7%) had more than or equal to sixteen lymph node metastasis (pN3b). Regarding to LNR, the numbers of patients in LNR0, 1 and 2 groups were 97, 51 and 63, respectively.
As for other pathological features, only a small percentage of cancers (17.1%) were poorly cohesive carcinoma, i.e. mucous adenocarcinoma (2.4%) and signet ring cell carcinoma (14.7%). Fifty-eight (27.5%) tumors were well differentiated and forty-seven (22.3%) tumors were moderate differentiated. All patients underwent adjuvant therapy, and almost a half of them (46.4%) underwent SOX.
2. Relationships between LNR and other clinicopathological characteristics
The associations between LNR and other clinicopathological characteristics could be seen in Table 1. Patients who had a larger tumor tended to have a worse LNR (p = 0.003). Patients who had a tumor of diffuse or mixed classification (p = 0.007) or had a poor differentiated tumor (p = 0.041) also showed a worse LNR. In addition, pathological T stage (p = 0.050) and N stage (p < 0.001) also showed relationships with LNR (Table 1). The adjuvant therapy showed no relationships with LNR (p = 0.661) (data not shown).
3. Prognostic value of LNR
The analyses for overall survival were shown in Table 2. In the univariable analysis, tumor size (HR = 2.545, p < 0.001), Lauren classification (HR = 1.924, p = 0.016), pathological T stage (pT) (HR = 5.679, p = 0.004), pathological N stage (HR = 16.302, p < 0.001) and LNR (HR = 7.023, p < 0.001) were related to the prognosis. Because pN and LNR had great collinearity, these two factors were included in the multivariable analysis respectively. In multivariable analysis including pN, pT (HR = 3.602, p = 0.043) and pN (HR = 11.986, p = 0.001) were independent prognostic factors. Similarly, in multivariable analysis including LNR, pT (HR = 3.694, p = 0.041) and LNR (HR = 4.852, p < 0.001) were independent prognostic factors (Table 2). The survival curves of pN and LNR were shown in Fig. 1. Pathological N stage (p < 0.001) and LNR (p < 0.001) were related to prognosis. In addition, ROC curves of pN stage and LNR were made, and the area under curves were 0.686 and 0.687, respectively, with no statistical significance (data not shown).
4. Stratification analysis on LNR according to pathological T stage
Because pT was also an independent prognostic factor besides pN and LNR, stratification analysis according to pT was performed. The survival curves of LNR stratified by pT were shown in Fig. 2. In pT1-2 (p = 0.043) patients and pT4 (p <0.001) patients, LNR was related to overall survival. However, in pT3 patients, LNR was not related to the prognosis (p = 0.374).
Multivariable analyses were performed after stratification (Table 3). In pT4 patients, LNR was still an independent prognostic factor (HR = 7.149, p < 0.001). However, in pT3 patients, LNR was no longer an independent prognostic factor (p = 0.361). Instead, tumor size was an independent prognostic factor (HR = 4.914, p = 0.020). In pT1-2 patients, LNR also showed no independent predictive value (p = 0.123) (data not shown).