The association of lymph node ratio to survival in gastric adenocarcinoma patients following radical gastrectomy

Objective: The TNM staging system offers prognostic insights, but its effectiveness is often limited by inadequate lymph node retrieval. The lymph node ratio (LNR) offers a more comprehensive assessment. This study aimed to evaluate the association between LNR and survival outcomes in Colombia, a country with a high prevalence of gastric cancer. Methods: This retrospective cohort study included patients with gastric adenocarcinoma who underwent oncologic resection at a single center between 2015 and 2018. The LNR was calculated as the ratio of affected lymph nodes to the total number dissected during gastrectomy. Perioperative characteristics were assessed based on LNR quartiles: LNR0 (0), LNR1 (>0–0.16), LNR2 (>0.16–0.4), and LNR3 (>0.4). Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluated the association between LNR and survival outcomes. Results: 157 patients were included, with a median age of 64 years; 63.1 % (n = 99) were men, and 74.5 % (n = 117) had an ECOG 1. The median number of lymph nodes collected was 24, with 77 % (n = 122) having more than 15 nodes resected. Significant differences in overall survival (OS) and disease-free survival (DFS) were observed among the LNR groups (p = 0.0010). As LNR increased, both OS and DFS declined. Patients with 40 % LNR involvement had twice the mortality hazard (HR 2.13, 95 % CI 1.02–4.48) and patients with 10 % LNR involvement had three times the recurrence risk (HR 3.12, 95 % CI 1.1–8.82). Conclusions: LNR is an independent prognostic factor for survival following radical gastrectomy. This highlights the need for careful lymph node evaluation and its integration into risk stratification and patient management.