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LNR was categorized into four groups and assessed for optimal cutoff and comparative prognostic accuracy against AJCC 8th edition pN stage. Results showed LNR as an independent predictor of overall survival, while conventional pN stage was not.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/lymph-node-ratio-a-novel-prognostic-indicator-for-gastric-cancer/458805/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/lymph-node-ratio-a-novel-prognostic-indicator-for-gastric-cancer/458805.png","ImageObject",300,407,{"name":42,"@type":43},"Fans","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What problem with AJCC N-staging does this study address?","Question",{"text":63,"@type":64},"AJCC N-staging can be affected by stage migration and by variability in how many lymph nodes are harvested and examined, which can compromise prognostic reliability. The study evaluates whether LNR mitigates these limitations.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How were patients grouped using lymph node ratio (LNR)?",{"text":68,"@type":64},"LNR was calculated as the ratio of positive lymph nodes to total examined lymph nodes, then categorized into four groups: LNR1 (0%), LNR2 (1–25%), LNR3 (26–50%), and LNR4 (51–100%).",{"name":70,"@type":61,"acceptedAnswer":71},"What were the main findings regarding prognosis?",{"text":72,"@type":64},"A higher LNR was strongly associated with poorer survival, with median overall survival decreasing from 36 months in LNR1 to 17 months in LNR4. Multivariate analysis showed LNR was an independent prognostic factor, while conventional pN stage was not.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},458805,1790833405,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":123,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},5909892330395,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Review began 11/23/2025  \nReview ended 12/03/2025  \nPublished 12/09/2025  \n© Copyright 2025  \nA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98792  \nOpen Access Original Article  \nLymph Node Ratio: A Novel Prognostic Indicator for Gastric Cancer  \nAnand Praveen Kumar A 1, Chandralekha K 1, Sathiyamoorthy P N 1  \n1. Medical Oncology, Stanley Medical College, Chennai, IND  \nCorresponding author: Anand Praveen Kumar A, [anandpraveen05@gmail.com](anandpraveen05@gmail.com)  \nAbstract  \nIntroduction  \nGastric cancer remains one of the most common malignancies and is a leading cause of cancer-related mortality worldwide. Accurate nodal staging is critical for gastric cancer prognosis but is often compromised by \"stage migration \" and variability in lymph node (LN) harvest inherent in the current AJCC N-staging system. The lymph node ratio (LNR) has emerged as a potentially more reliable prognostic indicator that accounts for the extent of lymphadenectomy. This study aimed to evaluate the prognostic significance of the LNR, determine an optimal cutoff value, and compare its accuracy against the conventional AJCC 8th edition N-stage in patients undergoing curative gastrectomy.  \nMethods and materials  \nThis was a single-institution, retrospective cohort study. The study analyzed 85 patients with nonmetastatic gastric cancer who underwent surgical treatment between January 2021 and December 2024. Clinicopathological data were collected, and the LNR was calculated and categorized into four groups: LNR1 (0%), LNR2 (1-25%), LNR3 (26-50%), and LNR4 (51-100%) .  \nResults  \nThe median overall survival (OS) was 26 months. Only 24. 7% of patients had an optimal LN dissection (>15 nodes) . A higher LNR was strongly associated with poorer survival, with median OS decreasing from 36 months in LNR1 to 17 months in LNR4. Multivariate analysis revealed that LNR was a significant independent prognostic factor for survival (p\u003C0 .001), whereas the conventional pN stage was not (p=0 .098) .  \nConclusions  \nThe LNR is a simple, robust, and independent prognostic indicator for overall survival in patients with gastric cancer, appearing superior to the conventional pN stage. Its use can improve risk stratification, particularly in cases of suboptimal lymphadenectomy.  \nCategories: Oncology  \nKeywords: gastric cancer, lymphadenectomy, lymph node ratio, pn stage, prognosis, survival  \nIntroduction  \nGastric cancer remains a significant global health challenge, ranking as the fifth most common malignancy and the fourth leading cause of cancer-related mortality worldwide [1] . Despite advances in diagnostic and therapeutic strategies, the overall prognosis for patients, particularly those with advanced disease, remains poor. Surgical resection with radical lymphadenectomy stands as the cornerstone of curative treatment for non-metastatic gastric cancer [2] . Accurate postoperative staging is paramount, as it critically informs prognosis, guides adjuvant therapy decisions, and allows for standardized comparison of treatment outcomes across different cohorts.  \nThe current gold standard for staging is the American Joint Committee on Cancer (AJCC) TNM classification system, which relies on the absolute number of metastatic lymph nodes (LNs) to define the pathologic Nstage [3] . However, this method is not without its limitations. A primary concern is the phenomenon of\"stage migration,\" where the accuracy of N-staging is highly dependent on the total number of LNs harvested and examined. A limited lymphadenectomy may result in an underestimation of the true nodal burden, potentially leading to suboptimal treatment for high-risk patients [4] . The variability in the number of retrieved nodes, which can be influenced by the extent of su","cbCaihthi7vs84RW","https://ap.wps.com/l/cbCaihthi7vs84RW","pdf",1008697,"English","# Abstract\n# Introduction\n# Methods and materials\n# Results\n# Conclusions","[{\"question\":\"What problem with AJCC N-staging does this study address?\",\"answer\":\"AJCC N-staging can be affected by stage migration and by variability in how many lymph nodes are harvested and examined, which can compromise prognostic reliability. The study evaluates whether LNR mitigates these limitations.\"},{\"question\":\"How were patients grouped using lymph node ratio (LNR)?\",\"answer\":\"LNR was calculated as the ratio of positive lymph nodes to total examined lymph nodes, then categorized into four groups: LNR1 (0%), LNR2 (1–25%), LNR3 (26–50%), and LNR4 (51–100%).\"},{\"question\":\"What were the main findings regarding prognosis?\",\"answer\":\"A higher LNR was strongly associated with poorer survival, with median overall survival decreasing from 36 months in LNR1 to 17 months in LNR4. Multivariate analysis showed LNR was an independent prognostic factor, while conventional pN stage was not.\"}]","Lymph Node Ratio - A Novel Prognostic Indicator for Gastric Cancer | PDF",1790754497,25]