Prognostic significance of lymph node ratio in adenocarcinoma of the esophagogastric junction: a study of patients after radical gastrectomy

The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Lymph node metastasis is a crucial prognostic factor in AEG patients. This study investigated the utility of lymph node ratio (LNR, the ratio of metastatic nodes to the total number of examined lymph nodes) in predicting the prognosis of AEG patients. The study conducted a retrospective analysis of 257 patients with AEG who underwent radical gastrectomy with lymphadenectomy. The patients were categorized into low-LNR (L-LNR) and high-LNR (H-LNR) groups, and their corresponding clinicopathological characteristics and survival rates were compared. Receiver Operating Characteristic (ROC) curves were generated to evaluate the sensitivity and specificity of LNR. The cutoff value for dividing the L-LNR group, and the H-LNR group was 0.20. In the L-LNR group, the 1, 3, and 5-year disease-free survival (DFS) rates and overall survival (OS) rates were higher than H-LNR group. Patients in the L-LNR group had better prognoses than those in the H-LNR group (P<0.001). Univariate analysis identified that vascular invasion, lymphatic invasion and LNR were risk factors for DFS and OS. Additionally, multivariate analysis demonstrated that LNR was independent risk factor for DFS and OS. In the subgroup analysis stratified by TNM stage, patients in the L-LNR group demonstrated better DFS and OS compared to those in the H-LNR group. The ROC curve identified that the LNR has good sensitivity and specificity for prognostic prediction in AEG patients, especially in stage III. Patients with LNR greater than 0.2 experienced significantly shorter OS and DFS in patients with AEG, especially in TNM stage III.