The effect of the histopathological prognostic criteria on the life time in gastric adenocarcinoma and staging technique according to metastatic LYMPH node ratio

Gastric cancer is the fifth most common cancer in the world and is the third most common cause of cancer related deaths. High incidence and mortality rates increase the importance of prognostic factors in determining treatment options. Histopathological criteria such as tumor stage, tumor size and location in the stomach, number of tumor-positive regional lymph nodes, presence of perineural invasion, histological type and grade of the tumor are used to determine prognosis after surgery. Lymph node status is the strongest indicator of the prognosis of gastric cancer patients. The pN stage graded by the number of metastatic lymph nodes may vary depending on the number of surgically dissected lymph nodes. In addition, at least 15 lymph nodes should be dissected to obtain accurate results. The staging system based on the metastatic lymph node ratio has been suggested as an alternative method especially for patients with less than 15 lymph node dissections. 221 patients with gastric adenocarcinoma following gastrectomy were included in this study within 10 years at Akdeniz University Department of Medical Pathology. H&E preparations were reviewed and parameters such as lymphovascular invasion, perineural invasion, depth of invasion, number of reactive lymph nodes, and number of metastatic lymph nodes were re-evaluated. Current stage calculation was performed by considering pTNM staging and AJCC 8th printing criteria. This current stage was used to compare the criteria. By calculating the ratio of metastatic lymph nodes to dissected lymph nodes, three main groups were formed for the new N category and pathological tumor stage was calculated according to the new N category. A statistically significant difference was determined between age, tumor size, lymphatic, vascular and perineural invasion, depth of invasion, tumor-positive surgical margin, distant metastasis and lymph node metastasis and 5-year survival. However, there was no significant difference between the survival rates of the patients grouped according to the number of lymph nodes and re-staging according to the metastatic lymph node ratio. In conclusion, the demographic and histopathological criteria of the patients are useful parameters for predicting prognosis and predicting survival. No significant difference was found between the stage graded according to the metastatic lymph node ratio and the current stage survival, and this evaluation is considered to be an alternative to the existing staging system.