Lymph Node Density Predicts Survival in
Gastric Cancer

M. Alexander Otto, PA, MMS

July 13, 2022

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Lymph node density, also called lymph node ratio, is an independent predictor of nonmetastatic gastric cancer survival.

Why This Matters

  • Accurate tumor staging is essential for gastric cancer prognosis and treatment selection.

  • Current tumor staging systems are based on regional positive lymph node counts and largely ignore the total number of nodes retrieved.

  • Many studies have demonstrated that positive node counts alone do not sufficiently predict gastric cancer survival.

  • Incorporating lymph node density into current staging strategies could improve prognostic accuracy.  

Study Design

  • The team reviewed 4281 participants in the SEER database with nonmetastatic gastric adenocarcinoma from 2010-2015.

  • The researchers calculated the ideal prognosis-related cut points for lymph node density, which is the ratio of positive nodes to total nodes examined.

Key Results

  • The median regional node count was 17.96.

  • The optimal prognosis-related lymph node density cut-off values were 0.1 and 0.4.

  • Overall, cancer-specific survival and overall survival decreased with increases in lymph node density. For instance, compared with patients who had a ratio below 0.1, those with middle and high lymph node density ratios had 2.04-fold and 3.61-fold higher risk of mortality, respectively.

  • In addition, patients with the middle and higher levels of lymph node density had a 2.43-fold and 4.69-fold worse cancer-specific survival, respectively.

  • Patients in the same lymph node stage still had different prognoses because of different lymph node density ratios after adjustment for confounders.


  • It was a retrospective study, and SEER does not include information on neoadjuvant chemotherapy and surgical complications that may have influenced survival.


  • There was no funding for the work, and the investigators did not report any competing interests.

This is a summary of a preprint research study, "Prognostic value of lymph node density on Cancer Staging System for non-metastatic gastric cancer: a population-based analysis of SEER database," led by Yuhua Liu of the Chinese PLA General Hospital, Beijing. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email:

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