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1. Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study

Author

De Rai, Paolo, Zerbi, Alessandro, Castoldi, Laura, Bassi, Claudio, Frulloni, Luca, Uomo, Generoso, Gabbrielli, Armando, Pezzilli, Raffaele, Cavallini, Giorgio, Di Carlo, Valerio, Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazzoni, G., Bartolo, F., Della Papa, D., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Bugnano, L., Buonanno, G. M., Esposito, C., Cordovana, A., Cavina, E., Seccia, M., Lippolis, P., Musco, B., Barletta, M., Chilovi, E., De Guelfi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Casentini, A., Costamagna, G., Trincali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosiani, V., D'Ambrosio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L., Morelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacignola, S., Calandro, L., Mazzitelli, L., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salval, N., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Lecconi, L., Valeri, L., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., Cipolla, A., De Rai, P, Zerbi, A, Castoldi, L, Bassi, C, Frulloni, L, Uomo, G, Gabbrielli, A, Pezzilli, R, Cavallini, G, Di Carlo, V, Proinf, Aisp, and Testoni, PIER ALBERTO

Subjects
Male, Time Factors, Pancreatitis, Alcoholic, medicine.medical_treatment, Acute pancreatitis, Surgery, Aged, Biliary Tract Diseases, Chi-Square Distribution, Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic, Female, Guideline Adherence, Humans, Italy, Pancreatitis, Pancreatitis, Acute Necrotizing, Practice Guidelines as Topic, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Treatment Outcome, Cholecystectomy, Jejunostomy, Pancreatectomy, Practice Patterns, Physicians', Hepatology, Gastroenterology, Physician's Practice Patterns, Practice Patterns, surgery, Endoscopic Retrograde, Medicine, Cholangiopancreatography, Laparoscopic, Acute Necrotizing, Alcoholic, Prospective cohort study, health care economics and organizations, acute pancreatitis, Corrigendum, Risk assessment, medicine.medical_specialty, education, Severity of illness, Intensive care medicine, Physicians', business.industry, General surgery, Original Articles, medicine.disease, business
Abstract

OBJECTIVE: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. METHODS: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. RESULTS: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. DISCUSSION: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.

Published
2010
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2. Surgical treatment of pancreatic endocrine tumours in Italy: results of a prospective multicentre study of 262 cases

Author

Zerbi, A, Capitanio, V, Boninsegna, L, Pasquali, C, Rindi, G, Delle Fave, G, Del Chiaro, M, Casadei, R, Falconi, M, Di Carlo V, Pederzoli P, Delle Fave G, Pedrazzoli S, Tomassetti P, Casadei R, Garcea D, Uomo G, Colangelo E, Mosca F, Fronda GR, Bresadola F, Cantore M, Leone BE, Farinati F, Toma SS, Luppi G, Bene A, Bajetta E, Ruffini L, Gebbia V, Liguori L, De Toma G, Dogliotti L, Massidda B, Zerbi, A, Capitanio, V, Boninsegna, L, Pasquali, C, Rindi, G, Delle Fave, G, Del Chiaro, M, Casadei, R, Falconi, M, Di Carlo, V, Pederzoli, P, Pedrazzoli, S, Tomassetti, P, Garcea, D, Uomo, G, Colangelo, E, Mosca, F, Fronda, G, Bresadola, F, Cantore, M, Leone, B, Farinati, F, Toma, S, Luppi, G, Bene, A, Bajetta, E, Ruffini, L, Gebbia, V, Liguori, L, De Toma, G, Dogliotti, L, Massidda, B, A., Zerbi, V., Capitanio, L., Boninsegna, C., Pasquali, G., Rindi, G. D., Fave, M. D., Chiaro, R., Casadei, Falconi, Massimo, A. I. S. P., Network Study Group, Zerbi A., Capitanio V., Boninsegna L., Pasquali C., Rindi G., Delle Fave G., Del Chiaro M., Casadei R., Falconi M., and AISP Network Study Group.

Subjects
Adult, Male, medicine.medical_specialty, Exploratory laparotomy, medicine.medical_treatment, Risk Assessment, Disease-Free Survival, pancreatic endocrine tumours, Pancreaticoduodenectomy, Pancreatectomy, medicine, Humans, Prospective Studies, Laparoscopy, Prospective cohort study, Aged, Neoplasm Staging, medicine.diagnostic_test, Settore MED/08 - ANATOMIA PATOLOGICA, business.industry, General surgery, Biopsy, Needle, Middle Aged, Debulking, endocrine, tumours,PET, Immunohistochemistry, Survival Analysis, Surgery, Pancreatic Neoplasms, Neuroendocrine Tumors, Treatment Outcome, Italy, Cardiothoracic surgery, Female, Neoplasm Recurrence, Local, business, PANCREATIC ENDOCRINE TUMOR, Abdominal surgery, Follow-Up Studies
Abstract

BACKGROUND: Information on the treatment of pancreatic endocrine tumours (PETs) comes mostly from small, retrospective, uncontrolled studies. METHODS: Newly diagnosed, histologically proven PETs, observed from June 2004 to March 2007 in 24 Italian centres, were included in a specific dataset. RESULTS: Three-hundred and ten patients (mean age 57.6 years, females 46.6%) were analysed. At the time of recruitment, 262 (84.5%) underwent surgery. The percentage of operated patients was 91.9% and 62.0% in surgical and non-surgical centres, respectively. A curative resection was carried out in 83.6% (n = 219) of cases, a palliative resection (debulking) in 10.7% (n = 28), an exploratory laparotomy in 4.6% (n = 12), and a bypass procedure in 1.1% (n = 3). Laparoscopy was performed in 8.0% (n = 21) of cases. Resection consisted of a pancreatoduodenectomy in 46 cases (21.0%), a distal pancreatectomy in 95 (43.4%), an enucleation in 50 (22.8%), a middle pancreatectomy in 16 (7.3%) and a total pancreatectomy in 12 (5.5%). Liver resection was associated with pancreatic resection in 26 cases (9.9%). Post-operative mortality was 1.5% and morbidity 39.7%, respectively. A curative resection was performed more frequently in asymptomatic, small, non-metastatic, benign and at uncertain behaviour tumours, with low Ki67 values. CONCLUSIONS: This study strongly indicates the fact that surgical resection represents the cornerstone treatment of PETs.

Published
2011

3. Clinicopathological features of pancreatic endocrine tumors: a prospective multicenter study in Italy of 297 sporadic cases

Author

Zerbi A, Falconi M, Rindi G, Delle Fave G, Tomassetti Casadei PR, Pasquali C, Di Carlo V, Capitanio V, Boninsegna L, Pederzoli P, Pedrazzoli S, Garcea D, Uomo G, Colangelo E, Mosca F, Fronda GR, Bresadola F, Cantore M, Farinati F, Leone BE, Toma SS, Luppi G, Bene A, Bajetta E, Ruffini L, Gebbia V, Liguori L, De Toma G, Dogliotti L, Massidda B., A., Zerbi, Falconi, Massimo, G., Rindi, G. D., Fave, P., Tomassetti, C., Pasquali, V., Capitanio, L., Boninsegna, V. D., Carlo, A. I. S. P., Network Study Group, Zerbi A, Falconi M, Rindi G, Delle Fave GF, Tomassetti P, Pasquali C, Capitanio V, Boninsegna L, Di Carlo V, and the members of the AISP-Network Study Group, Zerbi, A, Falconi, M, Rindi, G, Delle Fave, G, Tomassetti Casadei, P, Pasquali, C, Di Carlo, V, Capitanio, V, Boninsegna, L, Pederzoli, P, Pedrazzoli, S, Garcea, D, Uomo, G, Colangelo, E, Mosca, F, Fronda, G, Bresadola, F, Cantore, M, Farinati, F, Leone, B, Toma, S, Luppi, G, Bene, A, Bajetta, E, Ruffini, L, Gebbia, V, Liguori, L, De Toma, G, Dogliotti, L, and Massidda, B

Subjects
Adult, Male, medicine.medical_specialty, Pancreatic disease, Gastroenterology, Pancreatic tumor, Internal medicine, medicine, Carcinoma, Endocrine system, Humans, Prospective Studies, Prospective cohort study, Aged, Islet Cell, Female, Insulinoma, Italy, Middle Aged, Pancreatic Neoplasms, PANCREAS, Hepatology, business.industry, Pancreatic Neoplasm, medicine.disease, medicine.anatomical_structure, Multicenter study, Clinicopathological features, Carcinoma, Islet Cell, Pancreas, business, Human
Abstract

Objectives: Information on pancreatic endocrine tumors (PETs) comes mostly from small, retrospective, uncontrolled studies conducted on highly selected patients. The aim of the study was to describe the clinical and pathological features of PETs in a prospective, multicenter study.Methods: Newly diagnosed, histologically proven, sporadic PETs observed from June 2004 to March 2007 in 24 Italian centers were included in a specific data set.Results: Two hundred ninety-seven patients (mean age 58.614.7 years, females 51.2%, males 48.8%) were analyzed. In 73 cases (24.6%), the tumor was functioning (F) (53 insulinomas, 15 gastrinomas, 5 other syndromes) and in 232 (75.4%) it was non-functioning (NF); in 115 cases (38.7%), the diagnosis was incidental. The median tumor size was 20 mm (range 2-150). NF-PETs were significantly more represented among carcinomas (P0.001). Nodal and liver metastases were detected in 84 (28.3%) and 85 (28.6%) cases, respectively. The presence of liver metastases was significantly higher in the NF-PETs than in the F-PETs (32.1% vs. 17.8%; P0.05), and in the symptomatic than in the asymptomatic patients (34.6% vs. 19.1%; P

Published
2010

4. Diagnostic assessment and outcome of acute pancreatitis in Italy: results of a prospective multicentre study. ProInf-AISP: Progetto informatizzato pancreatite acuta, Associazione Italiana Studio Pancreas, phase II

Author

Uomo, G, Pezzilli, R., Gabbrielli, A., Castoldi, L., Zerbi, A., Frulloni, L., De Rai, P., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirrino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L. M., Murelli, Federica, Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzì, S., and Cipolla, A.

Subjects
Adult, Male, Pancreatic necrosis, Severity of Illness Index, Body Mass Index, Acute Pancreatitis, Clinical outcome, Computed tomography, Diagnosis, Pancreatitis, Prognosis, Ultrasonography, Aged, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Creatinine, Female, Humans, Italy, Middle Aged, Prospective Studies, Treatment Outcome, Hepatology, Gastroenterology, Endoscopic Retrograde, 80 and over, treatment, Medicine (all), Cholangiopancreatography, acute pancreatitis, diagnosis
Abstract

Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy.The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating centre was furnished with an ad hoc software including 530 items along with subsequent collection, tabulation and quality control of the data.One thousand five hundred and forty case report forms of patients affected by acute pancreatitis were collected but 367 of them (24%) were subsequently eliminated from the final analysis. Therefore, 1173 patients (581 females and 592 males) were recruited. Mean age of patients was 62.0+/-18.2 years (95% confidence interval, 60.9-63.0). On the basis of Atlanta classification, 1006 patients (85.8%) were defined as mild and 167 (14.2%) as severe pancreatitis. Biliary forms represented the most frequent aetiological category (813 cases, 69.3%) while alcoholic forms only 6.6% (77 cases); the remaining aetiologies accounted for 7.1% (83 cases) while 200 cases (17.1%) remained without a definite aetiological factor. Complete recovery was achieved in 1016 patients (86.6%) whereas morphological sequelae were found in 121 patients (10.3%) and mortality in 36 patients (3.1%; 0.4% in mild and 19.2% in severe acute pancreatitis). Ultrasonography was largely utilised as a first line diagnostic tool in all patients, with valuable visualisation of the pancreas in 85% of patients. Computer tomography scan was also widely used, with 66.7% of exams in mild and 33.3% in severe pancreatitis. Patients affected by biliary pancreatitis presented more severe (p=0.004) and necrotizing forms (p=0.021). Mortality was significantly related (p0.001) with the extension of pancreatic necrosis and with an age of over 70 years. Body mass index presented significantly greater values in severe than in mild forms (p0.001).Association of creatinine serum level over 2mg/dl with an abnormal chest X-ray showed a high significant correlation with a more severe outcome in terms of morphological sequelae and mortality (p=0.0001). Acute pancreatitis in Italy more commonly presents biliary aetiology and favourable outcome with low rate of complications and mortality. From a cost-effectiveness standpoint, diagnostic approach to this disease needs to be better standardised.

Published
2007

5. A prospective multicentre survey on the treatment of acute pancreatitis in Italy

Author

Pezzilli, R, Uomo, G., Gabbrielli, A., Zerbi, A., Frulloni, L., De Rai, P., Castoldi, L., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, Piero, Caronna, Roberto, Scozzafava, S., Cardi, Maurizio, Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, D., Mariani, L. M., Murelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., and Cipolla, A.

Subjects
Adult, Male, medicine.medical_specialty, ERCP, Pancreatitis, Pancreatitis acute necrotising, Aged, Aged, 80 and over, Analgesics, Anti-Bacterial Agents, Digestive System Surgical Procedures, Female, Histamine Antagonists, Humans, Italy, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Medicine (all), Hepatology, Gastroenterology, Therapeutic approach, Internal medicine, Severity of illness, 80 and over, Medicine, Prospective cohort study, business.industry, medicine.disease, Surgery, medicine.anatomical_structure, Acute pancreatitis, Tramadol, business, Pancreas, medicine.drug
Abstract

The Italian Association for the Study of the Pancreas released a diagnostic and therapeutic algorithm for acute pancreatitis in 1999.This study focused on the analysis of the therapeutic approach for the treatment of acute pancreatitis in Italy.One thousand, one hundred and seventy-three patients were recruited: 1006 patients (85.8%) had mild acute pancreatitis (MAP) and 167 (14.2%) had the severe acute pancreatitis (SAP); 161 patients showed pancreatic necrosis at computed tomography; 121 patients (10.3%) had sequelae and 36 (3.1%) died.Non-steroidal anti-inflammatory drugs and tramadol were used more frequently in patients with the MAP whereas opioids and the association schedules were used more frequently in patients with the SAP (P0.001). Gabexate mesilate was utilised in 831 out of 1173 patients (70.8%); in particular, gabexate mesilate was used in 70.6% patients with MAP and in 73.1% of those with SAP (P=0.521). The duration of the drug administration was significantly shorter in those having MAP than in those having the SAP (P0.001). The antibiotics most frequently used for the prophylaxis against infection from pancreatic necrosis (43.1%) were carbapenems. Only a small number of patients received enteral nutrition (4.7%). Endoscopic retrograde cholangiopancreatography was carried out in 344 of the 1173 patients (29.3%). Surgery was performed in 48 with SAP (19 had elective biliary surgery and 29 had pancreatic surgery).The results of this survey indicate a lack of compliance with the guidelines which regard the indications mainly for interventional endoscopy and surgery.

Published
2007

6. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients

Author

Luca Baiocchi, Franco Roviello, Donato Nitti, Alessandro Ambrosi, Domenico Garcea, Francesco De Santis, Giovanni de Manzoni, Arianna Coniglio, Paolo Morgagni, G. Natalini, Simone Mocellin, Annamaria Minicozzi, Daniele Marrelli, Alberto Marchet, Marchet, A, Mocellin, S, Ambrosi, Alessandro, Morgagni, P, Garcea, D, Marrelli, D, Roviello, F, de Manzoni, G, Minicozzi, A, Natalini, G, De Santis, F, Baiocchi, L, Coniglio, A, and Nitti, D.

Subjects
STAGE MIGRATION, Male, medicine.medical_specialty, RESECTION, CARCINOMA, medicine.medical_treatment, MODELS, TNM staging system, Gastroenterology, TNM, Metastasis, surgery, Stomach Neoplasms, STOMACH, Internal medicine, N-ratio, Gastric cancer, Prognosis, medicine, Humans, RECURRENCE, Stomach cancer, DISSECTION, Lymph node, Aged, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, business.industry, Cancer, RESIDUALS, Retrospective cohort study, TNM CLASSIFICATION, Original Articles, medicine.disease, Surgery, prognosis, lymphadenectomy, medicine.anatomical_structure, Italy, Lymphatic Metastasis, Multivariate Analysis, SURVIVAL, Lymph Node Excision, Lymphadenectomy, Female, Lymph, business
Abstract

Purpose: To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) is a better prognostic factor as compared with traditional staging systems in patients with gastric cancer regardless of the extension of lymph node dissection. Patients & Methods: We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma at 6 Italian centers. Patients with >15 (group 1, n = 1421) and those with 25%) were determined by the best cut-off approach. Results: After a median follow-up of 45.5 months (range, 4-182 months), the 5-year overall survival of N0, N1, and N2 patients of group 1 versus group 2 was 83.4% versus 74.2% (P = 0.0026), 54.3% versus 44.3% (P = 0.018), and 32.7% versus 14.7% (P = 0.004), respectively, suggesting that a low number of excised lymph nodes can lead to the understaging of patients. N ratio identified subsets of patients with significantly different survival rates within NI and N2 stages in both groups. At multivariate analysis, the N ratio (but not N stage) was retained as an independent prognostic factor both in group I and group 2 (HR for N ratio 1, N ratio 2, and N ratio 3 = 1.67, 2.96, and 6.59, and 1.56, 2.68, and 4.28, respectively). In our series, the implementation of N ratio led to the identification of subgroups of patients prognostically more homogeneous than those classified by the TNM system. Conclusion: N ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer also in case of limited lymph node dissection. These data may represent the rational for improving the prognostic power of current UICC TNM staging system and ultimately the selection of patients who may most benefit from adjuvant treatments.

Published
2007

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