Is there a survival difference between older adult and younger adult patients with locally advanced gastric cancer with the same lymph node ratio?

The aim of this study was to clarify the prognostic value of the pathological lymph node ratio for older adult and younger adult gastric cancer patients and to evaluate whether there is a difference in the survival of patients with the same lymph node ratio (LNR).A total of 222 patients diagnosed with locally advanced gastric cancer who underwent upfront gastrectomy without neoadjuvant chemotherapy and had negative surgical margins were included. The patients were divided into two groups according to age. Clinicopathological properties of the two groups were compared. Potential prognostic factors affecting survival were analyzed. Subsequently, the effect of lymphadenectomy and LNR on survival in both groups was evaluated.Thirty patients with perioperative mortality were excluded and 192 patients were analyzed. Significant differences were detected in terms of hemoglobin and albumin levels between older adult patients and younger adult patients (p < 0.05). Overall survival (OS) was significantly worse in older adult patients (22 months vs. 67 months, p < 0.001). The survival rates in older adult patients were significantly lower from those of younger adult in the subgroup LNR Stage 2 (12.1% vs. 47.9%, p = 0.004) and LNR Stage 3 classification (9.1% vs. 34.1%, p = 0.039). LNR was found to be significant for OS with a cut-off point of 0.18.A survival difference was found between the older adult and younger adult patients with the same LNR. LNR was found to be an independent factor for survival especially in older adult patients. Survival was found to be further decreased in older adult patients compared to younger adult patients with increasing LNR.