{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:14:13Z","timestamp":1786115653426,"version":"build-2736575974"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"DOI":"10.1186\/s12957-026-04482-5","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:14:31Z","timestamp":1782965671000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of lymph node ratio after suboptimal lymphadenectomy in gastric cancer: a retrospective cohort study with interaction analysis"],"prefix":"10.1186","volume":"24","author":[{"given":"Yusuf Emre","family":"Aytin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sezer Berkay","family":"Gorca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"issue":"1","key":"4482_CR1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","volume":"74","author":"RL Siegel","year":"2024","unstructured":"Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12\u201349. https:\/\/doi.org\/10.3322\/caac.21820.","journal-title":"CA Cancer J Clin"},{"issue":"5","key":"4482_CR2","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1038\/s41416-020-01190-z","volume":"124","author":"Z Li","year":"2021","unstructured":"Li Z, Wu X, Gao X, et al. Development and validation of a novel staging system integrating the number and location of lymph nodes for gastric adenocarcinoma. Br J Cancer. 2021;124(5):942\u201350. https:\/\/doi.org\/10.1038\/s41416-020-01190-z.","journal-title":"Br J Cancer"},{"key":"4482_CR3","doi-asserted-by":"publisher","unstructured":"Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2025 (7th edition). Gastric Cancer. 2026;29(2):271\u2009\u2013\u200999. https:\/\/doi.org\/10.1007\/s10120-025-01698-4","DOI":"10.1007\/s10120-025-01698-4"},{"issue":"5","key":"4482_CR4","doi-asserted-by":"publisher","first-page":"169","DOI":"10.6004\/jnccn.2025.0022","volume":"23","author":"JA Ajani","year":"2025","unstructured":"Ajani JA, D\u2019Amico TA, Bentrem DJ, et al. Gastric Cancer, Version 2.2025, NCCN Clinical Practice Guidelines In Oncology. J Natl Compr Canc Netw. 2025;23(5):169\u201391. https:\/\/doi.org\/10.6004\/jnccn.2025.0022.","journal-title":"J Natl Compr Canc Netw"},{"issue":"9","key":"4482_CR5","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1111\/jgh.13306","volume":"31","author":"W Okajima","year":"2016","unstructured":"Okajima W, Komatsu S, Ichikawa D, et al. Prognostic impact of the number of retrieved lymph nodes in patients with gastric cancer. J Gastroenterol Hepatol. 2016;31(9):1566\u201371. https:\/\/doi.org\/10.1111\/jgh.13306.","journal-title":"J Gastroenterol Hepatol"},{"key":"4482_CR6","doi-asserted-by":"publisher","unstructured":"Miciak M, Jurkiewicz K, Dzierzek P, Rudno-Rudzinska J, Kielan W. Prognostic Significance of Lymph Node Ratio (LNR) in Gastric Cancer in Predicting Postoperative Complications and Survival: A Single-Center Study. Cancers (Basel). 2025;17(5). https:\/\/doi.org\/10.3390\/cancers17050743.","DOI":"10.3390\/cancers17050743"},{"key":"4482_CR7","doi-asserted-by":"publisher","first-page":"595421","DOI":"10.3389\/fonc.2021.595421","volume":"11","author":"M Zhang","year":"2021","unstructured":"Zhang M, Ding C, Xu L, et al. Comparison of a Tumor-Ratio-Metastasis Staging System and the 8th AJCC TNM Staging System for Gastric Cancer. Front Oncol. 2021;11:595421. https:\/\/doi.org\/10.3389\/fonc.2021.595421.","journal-title":"Front Oncol"},{"issue":"1","key":"4482_CR8","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1186\/s12957-018-1504-5","volume":"16","author":"Y Hou","year":"2018","unstructured":"Hou Y, Wang X, Chen J. Prognostic significance of metastatic lymph node ratio: the lymph node ratio could be a prognostic indicator for patients with gastric cancer. World J Surg Oncol. 2018;16(1):198. https:\/\/doi.org\/10.1186\/s12957-018-1504-5.","journal-title":"World J Surg Oncol"},{"issue":"1","key":"4482_CR9","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s12893-023-02127-y","volume":"23","author":"M Ergenc","year":"2023","unstructured":"Ergenc M, Uprak TK, Akin MI, Hekimoglu EE, Celikel CA, Yegen C. Prognostic significance of metastatic lymph node ratio in gastric cancer: \u0effa Western-center analysis. BMC Surg. 2023;23(1):220. https:\/\/doi.org\/10.1186\/s12893-023-02127-y.","journal-title":"BMC Surg"},{"key":"4482_CR10","doi-asserted-by":"publisher","unstructured":"Jannasch O, Schwanz M, Otto R, Mik M, Lippert H, Mroczkowski P. Lymph Node Yield and Lymph Node Ratio for Prognosis of Long-Term Survival in Gastric Carcinoma. Cancers (Basel). 2025;17(3). https:\/\/doi.org\/10.3390\/cancers17030414.","DOI":"10.3390\/cancers17030414"},{"key":"4482_CR11","doi-asserted-by":"publisher","first-page":"1434999","DOI":"10.3389\/fendo.2025.1434999","volume":"16","author":"X Gu","year":"2025","unstructured":"Gu X, Du Y. Prognostic performance of examined lymph nodes, lymph node ratio, and positive lymph nodes in gastric cancer: a competing risk model study. Front Endocrinol (Lausanne). 2025;16:1434999. https:\/\/doi.org\/10.3389\/fendo.2025.1434999.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"4482_CR12","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1186\/s12889-024-19104-6","volume":"24","author":"JL Lin","year":"2024","unstructured":"Lin JL, Lin JX, Lin GT, et al. Global incidence and mortality trends of gastric cancer and predicted mortality of gastric cancer by 2035. BMC Public Health. 2024;24(1):1763. https:\/\/doi.org\/10.1186\/s12889-024-19104-6.","journal-title":"BMC Public Health"},{"key":"4482_CR13","doi-asserted-by":"publisher","first-page":"152209","DOI":"10.1016\/j.anndiagpath.2023.152209","volume":"67","author":"C Diaz Del Arco","year":"2023","unstructured":"Diaz Del Arco C, Ortega Medina L, Estrada Munoz L, Molina Roldan E, Garcia Gomez de Las Heras S, Fernandez Acenero MJ. Prognostic role of the number of resected and negative lymph nodes in Spanish patients with gastric cancer. Ann Diagn Pathol. 2023;67:152209. https:\/\/doi.org\/10.1016\/j.anndiagpath.2023.152209.","journal-title":"Ann Diagn Pathol"},{"issue":"6","key":"4482_CR14","doi-asserted-by":"publisher","first-page":"108318","DOI":"10.1016\/j.ejso.2024.108318","volume":"50","author":"PMD Costa","year":"2024","unstructured":"Costa PMD, Antunes C, Lages P, et al. Challenging the Dogma: Stage migration or negative lymph nodes, which of them is the main player on gastric cancer prognosis? Eur J Surg Oncol. 2024;50(6):108318. https:\/\/doi.org\/10.1016\/j.ejso.2024.108318.","journal-title":"Eur J Surg Oncol"},{"issue":"1","key":"4482_CR15","doi-asserted-by":"publisher","first-page":"28623","DOI":"10.1038\/s41598-025-13766-x","volume":"15","author":"D Matsubara","year":"2025","unstructured":"Matsubara D, Komatsu S, Konishi T, et al. Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers. Sci Rep. 2025;15(1):28623. https:\/\/doi.org\/10.1038\/s41598-025-13766-x.","journal-title":"Sci Rep"},{"key":"4482_CR16","doi-asserted-by":"publisher","first-page":"e18165","DOI":"10.7717\/peerj.18165","volume":"12","author":"G Jia","year":"2024","unstructured":"Jia G, Zhou D, Tang X, Liu J, Lei P. Prognostic value of a modified pathological staging system for gastric cancer based on the number of retrieved lymph nodes and metastatic lymph node ratio. PeerJ. 2024;12:e18165. https:\/\/doi.org\/10.7717\/peerj.18165.","journal-title":"PeerJ"},{"issue":"4","key":"4482_CR17","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/j.surg.2021.04.026","volume":"170","author":"DJ Erstad","year":"2021","unstructured":"Erstad DJ, Blum M, Estrella JS, et al. Benchmarks for nodal yield and ratio for node-positive gastric cancer. Surgery. 2021;170(4):1231\u20139. https:\/\/doi.org\/10.1016\/j.surg.2021.04.026.","journal-title":"Surgery"},{"key":"4482_CR18","doi-asserted-by":"publisher","unstructured":"Grigorie TR, Verdea C, Chiriac TD, et al. Improving Prognostic Stratification in Gastric Cancer: The Role of Lymph Node Staging Systems. Med (Kaunas). 2025;62(1). https:\/\/doi.org\/10.3390\/medicina62010085.","DOI":"10.3390\/medicina62010085"},{"issue":"3","key":"4482_CR19","doi-asserted-by":"publisher","first-page":"98103","DOI":"10.4251\/wjgo.v17.i3.98103","volume":"17","author":"M Cheng","year":"2025","unstructured":"Cheng M, Yu Y, Watanabe T, et al. Evaluation of three lymph node staging systems for prognostic prediction in gastric cancer: A systematic review and meta-analysis. World J Gastrointest Oncol. 2025;17(3):98103. https:\/\/doi.org\/10.4251\/wjgo.v17.i3.98103.","journal-title":"World J Gastrointest Oncol"},{"issue":"1","key":"4482_CR20","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1186\/s12885-023-10805-6","volume":"23","author":"Y Li","year":"2023","unstructured":"Li Y, Wu G, Liu J, et al. Log odds of positive lymph nodes as a novel prognostic predictor for gastric cancer: a systematic review and meta-analysis. BMC Cancer. 2023;23(1):523. https:\/\/doi.org\/10.1186\/s12885-023-10805-6.","journal-title":"BMC Cancer"},{"issue":"4","key":"4482_CR21","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.21037\/jgo-21-185","volume":"12","author":"YR Chen","year":"2021","unstructured":"Chen YR, Wang MQ, Li YT, et al. Prognostic performance of different lymph node classification systems in young gastric cancer. J Gastrointest Oncol. 2021;12(4):1285\u2013300. https:\/\/doi.org\/10.21037\/jgo-21-185.","journal-title":"J Gastrointest Oncol"},{"issue":"4","key":"4482_CR22","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1097\/JS9.0000000000000308","volume":"109","author":"Y Zeng","year":"2023","unstructured":"Zeng Y, Cai F, Wang P, et al. Development and validation of prognostic model based on extragastric lymph nodes metastasis and lymph node ratio in node-positive gastric cancer: a retrospective cohort study based on a multicenter database. Int J Surg. 2023;109(4):794\u2013804. https:\/\/doi.org\/10.1097\/JS9.0000000000000308.","journal-title":"Int J Surg"},{"key":"4482_CR23","doi-asserted-by":"publisher","first-page":"1376702","DOI":"10.3389\/fsurg.2024.1376702","volume":"11","author":"S Chen","year":"2024","unstructured":"Chen S, Ding P, Zhao Q. Comparison of the predictive performance of three lymph node staging systems for late-onset gastric cancer patients after surgery. Front Surg. 2024;11:1376702. https:\/\/doi.org\/10.3389\/fsurg.2024.1376702.","journal-title":"Front Surg"},{"issue":"16","key":"4482_CR24","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.3748\/wjg.v29.i16.2452","volume":"29","author":"WJ Yang","year":"2023","unstructured":"Yang WJ, Zhao HP, Yu Y, et al. Updates on global epidemiology, risk and prognostic factors of gastric cancer. World J Gastroenterol. 2023;29(16):2452\u201368. https:\/\/doi.org\/10.3748\/wjg.v29.i16.2452.","journal-title":"World J Gastroenterol"},{"issue":"1","key":"4482_CR25","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1186\/s12957-024-03629-6","volume":"22","author":"AI Alangari","year":"2024","unstructured":"Alangari AI, Kim S, Lee HH, Song KY, Seo H. Prognostic impact of lymphovascular invasion in node-negative gastric cancer: a retrospective cohort study. World J Surg Oncol. 2024;22(1):340. https:\/\/doi.org\/10.1186\/s12957-024-03629-6.","journal-title":"World J Surg Oncol"},{"issue":"13","key":"4482_CR26","doi-asserted-by":"publisher","first-page":"8928","DOI":"10.1245\/s10434-021-10224-6","volume":"28","author":"S Choi","year":"2021","unstructured":"Choi S, Song JH, Lee S, et al. Lymphovascular Invasion: Traditional but Vital and Sensible Prognostic Factor in Early Gastric Cancer. Ann Surg Oncol. 2021;28(13):8928\u201335. https:\/\/doi.org\/10.1245\/s10434-021-10224-6.","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"4482_CR27","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1007\/s00423-025-03861-y","volume":"410","author":"ON Kempf","year":"2025","unstructured":"Kempf ON, Thorsen LBJ, Nerup N, et al. Stage-dependent survival in gastric cancer: a Danish nationwide cohort study. Langenbecks Arch Surg. 2025;410(1):308. https:\/\/doi.org\/10.1007\/s00423-025-03861-y.","journal-title":"Langenbecks Arch Surg"},{"key":"4482_CR28","doi-asserted-by":"publisher","unstructured":"Diaz Del Arco C, Ortega Medina L, Estrada Munoz L, Molina Roldan E, Garcia Gomez de Las Heras S, Fernandez Acenero MJ. Impact of Age at Diagnosis on Clinicopathological Features, Prognosis, and Management of Gastric Cancer: A Retrospective Single-Center Experience from Spain. Cancers (Basel). 2023;15(17). https:\/\/doi.org\/10.3390\/cancers15174241.","DOI":"10.3390\/cancers15174241"},{"issue":"2","key":"4482_CR29","doi-asserted-by":"publisher","first-page":"139","DOI":"10.15537\/smj.2022.43.2.20210464","volume":"43","author":"R Topcu","year":"2022","unstructured":"Topcu R, Sahiner IT, Kendirci M, Erkent M, Sezikli I, Tutan MB. Does lymph node ratio (metastasis\/total lymph node count) affect survival and prognosis in gastric cancer? Saudi Med J. 2022;43(2):139\u201345. https:\/\/doi.org\/10.15537\/smj.2022.43.2.20210464.","journal-title":"Saudi Med J"},{"key":"4482_CR30","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.ijsu.2018.08.002","volume":"57","author":"J Zhu","year":"2018","unstructured":"Zhu J, Xue Z, Zhang S, et al. Integrated analysis of the prognostic role of the lymph node ratio in node-positive gastric cancer: A meta-analysis. Int J Surg. 2018;57:76\u201383. https:\/\/doi.org\/10.1016\/j.ijsu.2018.08.002.","journal-title":"Int J Surg"},{"issue":"4","key":"4482_CR31","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/j.amjsurg.2013.05.004","volume":"207","author":"BY Zhang","year":"2014","unstructured":"Zhang BY, Yuan J, Cui ZS, Li ZW, Li XH, Lu YY. Evaluation of the prognostic value of the metastatic lymph node ratio for gastric cancer. Am J Surg. 2014;207(4):555\u201365. https:\/\/doi.org\/10.1016\/j.amjsurg.2013.05.004.","journal-title":"Am J Surg"},{"issue":"11","key":"4482_CR32","doi-asserted-by":"publisher","first-page":"e49424","DOI":"10.1371\/journal.pone.0049424","volume":"7","author":"S Chen","year":"2012","unstructured":"Chen S, Zhao BW, Li YF, et al. The prognostic value of harvested lymph nodes and the metastatic lymph node ratio for gastric cancer patients: results of a study of 1,101 patients. PLoS ONE. 2012;7(11):e49424. https:\/\/doi.org\/10.1371\/journal.pone.0049424.","journal-title":"PLoS ONE"},{"issue":"6","key":"4482_CR33","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.3892\/ijo_00000632","volume":"36","author":"SY Lee","year":"2010","unstructured":"Lee SY, Hwang I, Park YS, Gardner J, Ro JY. Metastatic lymph node ratio in advanced gastric carcinoma: a better prognostic factor than number of metastatic lymph nodes? Int J Oncol. 2010;36(6):1461\u20137. https:\/\/doi.org\/10.3892\/ijo_00000632.","journal-title":"Int J Oncol"},{"issue":"8","key":"4482_CR34","doi-asserted-by":"publisher","first-page":"e050378","DOI":"10.1136\/bmjopen-2021-050378","volume":"11","author":"XQ Wang","year":"2021","unstructured":"Wang XQ, Bao M, Zhang C. Prognostic value of different lymph node staging methods for node-positive cardia gastric cancer: a register-based retrospective cohort study. BMJ Open. 2021;11(8):e050378. https:\/\/doi.org\/10.1136\/bmjopen-2021-050378.","journal-title":"BMJ Open"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12957-026-04482-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-026-04482-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-026-04482-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:32:18Z","timestamp":1785990738000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12957-026-04482-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4482"],"URL":"https:\/\/doi.org\/10.1186\/s12957-026-04482-5","relation":{},"ISSN":["1477-7819"],"issn-type":[{"value":"1477-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"assertion":[{"value":"19 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was obtained from the Ethics Committee of Trakya University Faculty of Medicine (approval number: TUTF-BAEK 2026\/125; March 16, 2026). The study was conducted in accordance with the Declaration of Helsinki. Informed consent was waived due to the retrospective design of the study and the use of anonymized data obtained from hospital records.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"325"}}