Can the ratio of metastatic to examined lymph nodes (N ratio) be used as an independent prognostic factor in patients with gastric cancer? Is the hypothetical TRM (tumor-ratio-metastasis) staging system an alternative to the TNM (tumor-node-metastasis) staging system?

Aim: Lymph node metastasis is the most important prognostic factor in patients with gastric cancer. However, lymph node classification is controversial. We reported the prognostic factors of gastric cancer and the impact of N ratio classification in predicting prognosis and the suitability of TRM classification as an alternative to TNM(tumor-node-metastasis) classification for lymph nodes to avoid stage migration in gastric cancer