Wang XQ, Bao M, Zhang C, et al. - Findings from this registry-based retrospective cohort study suggest better prognostic efficacy of lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) staging methods relative to the traditional N staging method in cardia gastric adenocarcinoma (CGA) with node metastasis. The two values are identified as promising substitutes for N staging in nomogram development when incorporation of other independent prognostic factors is done.

• Enrolled were a total of 1,038 patients diagnosed with node-positive CGA in the Surveillance, Epidemiology, and End Results database.

• Patients were randomly assigned (7:3) to the training set (n = 723) or validating set (n = 315).

• Based on the optimal cut-off values, classification of LNR was done into low (< 0.09), medium (0.09~0.33) and high (> 0.33) groups and classification of LODDS was done into low (< −2.09), medium (−2.09~−0.65) and high (> −0.65) groups.

• LNR and LODDS subgroups differ significantly in terms of cancer-specific survival (CSS).

• Race, T stage, M stage and LNR (or LODDS), were identified as independent predictors.

• Nomograms for 1-year, 2-year and 5-year CSS prediction were developed incorporating these predictors.

• In calibration plots, satisfactory results for internal and external validity of the nomogram were retrieved.