Objective  To evaluate the prognostic value of the tumor-ratio-metastasis (TRM) staging system in gastric cancer.

  Methods  Survival analysis was performed using the Cox regression model. Two parameters were used to compare the differences between the tumor-node-metastasis (TNM) and TRM staging systems and between the -2log likelihood and the hazard ratio (HR).

  Results  Univariate analysis showed that age, tumor size, tumor location, macroscopic type, histological grade, tumor depthUnion for International Cancer Control (UICC) T stage, number of metastatic lymph nodes (UICC N stage), ratio between metastatic and dissected lymph nodes (RML) staging system, and the TNM and TRM staging systems were related to the survival status. Under the same TRM staging score, no statistical differences were found among the results of different TNM staging cases. However, for TNM stages ⅢB and ⅢC cases, statistical differences were observed in the survival among patients with different TRM staging scores. The Cox multivariate analysis showed that the TRM staging system had a higher HR and a smaller -2log likelihood, compared with the TNM staging system.

  Conclusion  The TRM staging system is superior to the TNM staging system in the prognostic assessment of gastric cancer.