Impact of total retrieved lymph nodes on staging and survival of patients with gastric cancer invading the subserosa

Liu, Caigang; Yang, Lu; Zhu, Jia; Zhang, Ruishan; Yao, Fan; Lu, Ping; Jin, Feng; Li, Hua; Xu, Hui; Wang, Shubao; Chen, Junqing

doi:10.1016/j.suronc.2008.09.002

Cited by 22 publications

(26 citation statements)

References 21 publications

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“…A high lymph node yield usually indicates adequate tumour clearance and staging. 6 Compared with gastric cancer patients treated with surgery alone in the present 21 -24 The AJCC/UICC classification 9 that is currently used for gastric cancer is widely accepted because of its strength in prognostic stratification, simplicity, reproducibility and low rate of methodologically related problems. The present study raised the possibility that the number of residual lymph nodes left after neoadjuvant chemotherapy can assist the clinician in making a prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…6 At present ≥ 15 lymph nodes need to be harvested to assess the mLN stage accurately. 6 Many papers have reported a strong correlation between the number of lymph nodes harvested and the mLN count, and even patient prognosis has been found to be positively correlated with the number of lymph nodes harvested. 6,7 Shen et al 8 analysed data from 1895 patients with T 3 Impact of neoadjuvant chemotherapy on lymph node harvest gastric cancer and suggested that increasing the tLN count might improve the accuracy of staging in patients who have pT 3 gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

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Reduced Lymph Node Harvest after Neoadjuvant Chemotherapy in Gastric Cancer

et al. 2011

J Int Med Res

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This retrospective study investigated the impact of neoadjuvant chemotherapy on the number of lymph nodes harvested in patients with T 3 /T 4 gastric cancer. Lymph node counts in 58 patients who received preoperative neoadjuvant chemotherapy were compared with those in 168 patients who received surgery alone. Significantly more patients (n = 14, 24.1%) treated with neoadjuvant chemotherapy had < 15 lymph nodes harvested compared with patients (n = 13, 7.7%) treated with surgery alone. A significant correlation between the total number of harvested lymph nodes and the number of metastatic lymph nodes (mLNs) existed in both groups. Neoadjuvant chemotherapy was the only factor associated with the retrieval of < 15 lymph nodes. The number of mLNs was an independent predictive factor for overall survival.Although neoadjuvant chemotherapy decreased the number of lymph nodes harvested, the number of mLNs may still be an acceptable prognostic factor in patients with gastric cancer, following neoadjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduced Lymph Node Harvest after Neoadjuvant Chemotherapy in Gastric Cancer

et al. 2011

J Int Med Res

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“…Three studies found an association between tumor location (distal tumors in two studies, and middle or upper-third tumors in one study) and an increased number of assessed LNs [35,38,43], whereas four studies did not [5,31,44,48] (Table 2). Increased tumor size was significantly associated with a greater number of assessed LNs in 3 studies [35,38,48], while one study reported no significant relationship [31].…”

Section: Clinicopathological Factors and The Number Of Lns Assessedmentioning

confidence: 95%

“…Increased tumor size was significantly associated with a greater number of assessed LNs in 3 studies [35,38,48], while one study reported no significant relationship [31]. Four studies found a significant relationship between advanced T stage and increased number of LNs assessed [24,29,35,44]; six studies found a significant association between advanced N stage and increased number of assessed LNs [5,23,31,43,44,48]; and two studies found a significant association between advanced clinical stage and increased number of LNs assessed [31,44].…”

Section: Clinicopathological Factors and The Number Of Lns Assessedmentioning

confidence: 97%

“…One study found no significant association between the number of LNs assessed and survival rates according to T stage [50]. Eleven studies [18,24,30,31,38,39,43,45,47,48,50] reported survival rates by N stage (Table 8), and found a significant relationship with improved survival among N0 patients [24,30,31,38,45,50], N1 patients [18,31,39,45,50], and N2 patients [18,31,39,45,48,50], with an increased number of LNs assessed. Only one study found this relationship to be significant among N3 patients [39].…”

Section: Clinicopathological Factors and The Number Of Lns Assessedmentioning

confidence: 99%

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How many lymph nodes should be assessed in patients with gastric cancer? A systematic review

et al. 2012

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Background Nodal status is one of the most important prognostic factors in gastric adenocarcinoma (GC). As such, it is important to assess an appropriate number of lymph nodes (LNs) in order to accurately stage patients. However, the number of LNs assessed in each GC case varies, and in many cases the number examined per gastric specimen is less than current recommendations. Purpose We aimed to identify and synthesize findings from all articles evaluating the association of clinicopathological features and long-term outcomes with the number of LNs assessed among GC patients. Methods Systematic electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1998 to 2009.Results Twenty-five articles were included in this review. Extensive resection, increased tumor size, and greater TNM staging were all associated with a greater number of LNs assessed. The disease-free survival was longer and recurrence rate was lower in patients with more LNs assessed. Overall survival, as well as survival by TNM and clinical stage, was improved among patients with an increased number of LNs assessed, but much of this appears to be due to stage migration, with the effect more pronounced in more advanced disease. Conclusion More LNs assessed resulted in less stage migration and possibly better long-term outcomes. Although current guidelines suggest 16 LNs to be assessed, especially in advanced GC, a higher number of LNs should be assessed.

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Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer

Son

Hyung

Lee

et al. 2012

Cancer

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BACKGROUND: The seventh edition of the tumor, lymph node (LN), metastasis (TNM) staging system increased the required number of examined LNs in gastric cancer from 15 to 16. However, the same staging system defines lymph node‐negative gastric cancer regardless of the number of examined LNs. In this study, the authors evaluated whether gastric cancer can be staged properly with fewer than 15 examined LNs. METHODS: The survival rates of 10,010 patients who underwent curative gastrectomy from 1987 to 2007 were analyzed. The patients were divided into 2 groups according to the number of examined LNs, termed the “insufficient” group (≤15 examined LNs) and the “sufficient” group (≥16 examined LNs). The survival curves of patients from both groups were compared according to the seventh edition of the TNM classification. RESULTS: Three hundred sixteen patients (3.2%) had ≤15 examined LNs for staging after they underwent standard, curative lymphadenectomy. Patients who had T1 tumor classification, N0 lymph node status, and stage I disease with an insufficient number of examined LNs after curative gastrectomy had a significantly worse prognosis than patients who had ≥16 examined LNs. Moreover, having an insufficient number of examined LNs was an independent prognostic factor for patients who had T1, N0, and stage I disease. CONCLUSIONS: Lymph node‐negative cancers in which ≤15 LNs were examined, classified as N0 in the new TNM staging system, could not adequately predict patient survival after curative gastrectomy, especially in patients with early stage gastric cancer. Cancer 2012. © 2012 American Cancer Society.

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Impact of total retrieved lymph nodes on staging and survival of patients with gastric cancer invading the subserosa

Cited by 22 publications

References 21 publications

Reduced Lymph Node Harvest after Neoadjuvant Chemotherapy in Gastric Cancer

Reduced Lymph Node Harvest after Neoadjuvant Chemotherapy in Gastric Cancer

How many lymph nodes should be assessed in patients with gastric cancer? A systematic review

Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer

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