Impact on long-term survival of the number of lymph nodes resected in patients with pT1N0 gastric cancer after R0 resection

Abstract

Although studies on the association between the number of lymph nodes resected and prognosis in patients with pT2–4N0 stages of gastric cancer have reported consistent results, there is no consensus on the optimal number of lymph nodes to be examined for pT1N0 stage gastric cancer. The aim of this study was to evaluate the long-term effect of the number of lymph nodes removed on the outcomes of patients with pT1N0 stage gastric cancer after R0 resection.From December 2009 to December 2011, 227 patients undergoing R0 resection of pT1N0 stage gastric cancer at 4 Chinese centers were enrolled in this study. Patients were assigned to 2 groups according to the number of lymph nodes dissected (≤15 or > 15). Standard survival methods and restricted multivariable Cox regression models were applied.More women (P = 0.031) were in the ≤15 group than in the >15 group. The mean number of lymph nodes removed from women was greater than that from men (P = 0.007). The 5-year survival rate was significantly higher in the >15 lymph nodes resected group than the ≤15 group. The number of lymph nodes resected was identified as an independent prognostic factor and was significantly correlated with overall survival (OS).A lymphadenectomy with dissection of more than 15 lymph nodes improved the long-term survival of patients with pT1N0 gastric cancer after R0 resection. Therefore, it is necessary to consider removing more than 15 lymph nodes among such patients.

Insufficient lymph node assessment in gastric adenocarcinoma

“…The occurrence of gastric cancer in patients younger than 40 years old is uncommon; however, after which, its incidence increases progressively. In the current study, the patients with a median age of 60 years old were younger than that of the results of previous reports in which the average median age of 27,214 patients in 15 report series was 65.5 (range 54-71) years old [1,4,[6][7][8][9][10][11][12][13][14][15][16][17][18] (Table 5). During recent decades, the frequency of primary tumor location has been changed in favor of proximal gastric cancers.…”

“…In this study, most of the lesions were in the distal of stomach (50.5%). In major reported series, the average total number of lymph node evaluated was 27.7 (range 8.4-35.3) for 7643 patients in 8 studies [4,6,[8][9][10][11][12]20]. In this research, the average total number of evaluated lymph node was 11.1.…”

“…In this retrospective study, a chart review was performed on 449 patients with resected locoregional invasive gastric adenocarcinoma who were treated and followed up at a referral academic hospital, between 2004 and 2013. A minimum sample size required for the study was calculated based on the value of standard deviation of the mean total number of assessed LN (SD = 11.02) in previous study by Zhao [4]. Accordingly, a minimum of 117 patients were estimated for a precision of 2%.…”

Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion

“…Data indicated a protective effect between LND extent and CSM. Moreover, the same protective effect between LND extent and CSM was also reported in patients without evidence of LNI . Both concepts were examined in patients with localized PCa.…”

“…These observations suggest the possibility of a beneficial effect of PLND extent on CSM, regardless of LNI status. This effect was described in other solid tumor primaries, including gastric, bladder, and colorectal cancers, where more extensive lymph node dissection (LND) improves CSM . As a consequence, lymph node count targets at LND represent a quality of care indicator in several solid primary tumors, including bladder, colorectal, and gastric cancer …”