Insufficient lymph node assessment in gastric adenocarcinoma

Khanjani, Nezhat; Mirzaei, Sepideh; Nasrolahi, Hamid; Hamedi, Seyed Hasan; Ahmad, Mansoor; Omidvari, Shapour; Ahmadloo, Niloofar; Ansari, Mansour; Sobhani, Fatemeh; Mohammadianpanah, Μohammad

doi:10.1186/s43046-019-0004-1

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…Some study has noticed a stage-specific lymph node retrieving may present diverse survival benefits in gastric cancer [ 18 ]. A study of 449 gastric cancer patients from Iran reported that the median total number of examined lymph nodes were 9 (ranging 0–55), with only 21.2% patients has adequate lymph nodes yielding ( n ≥ 16) [ 27 ]. The National Comprehensive Cancer Network (NCCN) guideline suggests that a minimum 15 resecting lymph nodes is required, based on the evidence that 15 lymph nodes is the threshold number with a survival benefit [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Zhou

Liu

et al. 2022

Diagnostics

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Background: Gastric signet ring cell carcinoma (GSRCC) is a subset of gastric cancer with distinct histological and inconsistent prognosis outcome. Currently, the association between the adequate regional lymph node and proper nodal staging in GSRCC is rarely noticed. Materials and methods: Clinical data of GSRCC were retrieved from the Surveillance, Epidemiology, and End Results database. Beta-binomial distribution model was employed for the estimation of the probability of missing nodal disease, followed by the development of a nodal staging score (NSS). Results: A total of 561 GSRCC patients were included in this study, with 193 in lymph node-negative and 368 in lymph node-positive diagnoses. As the number of examined lymph nodes increased, the probability of missing nodal disease decreased rapidly, with T stage-specific curves. The probability of missing nodal disease in T4 was lower than that in T1. NSS calculation indicated that T1 stage patients commonly had NSS > 0.8. However, with the NSS of T2-T4 to reach 0.8, the number of examined lymph node was required to be larger than 12 in T2, 17 in T3 and 27 in T4. NSS ≥ 0.75 (quantile 75%) subgroup in T2–T4 subgroups tended to have better outcome; however, without significant prognostic value. Conclusion: NSS is served as a reliable and feasible tool in adequate nodal staging of GSRCC with statistical basis and provides further evidence for clinical decision making.

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Section: Discussionmentioning

confidence: 99%

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Zhou

Liu

et al. 2022

Diagnostics

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“…Meanwhile, insufficient LN assessment is often apparent in the current literature[ 20 ]. For example, in his review of 15 studies, which included 27,942 patients, Khanjani et al [ 5 ] showed that only 52.2% of the patients received an adequate nodal evaluation, given the AJCC’s current recommendation to assess at least 16 LNs[ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the national guidelines, many studies particularly those from Western countries continue to show high rates of inadequate nodal assessment[ 5 - 7 ]. To mitigate the effects of stage migration and survival inaccuracies in patients with locally advanced gastric cancer, use of the ratio of positive to total LN has been proposed[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term survival of patients with stage II and III gastric cancer who underwent gastrectomy with inadequate nodal assessment

Desiderio¹,

Sagnotta²,

Terrenato³

et al. 2021

WJGS

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BACKGROUND Gastric cancer is an aggressive disease with frequent lymph node (LN) involvement. The NCCN recommends a D2 lymphadenectomy and the harvesting of at least 16 LNs. This threshold has been the subject of great debate, not only for the extent of surgery but also for more appropriate staging. The reclassification of stage IIB through IIIC based on N3b nodal staging in the eighth edition of the American Joint Committee on Cancer (AJCC) staging system highlights the efforts to more accurately discriminate survival expectancy based on nodal number. Furthermore, studies have suggested that pathologic assessment of 30 or more LNs improve prognostic accuracy and is required for proper staging of gastric cancer. AIM To evaluate the long-term survival of advanced gastric cancer patients who deviated from expected survival curves because of inadequate nodal evaluation. METHODS Eligible patients were identified from the Surveillance, Epidemiology, and End Results database. Those with stage II–III gastric cancer were considered for inclusion. Three groups were compared based on the number of analyzed LNs. They were inadequate LN assessment (ILA, < 16 LNs), adequate LN assessment (ALA, 16-29 LNs), and optimal LN assessment (OLA, ≥ 30 LNs). The main outcomes were overall survival (OS) and cancer-specific survival. Data were analyzed by the Kaplan-Meier product-limit method, log-rank test, hazard risk, and Cox proportional univariate and multivariate models. Propensity score matching (PSM) was used to compare the ALA and OLA groups. RESULTS The analysis included 11607 patients. Most had advanced T stages (T3 = 48%; T4 = 42%). The pathological AJCC stage distribution was IIA = 22%, IIB = 18%, IIIA = 26%, IIIB = 22%, and IIIC = 12%. The overall sample divided by the study objective included ILA (50%), ALA (35%), and OLA (15%). Median OS was 24 mo for the ILA group, 29 mo for the ALA group, and 34 mo for the OLA group ( P < 0.001). Univariate analysis showed that the ALA and OLA groups had better OS than the ILA group [ALA hazard ratio (HR) = 0.84, 95% confidence interval (CI): 0.79–0.88, P < 0.001 and OLA HR = 0.73, 95%CI: 0.68–0.79, P < 0.001]. The OS outcome was confirmed by multivariate analysis (ALA HR = 0.68, 95%CI: 0.64–0.71, P < 0.001 and OLA: HR = 0.48, 95%CI: 0.44–0.52, P < 0.001). A 1:1 PSM analysis in 3428 patients found that the OLA group had better survival than the ALA group (OS: OLA median = 34 mo vs ALA median = 26 mo, P < 0.001, which was confirmed by univariate analysis (HR = 0.81, 95%CI: 0.75–0.89, P < 0.001) and multivariate analysis: (HR = 0.71, 95%CI: 0.65–0.78, P < 0.001). CONCLUSION Proper nodal staging is a critical issue in gas...

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“…Nevertheless, many conditions can lead to inadequate LN harvest. It is estimated that only one-fifth of the patients with GC have an adequate number of LN examined in Iran, 26 while more than 15 LNs are examined in 64% of the patients in the USA. 25 The LNR and LODDS staging methods do not require an adequate number of LNs to be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of different lymph node staging methods for node-positive cardia gastric cancer: a register-based retrospective cohort study

2021

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ObjectiveTo investigate the prognostic efficacy of lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in node-positive cardia gastric adenocarcinoma (CGA).DesignA registry-based retrospective cohort study.SettingPatients diagnosed with node-positive CGA in the Surveillance, Epidemiology, and End Results database from 2010 to 2015.ParticipantsA total of 1038 patients were enrolled and randomly assigned (7:3) to the training set (n=723) or validating set (n=315).Primary outcome measureCancer-specific survival (CSS).ResultsThe baseline characteristics of the training and validation sets were similar. Based on the optimal cut-off values, LNR was classified into low (<0.09), medium (0.09~0.33) and high (>0.33) groups; LODDS was also classified into low (<−2.09), medium (−2.09~−0.65) and high (>−0.65) groups. CSS was significantly different across LNR and LODDS subgroups. The Harrell concordance index of the N stage was lower than that of the LNR or LODDS. The Akaike information criterion of the N stage was higher than that of the LNR or LODDS. Independent predictors included race, T stage, M stage and LNR (or LODDS), and they were incorporated into nomograms for 1-year, 2-year and 5-year CSS prediction. Calibration plots showed satisfactory results for internal and external validity of the nomogram.ConclusionsLNR and LODDS staging methods have better prognostic efficacy than the traditional N staging method in CGA with node metastasis. Moreover, the two values are promising substitutes for N staging in nomogram development when other independent prognostic factors are incorporated.

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Insufficient lymph node assessment in gastric adenocarcinoma

Cited by 5 publications

References 25 publications

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Long-term survival of patients with stage II and III gastric cancer who underwent gastrectomy with inadequate nodal assessment

Prognostic value of different lymph node staging methods for node-positive cardia gastric cancer: a register-based retrospective cohort study

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