Lymph Node Evaluation after Neoadjuvant Chemotherapy for Patients with Gastric Cancer

Shannon, Adrienne B.; Straker, Richard J.; Keele, Luke; Fraker, Douglas L.; Roses, Robert E.; Miura, John T.; Karakousis, Giorgos C.

doi:10.1245/s10434-021-10803-7

Cited by 13 publications

(14 citation statements)

References 29 publications

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“…Undoubtedly, higher ELNs was associated with prolonged survival in patients with gastric cancer regardless of the neoadjuvant therapy status [6, 7,9,11,13,20,21]. Smith et al [6] have demonstrated that the greater number of ELNs, the better was the resulting survival of gastric cancer patients using 3814 patients from SEER database.…”

Section: Discussionmentioning

confidence: 99%

“…Mirkin et al [8] have investigated 1036 pathological N0 patients with gastric cancer who received neoadjuvant therapy, and found a survival bene t with 30 nodes examined. Even so, it needs to be considered that neoadjuvant therapy has the potential to downstage positive lymph node burden [9]. In addition, Smith et al provided support that examining as many lymph nodes as safely feasible during gastrectomy for gastric cancer [6].…”

Section: Introductionmentioning

confidence: 99%

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The Minimum Number of Examined Lymph Nodes was 24 for Optimal Survival of Pathological T2-4 Gastric Cancer: a multi-center, hospital-based study covering 20 years of data

Zhao

Zhang

Jiao

et al. 2023

Preprint

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Introduction: The current National Comprehensive Cancer Network (NCCN) guidelines recommend that at least 16 lymph nodes should be examined for gastric cancer patients to reduce staging migration. However, there is still debate regarding the optimal management of examined lymph nodes (ELNs) for gastric cancer patients. In this study, we aimed to develop and test the minimum number of ELNs that should be retrieved during gastrectomy for optimal survival in patients with gastric cancer.Methods We used the restricted cubic spline (RCS) to identify the optimal threshold of ELNs that should be retrieved during gastrectomy based on the China National Cancer Center Gastric Cancer (NCCGC) database. Northwest cohort, which sourced from the highest gastric cancer incidence areas in China, was used to verify the optimal cutoff value. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.Results In this study, 12670 gastrectomy patients were included in the NCCGC cohort and 4941 patients in the Northwest cohort. During 1999–2019, the average number of ELNs increased from 17.88 to 34.45 in the NCCGC cohort, while the number of positive lymph nodes remained stable (5%-6%). The RCS model showed a U-curved association between ELNs and the risk of all-cause mortality, and the optimal threshold of ELNs was 24 [Hazard ratio (HR) = 1.00]. The ELN ≥ 24 group had a better overall survival (OS) than the ELN < 24 group clearly (P = 0.003), however, with respect to the threshold of 16 ELNs, there was no significantly difference between the two groups (P = 0.101). In the multivariate analysis, ELN ≥ 24 group was associated with improved survival outcomes in total gastrectomy patients [HR = 0.787, 95% confidence interval (CI): 0.711–0.870, P < 0.001], as well as the subgroup analysis of T2 patients (HR = 0.621, 95%CI: 0.399–0.966, P = 0.035), T3 patients (HR = 0.787, 95%CI: 0.659–0.940, P = 0.008) and T4 patients (HR = 0.775, 95%CI: 0.675–0.888, P < 0.001).Conclusion In conclusion, the minimum number of ELNs for optimal survival of gastric cancer with pathological T2-4 was 24.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Minimum Number of Examined Lymph Nodes was 24 for Optimal Survival of Pathological T2-4 Gastric Cancer: a multi-center, hospital-based study covering 20 years of data

Zhao

Zhang

Jiao

et al. 2023

Preprint

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“…Given the prognostic impact of LN status, the number of LN retrieved and precise identification of LNs metastases is particularly important with regard to prognostication and further treatment guidance. 31 It is well known that the accuracy of LN status before treatment is crucial. Unfortunately, the accurate clinical diagnosis of the LN status remains difficult with the currently available diagnostic techniques.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nodal downstaging to ypN0 after neoadjuvant chemotherapy positively impacts on survival of cT4N+ GC/GEJ patients

Xing

Huang

et al. 2022

Journal of Surgical Oncology

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Background The prognostic value of histomorphologic regression in primary gastric and gastroesophageal cancers (GC/GEJ) has been previously established, however, the impact of lymph node (LN) regression on survival still remains unclear. Methods A prospectively maintained database was reviewed to identify cT4N+ gastric and gastroesophageal cancers (GC/GEJ) after NAC (neoadjuvant chemotherapy). Patients were categorized into two groups based on LN status: cN+/ypN0 (downstaged N0) and cN+/ypN+ (persistent N+), long‐term survival were analyzed using Kaplan–Meier survival estimates. Results In total, 125 patients with cT4N+ GC/GEJ underwent NAC followed by surgery were enrolled. A total of 39 patients (31.2%) had cN+/ypN0 (ypN0) disease, 86 patients (68.8%) had cN+/ypN+ (ypN+) disease. Prognosis in ypN+ patients was significantly worse than those in ypN0 group for 3‐ and 5‐year overall survival (OS) (p < 0.05). The 3‐year OS was 83%, 44% in ypN0 and ypN+ group, respectively. The 5‐year OS was 75%, 35% in ypN0 and ypN+ group, respectively. Multivariable analysis suggested that multivisceral resection (hazard ratio [HR] = 0.33, 95% confidence interval [CI]: 0.14–0.76, p = 0.009), and ypN+ (HR = 3.42, 95% CI: 1.15–10.13, p =0.027) were independent prognostic factors for OS. Conclusion Nodal downstaging is an important hallmark representing the effectiveness of NAC for GC/GEJ, and it positively impacts on survival of these patients.

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“…The American Joint Committee on Cancer proposed that radical gastrectomy for gastric cancer requires resection of >15 lymph nodes for accurate postoperative staging (22). Relevant studies have shown that the number of lymph nodes removed during gastric malignant tumor resection can, to a large extent, accurately determine disease progression and influence the choice of successive medication (23)(24)(25)(26). Therefore, in radical gastrectomy for gastric cancer, adequate lymph node dissection is necessary.…”

Section: Discussionmentioning

confidence: 99%

Analysis of safety and efficacy of laparoscopic radical gastrectomy combined with or without indocyanine green tracer fluorescence technique in treatment of gastric cancer: a retrospective cohort study

Chen¹,

Zhang²,

Zhang³

et al. 2022

J Gastrointest Oncol

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Background: An adequate resection margin and lymph node dissection are important factors for successful radical gastrectomy. The presence of near-infrared camera imaging with indocyanine green (ICG) gives new insight into radical gastrectomy. Laparoscopic radical gastrectomy with ICG is still in its initial stages and requires more evidence-based medical research. The aim of the present study was to evaluate the safety and availability of lymph node dissection and precise gastrectomy for gastric cancer patients undergoing radical resection under laparoscope with ICG, in the hope of providing evidence of application of ICG tracer fluorescence technique in radical gastrectomy.Methods: A retrospective cohort study was performed with 56 patients who underwent laparoscopic radical gastrectomy. The patients were categorized into the ICG (n=18) or the non-ICG (n=38) group based on whether preoperative endoscopic mucosal ICG injection was performed. Their clinical characteristics (age, tumor size, location, TNM stage and so on) were compared as baseline data. Perioperative outcomes (blood loss, time of first intestinal exhaust, early or long-term complications and so on) were used to assess safety.The status of lymph node dissection and tumor localization were analyzed to testify efficacy. SPSS version 26.0 was used for the statistical analysis.Results: There was no difference in clinical data at baseline. From the safety point of view, there was no difference in perioperative outcomes (operative time, blood loss, time of first intestinal exhaust and so on) between the two groups (all P>0.05). From the efficacy point of view, the number of lymph nodes <5 mm (21.84±1.86 vs. 16.24±2.10, P<0.001), the total number of lymph nodes (34.61±5.87 vs. 29.92±5.27, P=0.004), the number of lymph nodes dissected in perigastric regions (groups 1-7, 22.89±3.64 vs. 20.29±3.00, P=0.007), and the number of lymph nodes in extraperigastric regions (groups 8-12, 11.72±3.06 vs. 9.61±3.18, P=0.022) were greater in ICG group compared with non-ICG group. In ICG group, the average vertical distances between the top and bottom of the fluorescent edge and neoplastic edge were 2.65±0.58 and 2.67±0.65 cm, respectively. Fluorescent edge pathology was negative.Conclusions: ICG fluorescence could be conducive to lymph node dissection and precise gastrectomy in laparoscopic radical gastrectomy.

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Lymph Node Evaluation after Neoadjuvant Chemotherapy for Patients with Gastric Cancer

Cited by 13 publications

References 29 publications

The Minimum Number of Examined Lymph Nodes was 24 for Optimal Survival of Pathological T2-4 Gastric Cancer: a multi-center, hospital-based study covering 20 years of data

The Minimum Number of Examined Lymph Nodes was 24 for Optimal Survival of Pathological T2-4 Gastric Cancer: a multi-center, hospital-based study covering 20 years of data

Nodal downstaging to ypN0 after neoadjuvant chemotherapy positively impacts on survival of cT4N+ GC/GEJ patients

Analysis of safety and efficacy of laparoscopic radical gastrectomy combined with or without indocyanine green tracer fluorescence technique in treatment of gastric cancer: a retrospective cohort study

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