Number of Examined Lymph Nodes as a Risk Factor for Recurrence in pT1N+ or pT2-3N0 Gastric Cancer

Abstract

Background/Aim: Japanese Gastric Cancer Treatment Guidelines do not recommend adjuvant chemotherapy after radical gastrectomy for pathological stage (p) T1N+ or pT2~3N0 gastric cancer. However, some patients experience disease recurrence. This study aimed to identify the risk factors for recurrence in pT1N+ or pT2-3N0 gastric cancer. Patients and Methods: The study included 157 patients with diagnosed pT1N+ or pT2-3N0 gastric cancer who underwent radical gastrectomy at our institution between January 2001 and December 2020. Clinicopathological data and surgical data were obtained. Independent prognostic factors were analyzed using a Cox proportional hazards regression model. Results: Thirteen patients (8.3%) experienced disease recurrence. Multivariate analysis revealed that the number of examined lymph nodes was an independent prognostic factor for recurrence-free survival (hazard ratio=10.90; 95% confidence interval=1.39-85.86; p=0.023). The group with ≤35 examined lymph nodes had significantly worse recurrence-free survival compared with the group with ≥36 examined lymph nodes (80.7% versus 98.7%; p=0.0005). Conclusion: The number of examined lymph nodes (≤35) was an independent risk factor for recurrence after radical gastrectomy with pT1N+ or pT2-3N0 gastric cancer.

Indocyanine Green (ICG) in Robotic Gastrectomy: A Retrospective Review of Lymphadenectomy Outcomes for Gastric Cancer

“…Building on previous research, our study emphasizes the pivotal role of the ELN count in shaping the prognosis of gastric cancer patients [10,11,20,22]. A diminished ELN count can precipitate 'stage migration', which might culminate in a more advanced diagnosis than initially projected [10]. The eighth edition of the AJCC gastric cancer staging system advocates for the examination of at least 16 lymph nodes [18].…”

“…The total number of histologically assessed nodes, irrespective of the positive nodal count, is a crucial prognostic indicator for gastric cancer, yet its practical application and interpretation remain subjects of debate [10]. In our study, we anchored our ELN cut-off on the foundational insights from prior research.…”

“…Current guidelines advocate for the examination of a minimum of 16 LNs. However, some research suggests the necessity for an even more extensive LN retrieval, highlighting an ongoing debate in the field [7][8][9][10][11].…”