Prognostic impact of the number of retrieved lymph nodes in patients with gastric cancer

Okajima, Wataru; Komatsu, Shuhei; Ichikawa, Daisuke; Kosuga, Toshiyuki; Kubota, Takeshi; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Otsuji, Eigo

doi:10.1111/jgh.13306

Cited by 43 publications

(46 citation statements)

References 25 publications

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“…The eighth edition of the AJCC UICC/TNM staging system once again emphasizes the criteria of dissection for at least 16 lymph nodes, but for more accurate evaluation, the number of lymph nodes retrieved should be >30. Okajima et al (25) reported that the number of retrieved lymph nodes had a significant effect on survival of patients with stage II and III. In our study, the number of retrieved lymph nodes and resection type were both independent prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Thirty-year trends in clinicopathologic characteristics and prognosis after gastrectomy for gastric cancer: A single institution in Northern China

et al. 2020

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Background:We integrated changes in the trends in clinicopathologic characteristics and postoperative prognosis in patients with gastric cancer Northern China over a 30-year period. Methods: A retrospective analysis of patients undergoing gastric cancer resection and complete follow-up information from January 1981 to December 2010 in the first affiliated Hospital of China Medical University was carried out. We divided the patients into three consecutive periods. Results: A total of 3,520 patients were included in this study. The proportion of lower tumors increased (from 58.8 to 66.9%), while that of upper tumors decreased (from 21.3 to 13.4%). The proportion of tumors > 5cm decreased (from 58.6 to 41.1 %), but the increasing trend of poorly differentiated gastric cancer was obvious (from 60.1 to 75.7%). The percentage of early gastric cancer increased from 10.0 to 15.5 during the study periods, and that of TNM stage Ⅳ cancer decreased from 38.6 to 28.1. In surgery treatment, the rate of radical resection increased to 92.1% in recent period, and the average number of retrieved lymph nodes increased. The 5-year survival rate gradually increased from 36.5% to 48.5% (p<0.001). The Multivariate analysis showed that age, tumor size, T stage, N stage, number of retrieved lymph nodes and resection type were independent prognostic factors for gastric cancer. Conclusion: The patterns of clinicopathologic features for gastric cancer changed during the 30-year period in North China. Overall survival (OS) could be increased by early detection of tumors and standard surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Thirty-year trends in clinicopathologic characteristics and prognosis after gastrectomy for gastric cancer: A single institution in Northern China

et al. 2020

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“…Also, there is a survival advantage for Asian patients with GC, mostly due to the early diagnosis (as mass screening is uncommon in the Western world) and the higher extent of lymphadenectomy performed in the Eastern world (24). …”

Section: Introductionmentioning

confidence: 99%

Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

Giganti

Ambrosi

Chiari

et al. 2017

Chinese Journal of Cancer Research

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ObjectiveTo investigate the role of apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) when applied to the 7th TNM classification in the staging and prognosis of gastric cancer (GC).MethodsBetween October 2009 and May 2014, a total of 89 patients with non-metastatic, biopsy proven GC underwent 1.5T DW-MRI, and then treated with radical surgery. Tumor ADC was measured retrospectively and compared with final histology following the 7th TNM staging (local invasion, nodal involvement and according to the different groups — stage I, II and III). Kaplan-Meier curves were also generated. The follow-up period is updated to May 2016.ResultsMedian follow-up period was 33 months and 45/89 (51%) deaths from GC were observed. ADC was significantly different both for local invasion and nodal involvement (P<0.001). Considering final histology as the reference standard, a preoperative ADC cut-off of 1.80×10–3 mm2/s could distinguish between stages I and II and an ADC value of ≤1.36×10–3 mm2/s was associated with stage III (P<0.001). Kaplan-Meier curves demonstrated that the survival rates for the three prognostic groups were significantly different according to final histology and ADC cut-offs (P<0.001). ConclusionsADC is different according to local invasion, nodal involvement and the 7th TNM stage groups for GC, representing a potential, additional prognostic biomarker. The addition of DW-MRI could aid in the staging and risk stratification of GC.

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“…Zhao et al [18], who analyzed 2246 patients who underwent curative gastrectomy for advanced gastric cancer at a single center, recommend harvesting of ≥ 25 RLNs. In contrast, the AJCC recommendation (≥ 15 RLNs) is insufficient for determining the N stage [19].…”

Section: Discussionmentioning

confidence: 99%

“…The extent of LN dissection was based on the Japanese Gastric Cancer Treatment Guideline [7]. After removal of the stomach and surrounding tissues, surgeons retrieved as many LNs as possible from the resected specimen, and pathologists counted the RLNs and validated their characteristics [18].…”

Section: Retrieval Of Lnsmentioning

confidence: 99%

Number of retrieved lymph nodes is an independent prognostic factor after total gastrectomy for patients with stage III gastric cancer: propensity score matching analysis of a multi-institution dataset

et al. 2018

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Background The prognostic significance of the number of retrieved lymph nodes (RLNs) in gastric cancer remains controversial. Therefore, we designed a multicenter collaborative database to investigate the correlation between the number of RLNs and prognosis of patients with advanced gastric cancer after curative resection. Methods We retrospectively analyzed 1103 patients who underwent gastrectomy for stage II/III gastric cancer between 2010 and 2014. Lymph nodes, which were retrieved by surgeons from surgically resected specimens, were validated by pathologists. A target population and the optimal cutoff were determined using receiver operating characteristic (ROC) curve analysis. After propensity score matching of eight variables, including splenectomy and adjuvant chemotherapy, the prognostic significance of RLNs was evaluated. Results According to ROC curve analysis, the optimum cutoff score for predicting postoperative survival was 40. After matching, the backgrounds of patients in the RLN < 40 and RLN ≥ 40 groups (n = 87 each) became well-balanced. The RLN < 40 group experienced significantly shorter relapse-free and overall survival. The prevalence of peritoneal recurrence was significantly increased in the RLN < 40 group. RLN < 40 was an independent prognostic factor in multivariable analysis, although pathological N status was not. A forest plot revealed that the RLN < 40 group was at greater risk of recurrence in most subgroups. Conclusions RLN < 40 was associated with an adverse prognosis of patients with stage III gastric cancer who underwent total gastrectomy.

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Prognostic impact of the number of retrieved lymph nodes in patients with gastric cancer

Abstract: The RLN number may potentially affect the prognosis and the stage migration in pStage II or III gastric cancer patients. An RLN number of 25 or more could be sufficient for nodal staging.

Cited by 43 publications

References 25 publications

Thirty-year trends in clinicopathologic characteristics and prognosis after gastrectomy for gastric cancer: A single institution in Northern China

Thirty-year trends in clinicopathologic characteristics and prognosis after gastrectomy for gastric cancer: A single institution in Northern China

Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

Number of retrieved lymph nodes is an independent prognostic factor after total gastrectomy for patients with stage III gastric cancer: propensity score matching analysis of a multi-institution dataset

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