The impact of negative lymph nodes in the survival outcomes of pN+ patients following radical gastrectomy: the inverse lymph node ratio as a better score to study negative lymph nodes

Costa, Paulo; Lages, Patrícia; Onofre, Susana; Ribeiro, Ruy M.

doi:10.1007/s13304-020-00757-y

Cited by 4 publications

(5 citation statements)

References 34 publications

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“…First, NLNs may reflect the extent of lymphadenectomy and the quality of surgical technique, as more NLNs indicate a more thorough dissection of the lymphatic basin and a lower risk of residual disease[ 26 , 27 ]. Second, NLNs may have a protective role in preventing cancer spread by acting as barriers or filters that trap tumor cells and prevent them from reaching distant sites [ 26 , 28 ]. Third, NLNs may enhance the immune response against tumor cells by producing cytokines or presenting antigens that activate cytotoxic T cells and natural killer cells[ 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, NLNs may have a protective role in preventing cancer spread by acting as barriers or filters that trap tumor cells and prevent them from reaching distant sites [ 26 , 28 ]. Third, NLNs may enhance the immune response against tumor cells by producing cytokines or presenting antigens that activate cytotoxic T cells and natural killer cells[ 26 – 28 ]. However, it is also possible that some patients with low NLN counts may have been misclassified as node-negative due to insufficient sampling or detection of micrometastases, which may affect the survival outcomes [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…For example, patients with low NLN counts and high nodal ratios may have a higher risk of recurrence or metastasis and may require more aggressive treatment or surveillance than patients with high NLN counts and low nodal ratios. Therefore, the NLN count and nodal ratio assessment may provide valuable prognostic information for GC patients and guide individualized therapeutic decisions [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Effect of the number of negative lymph nodes removed on the survival and recurrence rate after gastrectomy in patients with gastric cancer: a multicenter retrospective cohort study

Bahardoust,

Kheirabadi,

Donyadideh

et al. 2023

BMC Surg

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Background Various factors affect the survival rate of Gastric cancer (GC) patients after gastrectomy. This study aimed to investigate the effect of the number of negative lymph nodes (NLNs) removed on GC patients’ survival and recurrence rate after gastrectomy. Methods In this retrospective, multicenter cohort study, we reviewed the medical profile of 639 patients with a definite diagnosis of GC who underwent gastrectomy from 2010 to 2022 in one of the medical centers affiliated with the Iran University of Medical Sciences. Based on the number of NLNs removed, patients were divided into three groups, including (0–9NLNs), (10–15 NLNs), and (≥ 16 NLNs), including 155, 231, and 253 GC patients, respectively. Demographic characteristics, tumor characteristics, and pathological findings of the patients were extracted by referring to the patient’s files. Results The 5-year survival rate of patients was estimated at 48.2%. The 5-year tumor recurrence rate in patients with the number of NLNs 1–9, NLNs 10–15, and ≥ 16 NLNs were 79.4%, 51.1%, and 30.8%, respectively. (Log-rank = 9.24, P 0.001) The multivariate analysis showed that the 5-year survival rate in patients with fewer NLNs removed ≥ 16 was significantly higher than in the other two groups. In addition, age, BMI, tumor size, tumor stage, metastasis, and tumor differentiation were significantly related to the survival of GC patients after gastrectomy. (p < 0.05) Conclusion Paying attention to the number of NLNs removed during gastrectomy can be a key factor in improving the survival prediction of GC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of the number of negative lymph nodes removed on the survival and recurrence rate after gastrectomy in patients with gastric cancer: a multicenter retrospective cohort study

Bahardoust,

Kheirabadi,

Donyadideh

et al. 2023

BMC Surg

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“…It is fair to reiterate that suboptimal LN harvesting contributes to stage migration, inadequate treatment planning and poor outcome [ 40 , 41 , 42 , 43 ]. However, the hot question of how accomplish complete LNs removing still remains, as all the procedures proposed and applied so far have often been disappointing.…”

Section: Discussionmentioning

confidence: 99%

Surgeon–Pathologist Team Approach Dramatically Affects Lymph Nodes Detection and Improves Patients’ Short-Term Outcome

Ambrosio

Battini

et al. 2022

Cancers

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The downstaging of gastric cancer has recently gained particular attention in the field of gastric cancer surgery. The phenomenon is mainly due to an inappropriate sampling of lymph nodes during standard lymphadenectomy. Hence, collection of the maximum number of lymph nodes is a critical factor affecting the outcome of patients. None of the techniques proposed so far have demonstrated a real efficiency in increasing the number of identified lymph nodes. To harvest the maximum number of lymph nodes, we designed a protocol for on-site macroscopic evaluation and sampling of lymph nodes according to the Japanese Gastric Cancer Association protocol. The procedure was carried out by a surgeon/pathologist team in the operating room. We enrolled one hundred patients, 50 of whom belonged to the study group and 50 to a control group. The study group included patients who underwent lymph node dissection following the proposed protocol; the control group encompassed patients undergoing standard procedures for sampling. We compared the number and maximum diameter of lymph nodes collected in both groups, as well as some postoperative variables, the 30-day mortality and the overall survival. In the study group, the mean number of lymph nodes harvested was higher than the control one (p = 0.001). Moreover, by applying the proposed technique, we sampled lymph nodes with a very small diameter, some of which were metastatic. Noticeably, no difference in terms of postoperative course was identified between the two groups, again supporting the feasibility of an extended lymphadenectomy. By comparing the prognosis of patients, a better overall survival (p = 0.03) was detected in the study group; however, to date, no long-term follow-up is available. Interestingly, patients with metastasis in node stations number 8, 9, 11 or with skip metastasis, experienced a worse outcome and died. Based on our preliminary results, the pathologist/surgeon team approach seems to be a reliable option, despite of a slight increase in sfaff workload and technical cost. It allows for the harvesting of a larger number of lymph nodes and improves the outcome of the patients thanks to more precise staging and therapy. Nevertheless, since a higher number of patients are necessary to confirm our findings and assess the impact of this technique on oncological outcome, our study could serve as a proof-of-concept for a larger, multicentric collaboration.

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“…The surgical and pathological skills and techniques heavily impact on the number of retrieved LNs, justifying an accurate training of dedicated medical personnel with a learning curve in particular in low-volume centers. Surgeons with thorough anatomical knowledge of the various LN stations and surgical experience should perform the gastrectomy, and skilled pathologists should examine and count LNs providing a complete pathological evaluation [10,11]. In fact, the lymphatic system involved in GC is complex since it is three-dimensional and multi-directional.…”

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confidence: 99%

How surgeon and pathologist cooperation may drive toward a more efficient nodes harvesting in gastric cancer surgery

Ambrosio

Cavazzana

et al. 2021

Updates Surg

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The impact of negative lymph nodes in the survival outcomes of pN+ patients following radical gastrectomy: the inverse lymph node ratio as a better score to study negative lymph nodes

Cited by 4 publications

References 34 publications

Effect of the number of negative lymph nodes removed on the survival and recurrence rate after gastrectomy in patients with gastric cancer: a multicenter retrospective cohort study

Effect of the number of negative lymph nodes removed on the survival and recurrence rate after gastrectomy in patients with gastric cancer: a multicenter retrospective cohort study

Surgeon–Pathologist Team Approach Dramatically Affects Lymph Nodes Detection and Improves Patients’ Short-Term Outcome

How surgeon and pathologist cooperation may drive toward a more efficient nodes harvesting in gastric cancer surgery

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