Factors Associated With Recurrence and Survival in Lymph Node–negative Gastric Adenocarcinoma

Abstract

Despite absence of lymph node involvement, patients with T-stage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.

Tumor budding in intestinal-type gastric adenocarcinoma is associated with nodal metastasis and recurrence

“…Unfortunately, even in very early stage cancers that meet these criteria, the risk of lymph node metastasis remains significant (3-20%) [8,9,10], highlighting the need for additional features that can provide risk stratification in GAC. Additionally, even in node-negative patients, pathologic T-stage has been shown to independently predict earlier recurrence further emphasizing the possibility of identifying other prognostic features [11].…”

Survival impact of the number of lymph node dissection on stage I–III node-negative gastric cancer

“…Tumor location, size, tumor invasion depth, and perineural invasion were associated with tumor recurrence and outcome. In contrast to our published article (6), Jin et al included only 148 patients with T2-4 nodenegative GC (n=148) and found that tumor recurrence rates were 9.1%, 29.7% and 35.0% in T2, T3 and T4 disease, respectively (8). The mean number of examined LN was 16 in patients with recurrence, which might result in inadequate lymphadenectomy in T2-T4 tumor and…”

“…In contrast to the results of Jin et al, our large-scale study (n=1,030) indicated that tumor size, tumor location, the number of nodal retrieval, T4 status, and presence of perineural invasion were prognostic factors for T1-T4 node-negative GC based on multivariate analysis (7). The extent of lymphadenectomy and the number of LNs retrieved might explain the great survival discrepancy between Jin's and our studies (7,8).…”

“…In contrast to the results of Jin et al, our large-scale study (n=1,030) indicated that tumor size, tumor location, the number of nodal retrieval, T4 status, and presence of perineural invasion were prognostic factors for T1-T4 node-negative GC based on multivariate analysis (7). The extent of lymphadenectomy and the number of LNs retrieved might explain the great survival discrepancy between Jin's and our studies (7,8).As T1 node-negative GC patients undergoing R0 resection had an excellent 5-year survival period and extremely low recurrence rates (7), we enrolled 448 T2-4 node-negative GC patients, who underwent radical resection (>10 nodes retrieved) without receiving neoadjuvant chemotherapy or postoperative irradiation therapy to identify determinants of tumor recurrence and to analyze the prognostic factors (6). Our results show that there was no significant difference in mean number of LN retrieved between GC patients without recurrence and with recurrence (26 vs. 24).…”

“…Unfortunately, a subgroup of patients with node-negative GC who underwent radical surgery including extensive LN dissection still experiences tumor recurrence, distant metastasis and subsequently died from the disease (6,7). In the issue of Annals of Surgery, Jin et al indicated that in node-negative GC patients undergoing curative intent surgery, T3/T4 tumors, presence of lymphovascular invasion and signet ring histology independently affected overall survival suggesting that these patients may benefit from more aggressive adjuvant therapies (8). However, it should be noted that recurrence rates were 8.4% and 10.5% in T1 and stage I GC, respectively and 35.0% and 37.5% in T4 and stage III cancer, respectively in their study.…”