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

Hayashi, Shogo; Kanda, Mitsuro; Ito, Seiji; Mochizuki, Yoshinari; Teramoto, Hitoshi; Ishigure, Kiyoshi; Murai, Toshifumi; Asada, Takahiro; Ishiyama, Akiharu; Matsushita, Hidenobu; Tanaka, Chie; Kobayashi, Daisuke; Fujiwara, Michitaka; Murotani, Kenta; Kodera, Yasuhiro

doi:10.1007/s10120-018-0902-2

Cited by 37 publications

(26 citation statements)

References 29 publications

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“…Many studies have suggested that overall survival (OS) is associated with the number of retrieved lymph nodes (RLNs) (1)(2)(3). The results based on data from the Surveillance, Epidemiology, and End Results (SEER) database showed that OS was dependent on the number of RLNs (1).…”

Section: Introductionmentioning

confidence: 99%

“…However, the number of RLNs cannot separate the impact of stage migration versus improved regional disease control to favor survival. Recently, Hayashi et al showed that the number of RLNs < 40 could be attributed to an inferior survival for stage III gastric cancer (GC) patients who underwent total gastrectomy (2). Consistently, another large international dataset analysis, including the SEER database (n = 13,932) and the Yonsei University Gastric Cancer database (n = 11,358), also proposed that a greater number of RLNs (a minimum of 29) improves staging and OS in GC patients undergoing radical resection (3).…”

Section: Introductionmentioning

confidence: 99%

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The Methods of Lymph Node Examination Make a Difference to Node Staging and Detection of N3b Node Status for Gastric Cancer

Chen

et al. 2020

Front. Oncol.

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Background: The number of retrieved lymph nodes (RLNs) affects the likelihood of detecting metastatic lymph nodes (MLNs) for gastric cancer (GC), but the retrieval of LNs is not satisfactory worldwide. There is no standard for LN examination.Methods: We retrospectively analyzed 2,163 patients diagnosed with GC who underwent surgery at Nanfang Hospital between October 2004 and September 2016. According to the methods of LN examination, patients were classified into two groups: LN detection by pathologists (pathologist group) and LN examination by surgicopathologic team (surgicopathologist group). The relationship between RLNs and LN staging accuracy as well as the factors influencing the detection of MLNs were evaluated.Results: There were 472 males in pathologist group and 467 males in surgicopathologist group. The number of RLNs and MLNs in surgicopathologist group was significantly higher than that in pathologist group (RLNs: 53.8 ± 20.9 vs. 18.8 ± 11.5, p < 0.001; MLNs: 5.6 ± 9.8 vs. 3.9 ± 5.7, p < 0.001). Notably, the detection of N3b node status was significantly improved in surgicopathologist group [83 (11.9%) vs. 34 (4.8%), p < 0.001]. Additionally, the detection rate of N3b status gradually increased from 0 in patients with 1-16 RLNs to 16.6% in patients with more than 49 RLNs. The MLNs detected increased gradually from 2.3 ± 3.0 in patients with 1-16 RLNs to 7.3 ± 11.7 in patients with more than 49 RLNs. Univariate and multivariate analyses indicated that LN examination by surgicopathologic team, more advanced pT, tumor size ≥5 cm and combined organ(s) resection were related to detecting more MLNs. Conclusions:The retrieval of nodes immediately postoperatively by the surgicopathologic team could significantly improve the number of RLNs, detect more MLNs, and screen more patients with N3b node status.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Methods of Lymph Node Examination Make a Difference to Node Staging and Detection of N3b Node Status for Gastric Cancer

Chen

et al. 2020

Front. Oncol.

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“…Zhao et al suggested that the ELN number should be greater than 25 for patients with advanced gastric cancer 22 . Hayashi et al assessed gastric cancer patients who underwent total gastrectomy at stage III, and the results showed that an ELN number > 40 was associated with the patients' prolonged OS and RFS 23 . Although the above studies identified ELN number as an independent risk factor for patients with gastric cancer, there were discrepancies among the included populations.…”

Section: Discussionmentioning

confidence: 99%

The assessment of the optimal number of examined lymph nodes and prognostic models based on lymph nodes for predicting survival outcome in patients with stage N3b gastric cancer

Guo

Shang

Dong

et al. 2020

Asia-Pac J Clncl Oncology

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Background: The optimal number of examined lymph nodes (ELNs) and the prognostic value of different nodal staging systems remain unclear in the context of N3b gastric cancer. Aim: To evaluate the optimal number of ELNs and compare the predictive ability of the ELN number, LN ratio (LNR), and log odds of metastatic LNs (LODDS) for overall survival (OS) in patients with resected stage N3b gastric adenocarcinoma in an international database. Methods: A total of 868 patients diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database (training cohort) and 144 patients diagnosed between 2011 and 2016 at the Liaoning Cancer Hospital (validation cohort) were identified. Cutoff values were established with X-tile. The 5-year OS rates were compared using Kaplan-Meier curves. Multivariate analysis was conducted with a Cox regression model. The Harrell's concordance index and Akaike's information criterion were used to compare the predictive accuracy of different nodal staging systems. Results: The ELN number, LNR, and LODDS were independent prognostic factors for both the training and validation cohorts in the multivariate analysis. Patient with ≤26 ELNs, LNR of more than 0.9, and LODDS of more than 1.0 were associated with decrease OS. The LNR and LODDS had similar discriminatory ability for OS and performed better than the ELN number in the Eastern and Western populations. Conclusion: The optimal number of ELN may be 27 or more because LNs retrieved ≤26 was an independent risk factor for the prognosis. The prognostic prediction efficacy of LNR and LODDS was similar and better than that of ELN. Thus, LNR and LODDS could both serve as valid tools to predict OS for stage N3b patients. K E Y W O R D S gastric adenocarcinoma, log odds of metastatic lymph nodes (LODDS), lymph node ratio (LNR), prognostic model, the optimal number of lymph node retrieved 1 INTRODUCTION Gastric cancer is the fifth most common cancer in the world and is the third leading cause of cancer mortality. 1 Gastric cancer ranks second among all cancers for incidence and mortality rates in China. 2 Lymph node (LN) metastasis is one of the most important prognostic indicators for survival outcomes. 3,4 From the fifth edition of the Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) staging system to the eighth edition, the N stage has been based on the number of metastatic LNs (MLNs), and it is

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“…However, the optimal number of retrieved LNs remains controversial. For example, Hayashi et al [13] recommended retrieval of > 40 LNs after total gastrectomy for stage III patients, whereas Lu et al [12] suggested that harvesting 21 LNs might represent a superior cut-off point for radical total gastrectomy to better determine the prognosis of the patients. Although a greater number of retrieved LNs has been associated with longer survival of patients with node-metastatic cancer, the optimal number of LNs to be examined at different stages remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Retrieved lymph nodes from different anatomic groups in gastric cancer: a proposed optimal number, comparison with other nodal classification strategies and its impact on prognosis

Pan

Wang

Xing

et al. 2019

Cancer Communications

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BackgroundThe optimal number of retrieved lymph nodes (LNs) in gastric cancer (GC) is still debatable and previous studies proposing new classification alternatives mostly focused on the number of retrieved LNs without proper consideration on the anatomic nodal groups’ location. Here, we assessed the impact of retrieved LNs from different nodal location groups on the survival of GC patients.MethodsStage I–III gastric cancer patients who had radical gastrectomy were investigated. LN grouping was determined according to the 13th edition of the JCGC. The optimal cut-off values of retrieved LNs in different LN groups (Group 1 and 2) were calculated, based on which a proposed nodal classification (rN) simultaneously accounting the optimal number and location of retrieved LNs was proposed. The performance of rN was then compared to that of LN ratio, log-odds of metastatic LNs (LODDs) and the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) N classification.ResultsThe optimal cut-off values for Group 1 and 2 were 13 and 9, respectively. The 5-year overall survival (OS) was higher for patients in retrieved Group 1 LNs > 13 (vs. Group 1 LNs ≤ 13, 63.2% vs. 57.9%, P = 0.005) and retrieved Group 2 LNs > 9 (vs. Group 2 LNs ≤ 9, 72.5% vs. 60.7%, P = 0.009). Patients staged as pN0–3b were sub classified using this Group 1 and 2 nodal analogy. The OS of pN0–N2 patients in retrieved Group 1 LNs > 13 or Group 2 LNs > 9 were superior to those in retrieved Group 1 LNs ≤ 13 and Group 2 LNs ≤ 9 (All P < 0.05); except for pN3 patients. The rN classification was formulated and demonstrated better 5-year OS prognostication performance as compared to the LNR, LODDs, and the 8th UICC/AJCC N staging system.ConclusionsThe retrieval of > 13 and > 9 LNs for Group 1 and Group 2, respectively, could represent an alternative lymph node retrieval approach in radical gastrectomy for more precise survival prognostication and minimizing staging migration, especially if > 16 LNs is found to be difficult.

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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

Cited by 37 publications

References 29 publications

The Methods of Lymph Node Examination Make a Difference to Node Staging and Detection of N3b Node Status for Gastric Cancer

The Methods of Lymph Node Examination Make a Difference to Node Staging and Detection of N3b Node Status for Gastric Cancer

The assessment of the optimal number of examined lymph nodes and prognostic models based on lymph nodes for predicting survival outcome in patients with stage N3b gastric cancer

Retrieved lymph nodes from different anatomic groups in gastric cancer: a proposed optimal number, comparison with other nodal classification strategies and its impact on prognosis

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