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

Abstract

It is well known that lymph node (LN) status is the most important prognostic factor in localized gastric adenocarcinoma (GC) (1-4). Curative resection including adequate lymphadenectomy provided the chance of a cure for stage I-III disease (1,4,5). 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. The median number of nodes examined for patients with recurrence was 14 (range, 6-22), which might result in the possibility of underestimation of nodal involvement and understaging. In addition, tumor recurrence rates did not differ regardless of the extent of lymphadenectomy or the total nodes examined. The overall 5-year survival rate was 53% for the whole cohort.Our previous study has shown that there was no survival benefit of >15 nodes retrieved for patients with T1 node-negative GC; however, patients with T2-4 nodenegative GC with extensive lymphadenectomy (>25 nodal dissection) had longer survival time than those with nodes retrieved <25 (6). The GC-specific 5-year survival rates were 96.2%, 94.6%, and 97.9% in T1 tumor with the number of examined LN <15, 16-25 and >25, respectively (P=0.468). The overall 5-year survival rates were 74.0%, 81.9% and 84.4% for patients with T2, T3 and T4 nodenegative GC, respectively. 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). The median followup time was 78.7 months. Recurrence was found in 85 patients (18.9%) in the whole cohort. Patients with T2, T3 and T4 tumor had recur...

Survival impact of the number of lymph node retrieved on patients with node-negative gastric cancer: more is better?

“…We p r o p o s e t h a t a d j u n c t t h e r a p i e s i n c l u d i n g chemotherapy or radiation may benefit advanced nodenegative GC patients with NELN <25 or negative prognostic factors such as tumor size >3.5 cm, T4 lesion and presence of perineural invasion to reduce recurrence rates and prolong patients' survival (19). Nonetheless, a prospective randomized controlled trial is needed for validating the treatment strategy for those patients with poor prognostic factors, and useful biomarkers are urgently necessary for predicting efficacy of adjuvant treatment in the era of precision medicine.…”

Assessment of Carbon Nanoparticle Suspension Lymphography–Guided Distal Gastrectomy for Gastric Cancer

“…Our results show that with CNSI, the accuracy of negative LNs and LN pathological staging may be improved, and it could provide the guidance for postoperative adjuvant therapy, which in turn may improve the prognosis of patients. [21][22][23][24][25] The results of this study showed that the number of LNs detected in black-stained stations was greater than that detected in nonblack-stained stations, and the metastasis rate of black-stained LNs was higher than that of nonblack-stained LNs. Both black-stained LNs and stations were highly sensitive to pathological diagnosis, and the NPV of unstained LNs was also satisfactory.…”

“…It also was associated with increasing the number of micro-LNs detected compared with conventional treatment. Our results show that with CNSI, the accuracy of negative LNs and LN pathological staging may be improved, and it could provide the guidance for postoperative adjuvant therapy, which in turn may improve the prognosis of patients …”

Greater Lymph Node Retrieval Improves Survival in Node-Negative Resected Gastric Cancer in the United States

“…In the United States, the National Comprehensive Cancer Network (NCCN) guidelines currently recommend gastrectomy with D1 or modified D2 LN dissection, with preservation of the distal pancreas and spleen; the surgeon should examine at least LNs [ 9 ]. Recent evidence from Asian populations demonstrates a survival benefit to increasing the number of examined lymph nodes (eLNs), even in node-negative disease [ 10 11 12 13 ]. However, this has not been explored in African, European, or North and South American populations.…”