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

Le, Puo‐Hsien; Kuo, Chia‐Jung; Yeh, Ta‐Sen; Jan, Yi-Yin

doi:10.21037/tgh.2017.12.02

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…In the literature, large numbers of NDLNs were reported to be associated with prolonged survival in patients with ESCC, gastric cancer, or CRC [14][15][16][17]. Compatible with these results, our preliminary results also demonstrated that a large number of NDLNs was related to prolonged survival among the 73 CRC patients (p = 0.071, subgrouped, ≤ 9, 9-25, and > 25, Table 2).…”

Section: Discussionsupporting

confidence: 78%

A reappraisal of lymph node dissection in colorectal cancer during primary surgical resection

et al. 2020

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Purpose Controversy exists regarding the extent to which lymph node dissection (LND) should be performed for operable colorectal cancers (CRCs) during primary surgical resection. We reappraised the role of LND in CRCs. Methods Seventy-three CRC patients (mean age, 65.3 years; 43 males) undergoing primary surgical resection at Taipei Hospital, Ministry of Health and Welfare, Taiwan, within a 3-year period were retrospectively analyzed. Their pathological T/N/M statuses and cancer stages were defined according to the American Joint Committee on Cancer (AJCC) 8th edition staging system. The numbers of total dissected lymph nodes (TDLNs), positive dissected lymph nodes (PDLNs), and negative dissected lymph nodes (NDLNs) for each CRC patient were recorded in detail (TDLNs = PDLNs + NDLNs). Possible prognostic variables were evaluated. Results An advanced N status (N1/N2 vs. N0; HR, 5.749/17.677 vs. 1.000; p = 0.056/0.009) and M1 status (M1 vs. M0; HR, 7.517 vs. 1.000; p = 0.010) were independent variables for a poor prognosis. For all 73 CRC patients (p = 0.030), as well as T2 CRC patients (p = 0.061), those with > 15 TDLNs tended to have more PDLNs than those with ≤ 15 TDLNs. For 42 N(+) CRC patients (p = 0.007), as well as N2 CRC patients (p = 0.011), those with > 21 TDLNs tended to have more PDLNs than those with ≤ 21 TDLNs. Conclusion For CRC patients undergoing primary surgical resection, the number of TDLNs influences the accuracy of nodal staging. A minimum of 15 TDLNs is necessary for positive lymph nodes to be identified in CRC patients, and 21 TDLNs is sufficient for the severity of the N(+) status to be distinguished in N(+) CRC patients.

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Section: Discussionsupporting

confidence: 78%

A reappraisal of lymph node dissection in colorectal cancer during primary surgical resection

et al. 2020

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“…A wide range of clinicopathological factors affecting survival in patients with gastric cancer without lymph node involvement have been presented [17]. These include tumor size, serosal invasion, lymphovascular invasion, tumor localization, age, gender, perineural invasion and total number of removed lymph nodes [18][19][20][21][22]. The present study identified surgery type, tumor diameter, T stage and presence of complications as the factors affecting mortality risk.…”

Section: Discussionmentioning

confidence: 89%

Are the type of gastrectomy and the presence of complications prognostic factors in patients with gastric cancer without lymph node involvement?

Uzun¹,

Gülmez²,

Senger³

et al. 2020

J Clin Med Kaz

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Objective: Lymph node involvement is one of the leading prognostic factors in patients with gastric cancer without distant metastasis, although disease-related death also occurs in patients without lymph node involvement. The present study investigates whether gastrectomy type and complication presence is a prognostic factor in gastric cancer patients without lymph node involvement.Material and methods: The data of 262 patients who underwent curative gastrectomy at our clinic between November 2006 and December 2018 was reviewed retrospectively.Results: No lymph node involvement was identified in 33.2% of the patients who underwent curative gastrectomy, and survival in this group was better than in the patient group with lymph node involvement (75.9% vs. 32.6%). A comparison of the two groups revealed significant differences in terms of Borrmann's classification, Lauren classification, T stage, vascular invasion, perineural invasion, tumor diameter and total number of lymph nodes. Diseaserelated death occurs also in patients without lymph node involvement, with tumor diameter, T stage, gastrectomy type and the presence of complications all found to be factors affecting the risk of death.Conclusion: Patients without lymph node involvement have a better prognosis, and aside from tumor diameter and T stage, the present study found gastrectomy type and the presence of complications to be prognostic risk factors.

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“…[19] The number of retrieved LNs is associated with survival for LN-negative gastric cancer. [26, 27] Several modifications to the LN staging system, such as log odds of positive LNs,[28, 29] LN ratio,[30] and anatomical LN distribution,[23] were proposed to improve the AJCC N system. A modified T classification of gastric cancer into proximal non-diffuse, diffuse, and distal non-diffuse types based on Lauren's classification of gastric cancer was reported.…”

Section: Discussionmentioning

confidence: 99%

Anatomical location-based nodal staging system is superior to the 7th edition of the American Joint Committee on Cancer staging system among patients with surgically resected, histologically low-grade gastric cancer: A single institutional experience

et al. 2019

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BackgroundA hybrid topographic and numeric lymph node (LN) staging system for gastric cancer, which was recently proposed by Japanese experts as a simple method with a prognostic predictive power comparable to the N staging of the American Joint Committee on Cancer (AJCC) Tumor-node-metastasis classification, has not yet been validated in other Asian countries. This study aimed to examine the prognostic predictability of the hybrid staging system with the current AJCC staging system in gastric cancer.MethodsOverall, 400 patients with gastric cancer who underwent surgery at Changhua Christian Hospital from January 2007 to December 2017 were included in the study. Univariate and multivariate analyses were performed to identify prognostic factors for gastric cancer-related death. Homogeneity and discrimination abilities of the two staging systems were compared using likelihood ratio chi-square test, linear trend chi-square test, Harrell’s c-index, and bootstrap analysis.ResultsOne-third of the LN-positive patients were reclassified into the new N and Stage system. The concordance rates of the two staging systems and the N staging between the two staging systems were 0.810 and 0.729, respectively. Harrell’s c-indices for the stage and N staging were higher in the 7th AJCC staging system than the hybrid staging system (c-index for stage, 0.771 vs 0.764; c-index for nodal stage, 0.713 vs 0.705). Stratification of the patients according to the histological grade revealed that Harrell’s c-indices for the stage and N stage of the hybrid staging system were comparable with those of the 7th AJCC staging system (c-index for AJCC stage vs hybrid stage, 0.800 vs 0.791; c-index for AJCC N stage vs hybrid N stage, 0.746 vs 0.734) among patients with histologically lower grade gastric cancer. The performance of the new nodal staging system was better than that of the 7th AJCC staging system by likelihood ratio and linear trend tests and bootstrap analysis in the low-grade group.ConclusionsThe hybrid anatomical location-based classification may have better prognostic predictive ability than the 7th AJCC staging system for LN metastasis of low-grade gastric cancer. Further studies involving different ethnic populations are necessary for the validation of the new staging system.

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

Cited by 4 publications

References 18 publications

A reappraisal of lymph node dissection in colorectal cancer during primary surgical resection

A reappraisal of lymph node dissection in colorectal cancer during primary surgical resection

Are the type of gastrectomy and the presence of complications prognostic factors in patients with gastric cancer without lymph node involvement?

Anatomical location-based nodal staging system is superior to the 7th edition of the American Joint Committee on Cancer staging system among patients with surgically resected, histologically low-grade gastric cancer: A single institutional experience

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