Open AccessDoes a Higher Cutoff Value of Lymph Node Retrieval Substantially Improve Survival in Patients With Advanced Gastric Cancer?—Time to Embrace a New Digit
Author(s) -
Liu YuYin,
Fang WenLiang,
Wang Frank,
Hsu JunTe,
Tsai ChunYi,
Liu KengHao,
Yeh ChunNan,
Chen TseChing,
Wu RenChin,
Chiu ChengTang,
Yeh TaSen
Publication year - 2017
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2016-0239
Subject(s) - medicine , gastrectomy , lymph node , cancer , stage (stratigraphy) , lymph , gastroenterology , multivariate analysis , oncology , pathology , paleontology , biology
Background The present study assessed the impact of the retrieval of >25 lymph nodes (LNs) on the survival outcome of patients with advanced gastric cancer after curative‐intent gastrectomy. Patients and Methods A total of 5,386 patients who had undergone curative gastrectomy for gastric cancer from 1994 to 2011 were enrolled. The clinicopathological parameters and overall survival (OS) were analyzed according to the number of LNs examined (≤15, n = 916; 16–25, n = 1,458; and >25, n = 3,012). Results The percentage of patients with >25 LNs retrieved increased from 1994 to 2011. Patients in the LN >25 group were more likely to have undergone total gastrectomy and to have a larger tumor size, poorer tumor differentiation, and advanced T and N stages. Hospital mortality among the LN ≤15, LN 16–25, and LN >25 groups was 6.1%, 2.7%, and 1.7%, respectively ( p < .0001). The LN >25 group consistently exhibited the most favorable OS, in particular, with stage II disease ( p = .011) when OS was stratified according to tumor stage. Similarly, the LN >25 group had significantly better OS in all nodal stages (from N1 to N3b). The discrimination power of the lymph node ratio (LNR) for the LN ≤15, LN 16–25, and LN >25 groups was 483, 766, and 1,560, respectively. Multivariate analysis demonstrated that the LNR was the most important prognostic factor in the LN >25 group. Conclusion Retrieving more than 25 lymph nodes during curative‐intent gastrectomy substantially improved survival and survival stratification of advanced gastric cancer without compromising patient safety. Implications for Practice D2 lymph node (LN) dissection is currently the standard of surgical management of gastric cancer, which is rarely audited by a third party. The present study, one of the largest surgical series worldwide, has shown that the traditionally recognized retrieval of ≥16 LNs during curative‐intent gastrectomy might not be adequate in regions in which locally advanced gastric cancers predominate. The presented data show that retrieval of >25 LNs, which more greatly mimics D2 dissection, improves long‐term outcomes and survival stratification without compromising patient safety.