Greater Lymph Node Retrieval Improves Survival in Node-Negative Resected Gastric Cancer in the United States
Journal of Gastric Cancer
;
: 306-318, 2017.
Article
in English
| WPRIM
| ID: wpr-179811
ABSTRACT
PURPOSE:
Guidelines in western countries recommend retrieving ≥15 lymph nodes (LNs) during gastric cancer resection. This study sought to determine whether the number of examined lymph nodes (eLNs), a proxy for lymphadenectomy, effects survival in node-negative disease. MATERIALS ANDMETHODS:
The US National Cancer Database (2003–2011) was reviewed for node-negative gastric adenocarcinoma. Treatment was categorized by neoadjuvant therapy (NAT) vs. initial resection, and further stratified by eLN. Kaplan-Meier and Weibull models were used to analyze overall survival.RESULTS:
Of the 1,036 patients who received NAT, 40.5% had ≤10 eLN, and most underwent proximal gastrectomy (67.8%). In multivariate analysis, greater eLN was associated with improved survival (eLN 16–20 HR, 0.71; P=0.039, eLN 21–30 HR, 0.55; P=0.001). Of the 2,795 patients who underwent initial surgery, 42.5% had ≤10 eLN, and the majority underwent proximal gastrectomy (57.2%). In multivariate analysis, greater eLN was associated with improved survival (eLN 11–15 HR, 0.81; P=0.021, eLN 16–20 HR, 0.73; P=0.004, eLN 21–30 HR, 0.62; P30 HR, 0.58; P<0.001).CONCLUSIONS:
In the United States, the majority of node-negative gastrectomies include suboptimal eLN. In node-negative gastric cancer, greater LN retrieval appears to have therapeutic and prognostic value, irrespective of initial treatment, suggesting a survival benefit to meticulous lymphadenectomy.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Stomach Neoplasms
/
United States
/
Adenocarcinoma
/
Multivariate Analysis
/
Neoadjuvant Therapy
/
Proxy
/
Gastrectomy
/
Lymph Node Excision
/
Lymph Nodes
Type of study:
Practice guideline
/
Prognostic study
Limits:
Humans
Country/Region as subject:
North America
Language:
English
Journal:
Journal of Gastric Cancer
Year:
2017
Type:
Article
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