Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study.
OBJECTIVE
This study was aimed at evaluating the prognostic significance of the number of metastatic nodes in early gastric cancer (EGC).


METHODS
In this multicenter retrospective study 652 cases of resected EGC were analyzed. We searched for lymph node metastases-associated risk factors and to identify subsets of patients with different prognosis according to the number of involved nodes.


RESULTS
Nodal involvement was observed in 14.1%. A significant correlation was found between the presence of node metastases and tumor size (RR 1.34, P = 0.001), submucosal invasion (RR: 3.14, P = 0.007), Lauren diffuse/mixed type (RR: 4.88, P < 0.001) and Kodama Pen A type (RR: 4.59, P < 0.001). The 10-year survival rate was 92% for N0 cases, 82% and 73% for tumors with one to three and four to six positive nodes while it dropped to 27% with more than six metastatic nodes. Interestingly enough, the 10-year risk of recurrence diminished with the increasing number of retrieved nodes (>15) even in N0 patients.


CONCLUSIONS
Nodal involvement confirmed to be a significant prognostic factor. In view of the trend to a lower risk of recurrence when more than 15 nodes were retrieved and the better staging achieved we consider D2 lymphadenectomy the treatment of choice.
Roviello
Franco
F
Dipartimento di Chirurgia Generale ed Oncologica, Università di Siena, Siena, Italia. roviello@unisi.it
Rossi
Simone
S
Marrelli
Daniele
D
Pedrazzani
Corrado
C
Corso
Giovanni
G
Vindigni
Carla
C
Morgagni
Paolo
P
Saragoni
Luca
L
de Manzoni
Giovanni
G
Tomezzoli
Anna
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate