The impact of total retrieved lymph nodes on staging and survival of patients with pT3 gastric cancer.
BACKGROUND
The incidence of lymph node metastasis is high in patients who have pT3 gastric cancer. However, the impact of total retrieved lymph nodes (tLNs) on staging and survival of these patients is not clear.


METHODS
For this study, the authors examined 1895 patients with pT3 gastric cancer who underwent surgery at Yonsei University Medical College from January 1987 to June 2000.


RESULTS
Four hundred sixty of 1895 patients (24.3%) were diagnosed with pT3N0 gastric cancer. Patients who had < 31 tLNs (25th percentile) had less advanced lymph node (N) stage than the other patients (P < .001). Lymph node metastasis had a positive association with the number of tLNs in a logistic regression analysis (P < .001; hazards ratio, 1.014; 95% confidence interval, 1.006-1.021). With a median follow-up of 61.1 months, the overall 10-year survival rate (10-YSR) was 42.8%. Patients with pT3N0 disease who had < 31 tLNs had a 10-YSR of only 55.4%. Although this 10-YSR did not differ significantly from the rate for patients with N0 disease who had > or =31 tLNs (65.8%; P = .108), it approached the rate for the N1 group (53.3%; P = .207). In multivariable analyses, the number of tLNs emerged as an independent prognostic predictor in patients with pT3N2 and pT3N3 disease, but not in patients with pT3N0 or pT3N1 disease.


CONCLUSIONS
Increasing numbers of tLNs may improve the accuracy of staging in patients who have pT3 gastric cancer. Because preoperative lymph node staging is difficult, a thorough lymph node dissection is mandatory in all serosa-positive patients.
Shen
Jia Yun
JY
Department of Surgery, Yonsei University College of Medicine, Seodaemun-Gu, Seoul, Korea.
Kim
Sungsoo
S
Cheong
Jae-Ho
JH
Kim
Yong Il
YI
Hyung
Woo Jin
WJ
Choi
Won Hyuk
WH
Choi
Seung Ho
SH
Wang
Lin Bo
LB
Noh
Sung Hoon
SH
D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology*; D016019:Survival Analysis