title: Effect of lymphadenectomy extent on advanced gastric cancer located in the cardia and fundus.
abstract: OBJECTIVE
  To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus.
  
  
  METHODS
  Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes (LNs) dissected and survival was analyzed among different clinical stage subgroups.
  
  
  RESULTS
  The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected (P < 0.0001; or number of negative LNs examined, P < 0.0001), number of positive LNs (P < 0.0001), T category (P < 0.0001) and tumor size (P = 0.015). The greatest survival differences were observed at cutoff values of 20 LNs resected for stage II (P = 0.0136), 25 for stage III(P < 0.0001), 30 for stage IV (P = 0.0002), and 15 for all patients (P = 0.0024). Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative LNs for patients of stages III (P = 0.013) and IV (P = 0.035).
  
  
  CONCLUSIONS
  To improve the long-term survival of patients with advanced gastric cancer located in the cardia and fundus, removing at least 20 LNs for stage II, 25 LNs for stage III, and 30 LNs for stage IV patients during D2 radical dissection is recommended.
authors.affiliation: Department of Oncology, Affiliated Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou 350001, Fujian Province, China. hcmlr253@sohu.com
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Huang
authors.forename: Bi-Juan
authors.initials: BJ
authors.lastname: Lin
authors.forename: Hui-Shan
authors.initials: HS
authors.lastname: Lu
authors.forename: Xiang-Fu
authors.initials: XF
authors.lastname: Zhang
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia; D005260:Female; D005748:Gastric Fundus; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*