Effect of lymphadenectomy extent on advanced gastric cancer located in the cardia and fundus.
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.
Huang
Chang-Ming
CM
Department of Oncology, Affiliated Union Hospital, Fujian Medical University, Xinquan Road No. 29, Fuzhou 350001, Fujian Province, China. hcmlr253@sohu.com
Lin
Bi-Juan
BJ
Lu
Hui-Shan
HS
Zhang
Xiang-Fu
XF
Li
Ping
P
Xie
Jian-Wei
JW
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*