Effect of lymph node number on survival of patients with lymph node-negative gastric cancer according to the 7th edition UICC TNM system.
BACKGROUND
For the patients with node-negative gastric cancer, the 7th edition classification does not define the minimum number of lymph nodes necessary. We aimed to explore the prognostic significance of examined lymph nodes and determine how many nodes must be examined.


RESULTS
435 patients underwent D2 gastrectomy with node-negative gastric cancer between December 1992 and December 2006 were obtained. Patients were classified into 4 groups by the number of negative LNs examined during surgery (1-6LNs, 7-10 LNs, 11-15 LNs, and > = 16 LNs). Stratified and Cox regression analyses were used to evaluate the association between survival and the number of negative LNs. Survival was significantly better in the > = 16 LNs, compared with the 1-5 LNs, 6-10 LNs and 11-15 LNs group in T2-4 patients; Multivariate analysis demonstrated tumor size, depth of invasion, 7th UICC stage and the number of examined nodes are strongly independent predictors of survival.


CONCLUSIONS
This study first demonstrates that patients with lymph node-negative gastric cancer underwent D2 dissection should have at least 16 LNs examined, especially in advanced gastric cancer. These results are a reasonable supplement to our previous tumor-ratio-metastasis staging system and a stratification criterion in clinical practice.
State Key Laboratory of Oncology in South China, Guangzhou, China. xudzh@sysucc.org.cn
Dazhi
D
Xu
Ying
Y
Huang
Qirong
Q
Geng
Yuanxiang
Y
Guan
Yuanfang
Y
Li
Wei
W
Wang
Shuqiang
S
Yuan
Xiaowei
X
Sun
Yingbo
Y
Chen
Wei
W
Li
Zhiwei
Z
Zhou
Youqing
Y
Zhan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology*; D055815:Young Adult