Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer.
OBJECTIVE
To elucidate the potential impact of examined lymph nodes (eLNs) on long-term survival of node-negative gastric cancer patients after curative surgery.


METHODS
A total of 497 node-negative gastric cancer patients who underwent curative gastrectomy between January 2000 and December 2008 in our center were enrolled in this study. Patients were divided into 4 groups according to eLNs through cut-point analysis. Clinicopathological features were compared between ≤ 15 eLNs group and > 15 eLNs group and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified using the Cox proportional hazards regression model. Stratified analysis was performed to investigate the impact of eLNs on patient survival in each stage. Overall survival was also compared among the four groups. Finally, we explored the recurrent sites associated with eLNs.


RESULTS
Patients with eLNs > 15 had a better survival compared with those with eLNs ≤ 15 for the entire cohort. By the multivariate survival analysis, we found that the depth of invasion and the number of eLNs were the independent predictors of overall survival (OS) of patients with node-negative gastric cancer. According to the cut-point analysis, T2-T4 patients with 11-15 eLNs had a significantly longer mean OS than those with 4-10 eLNs or 1-3 eLNs. Patients with ≤ 15 eLNs were more likely to experience locoregional and peritoneal recurrence than those with > 15 eLNs.


CONCLUSIONS
Number of eLNs could predict the prognosis of node-negative gastric cancer, and dissection of > 15 eLNs is recommended during lymphadenectomy so as to improve the long-term survival.
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Xu-Guang
XG
Jiao
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Jing-Yu
JY
Deng
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Ru-Peng
RP
Zhang
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Liang-Liang
LL
Wu
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Li
L
Wang
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Hong-Gen
HG
Liu
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Xi-Shan
XS
Hao
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Han
H
Liang
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
Examined lymph nodes; Gastric carcinoma; Node-negative; Prognosis