Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection: An Analysis from the US Gastric Cancer Collaborative

Gholami, Sepideh, Janson, Lucas, Worhunsky, David J, Tran, Thuy B, Squires, Malcolm Hart, Jin, Linda X, Spolverato, Gaya, Votanopoulos, Konstantinos I, Schmidt, Carl, Weber, Sharon M, Bloomston, Mark, Cho, Clifford S, Levine, Edward A, Fields, Ryan C, Pawlik, Timothy M, Maithel, Shishir K, Efron, Bradley, Norton, Jeffrey A, Poultsides, George A (August 2015) Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection: An Analysis from the US Gastric Cancer Collaborative. Journal of the American College of Surgeons, 221 (2). pp. 291-299. ISSN 1072-7515

[thumbnail of Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection An Analysis from the US Gastric Cancer Collaborati.pdf] PDF
Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection An Analysis from the US Gastric Cancer Collaborati.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (810kB)
URL: https://www.ncbi.nlm.nih.gov/pubmed/26206635
DOI: 10.1016/j.jamcollsurg.2015.04.024

Abstract

BACKGROUND: Examination of at least 16 lymph nodes (LNs) has been traditionally recommended during gastric adenocarcinoma resection to optimize staging, but the impact of this strategy on survival is uncertain. Because recent randomized trials have demonstrated a therapeutic benefit from extended lymphadenectomy, we sought to investigate the impact of the number of LNs removed on prognosis after gastric adenocarcinoma resection. STUDY DESIGN: We analyzed patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012, at 7 US academic institutions. Patients with M1 disease or R2 resections were excluded. Disease-specific survival (DSS) was calculated using the Kaplan-Meier method and compared using log-rank and Cox regression analyses. RESULTS: Of 742 patients, 257 (35%) had 7 to 15 LNs removed and 485 (65%) had ≥16 LNs removed. Disease-specific survival was not significantly longer after removal of ≥16 vs 7 to 15 LNs (10-year survival, 55% vs 47%, respectively; p = 0.53) for the entire cohort, but was significantly improved in the subset of patients with stage IA to IIIA (10-year survival, 74% vs 57%, respectively; p = 0.018) or N0-2 disease (72% vs 55%, respectively; p = 0.023). Similarly, for patients who were classified to more likely be "true N0-2," based on frequentist analysis incorporating both the number of positive and of total LNs removed, the hazard ratio for disease-related death (adjusted for T stage, R status, grade, receipt of neoadjuvant and adjuvant therapy, and institution) significantly decreased as the number of LNs removed increased. CONCLUSIONS: The number of LNs removed during gastrectomy for adenocarcinoma appears itself to have prognostic implications for long-term survival.

Item Type: Paper
Subjects: diseases & disorders > cancer > cancer types > stomach cancer
CSHL Authors:
Communities: CSHL labs > Gholami Lab
SWORD Depositor: CSHL Elements
Depositing User: CSHL Elements
Date: August 2015
Date Deposited: 05 Oct 2023 19:40
Last Modified: 05 Oct 2023 19:40
PMCID: PMC4654942
Related URLs:
URI: https://repository.cshl.edu/id/eprint/41151

Actions (login required)

Administrator's edit/view item Administrator's edit/view item
CSHL HomeAbout CSHLResearchEducationNews & FeaturesCampus & Public EventsCareersGiving