Retrieval of 30 Lymph Nodes Is Mandatory for Selected Stage II Gastric Cancer Patients

Yong-He Chen; Jun Lu; Run-Cong Nie; Dan Liu; Ai-Hong Liu; Zi-Jian Deng; Xi-Jie Chen; Jun Xiang; Ying-Bo Chen; Chang-Ming Huang; Shi Chen; Jun-Sheng Peng

doi:10.3389/fonc.2021.593470

Retrieval of 30 Lymph Nodes Is Mandatory for Selected Stage II Gastric Cancer Patients

Front Oncol. 2021 Apr 30:11:593470. doi: 10.3389/fonc.2021.593470. eCollection 2021.

Authors

Yong-He Chen^{1

2

3}, Jun Lu⁴, Run-Cong Nie⁵, Dan Liu⁶, Ai-Hong Liu^{1

2

3}, Zi-Jian Deng^{1

2

3}, Xi-Jie Chen^{1

2

3}, Jun Xiang^{1

2

3}, Ying-Bo Chen⁵, Chang-Ming Huang⁴, Shi Chen^{1

2

3}, Jun-Sheng Peng^{1

2

3}

Affiliations

¹ Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
² Department of Surgery, Guangdong Institute of Gastroenterology, Guangzhou, China.
³ Department of Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, China.
⁴ Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
⁵ Department of Gastric Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
⁶ Department of Laboratory Science, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.

Abstract

Background: According to the 8th edition AJCC staging manual, a least of 16 lymph nodes retrieval (LNRs) is the minimal requirement for lymph nodes (LNs) dissection of gastric cancer surgery. Previous studies have shown that increasing the number of LNRs (≥30) prolongs survival for selected patients. However, the necessity of retrieving 30 or more LN for stage II gastric cancer patients is still under debate.

Aim: This study aims to explore the impact of retrieving 30 or more lymph nodes on the survival of stage II cancer patients.

Methods: A total of 1,177 patients diagnosed with stage II gastric cancer were enrolled in this study. The clinicopathological parameters and the impact of different LNRs (<30 or ≥30) and positive lymph node ratio (NR) on overall survival (OS) were retrospectively analyzed.

Results: The mean number of LNRs was 34 ± 15. A total of 44% (518/1,177) of patients had an LNRs <30, while 56% (659/1,177) of patients had an LNRs ≥30. The 5-year survival rate was 81% for all patients, 76% for the LNRs <30 group, and 86% for LNRs ≥30 group, respectively (P = 0.003). The survival benefit of retrieving 30 lymph nodes was significant in certain subgroups: age >60 years/male/underwent total gastrectomy/stage IIB. For N+ patients, higher NR was significantly correlated with poor survival.

Conclusion: The survival benefit of retrieving 30 LNs varies in different subgroups. An LNRs of 30 is mandatory for selected stage II gastric cancer patients.

Keywords: Chinese people; gastric cancer; lymph node retrieval; prognosis; stage II.