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Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer
Article first published online: 25 SEP 2006
Copyright © 2006 American Cancer Society
Volume 107, Issue 9, pages 2143–2151, 1 November 2006
How to Cite
Coburn, N. G., Swallow, C. J., Kiss, A. and Law, C. (2006), Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer, 107: 2143–2151. doi: 10.1002/cncr.22229
- Issue published online: 24 OCT 2006
- Article first published online: 25 SEP 2006
- Manuscript Accepted: 1 AUG 2006
- Manuscript Revised: 30 JUL 2006
- Manuscript Received: 19 MAY 2006
- gastric cancer;
- lymph node assessment;
- overall survival;
- population-based study;
- Surveillance, Epidemiology and End Results (SEER) database
Lymph node (LN) status is a major determinant of prognosis and treatment of gastric adenocarcinoma. The 1997 American Joint Commission on Cancer/Union Internationale Contre le Cancer guidelines were revised, requiring examination of ≥15 LN for staging.
We investigated compliance with these guidelines and the correlation with overall survival (OS) by analyzing 10,807 resected gastric cancers in the Surveillance, Epidemiology and End Results (SEER) database, 1988–2002. Kaplan–Meier survival curves were constructed; survival was compared by using Cox proportional hazards.
Overall, 29% of cases had ≥15 LN examined. After 1997, the median number of LN assessed increased from 9 to 10 (P < .0001). Factors predictive of adequate LN assessment (ALNA) were higher stage, worse grade, age <74 years, later year of diagnosis, nonwhite race, more extensive surgery, female sex, and SEER region. Differences in the rate of ALNA between regions were noted, ranging from 19.7–53% (P < .0001). Of T1N0 patients, 19% had ALNA. Improved OS was predicted by earlier stage, lower grade, marital status, Asian race, younger age, T-stage, female sex, SEER region, and ALNA. Median OS was highest in the region with the best ALNA rate and worst in the region with the lowest (33 mos vs. 17 mos, P < .0001). Inadequate LN assessment led to poorer survival at every stage (P < .001).
The overwhelming majority of patients have an inadequate LN assessment. ALNA was associated with improved OS, with significant variation across regions. Understaging due to inadequate LN assessment may affect eligibility for adjuvant therapy. Education is required to improve LN retrieval. Cancer 2006. © 2006 American Cancer Society.