Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer

Authors

  • Taeil Son MD,

    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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  • Woo Jin Hyung MD,

    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
    2. Brain Korea 21 Project for Medical Science, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
    3. Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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  • Joong Ho Lee MD,

    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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  • Yoo Min Kim MD,

    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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  • Hyoung-Il Kim MD,

    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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  • Ji Yeong An MD,

    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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  • Jae-Ho Cheong MD,

    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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  • Sung Hoon Noh MD, PhD

    Corresponding author
    1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
    2. Brain Korea 21 Project for Medical Science, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
    • Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-ku, Seoul 120-752, Republic of Korea
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    • Fax: (011) 82-2-313-8289


  • All authors contributed equally to this article. S.H.N, T.S., and W.J.H. were responsible for study conception and design; S.H.N, T.S., J.H.L., Y.M.K., and J.Y.A. were responsible for data acquisition; S.H.N., T.S., W.J.H., and H.-I.K. were responsible for data analysis and interpretation; S.H.N, T.S., and W.J.H. drafted the article; and W.J.H., J.-H.C., and S.H.N. made critical revisions to the article.

Abstract

BACKGROUND:

The seventh edition of the tumor, lymph node (LN), metastasis (TNM) staging system increased the required number of examined LNs in gastric cancer from 15 to 16. However, the same staging system defines lymph node-negative gastric cancer regardless of the number of examined LNs. In this study, the authors evaluated whether gastric cancer can be staged properly with fewer than 15 examined LNs.

METHODS:

The survival rates of 10,010 patients who underwent curative gastrectomy from 1987 to 2007 were analyzed. The patients were divided into 2 groups according to the number of examined LNs, termed the “insufficient” group (≤15 examined LNs) and the “sufficient” group (≥16 examined LNs). The survival curves of patients from both groups were compared according to the seventh edition of the TNM classification.

RESULTS:

Three hundred sixteen patients (3.2%) had ≤15 examined LNs for staging after they underwent standard, curative lymphadenectomy. Patients who had T1 tumor classification, N0 lymph node status, and stage I disease with an insufficient number of examined LNs after curative gastrectomy had a significantly worse prognosis than patients who had ≥16 examined LNs. Moreover, having an insufficient number of examined LNs was an independent prognostic factor for patients who had T1, N0, and stage I disease.

CONCLUSIONS:

Lymph node-negative cancers in which ≤15 LNs were examined, classified as N0 in the new TNM staging system, could not adequately predict patient survival after curative gastrectomy, especially in patients with early stage gastric cancer. Cancer 2012. © 2012 American Cancer Society.

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