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01-12-2021 | Gastrectomy | Research article

A greater lymph node yield is required during pathological examination in microsatellite instability-high gastric cancer

Authors: Zhenghao Cai, Haiqin Song, Abe Fingerhut, Jing Sun, Junjun Ma, Luyang Zhang, Shuchun Li, Chaoran Yu, Minhua Zheng, Lu Zang

Published in: BMC Cancer | Issue 1/2021

Abstract

Background

The impact of microsatellite status on lymph node (LN) yield during lymphadenectomy and pathological examination has never been assessed in gastric cancer (GC). In this study, we aimed to appraise the association between microsatellite instability-high (MSI-H) and LN yield after curative gastrectomy.

Methods

We retrospectively analyzed 1757 patients with GC undergoing curative gastrectomy and divided them into two groups: MSI-H (n = 185(10.5%)) and microsatellite stability (MSS) (n = 1572(89.5%)), using a five-Bethesda-marker (NR-24, BAT-25, BAT-26, CAT-25, MONO-27) panel. The median LN count and the percentage of specimens with a minimum of 16 LNs (adequate LN ratio) were compared between the two groups. The log odds (LODDS) of positive LN count (PLNC) to negative LN count (NLNC) and the target LN examined threshold (TLNT_(x%)) were calculated in both groups.

Results

Statistically significant differences were found in the median LN count between MSI-H and MSS groups for the complete cohort (30 vs. 28, p = 0.031), for patients undergoing distal gastrectomy (DG) (30 vs. 27, p = 0.002), for stage II patients undergoing DG (34 vs. 28, p = 0.005), and for LN-negative patients undergoing DG (28 vs. 24, p = 0.002). MSI-H was an independent factor for higher total LN count in patients undergoing DG (p = 0.011), but it was not statistically correlated to the adequate LN ratio. Statistically significant differences in PLNC, NLNC and LODDS were found between MSI-H GC and MSS GC (all p < 0.001). The TLNT_(90%) for MSI-H and MSS groups were 31 and 25, respectively. TLNT_(X%) of MSI-H GC was always higher than that of MSS GC regardless of the given value of X%.

Conclusions

MSI-H was associated with higher LN yield in patients undergoing gastrectomy for GC. Although MSI-H did not affect the adequacy of LN harvest, we speculate that a greater lymph node yield is required during pathological examination in MSI-H GC.

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Title: A greater lymph node yield is required during pathological examination in microsatellite instability-high gastric cancer
Authors: Zhenghao Cai
Haiqin Song
Abe Fingerhut
Jing Sun
Junjun Ma
Luyang Zhang
Shuchun Li
Chaoran Yu
Minhua Zheng
Lu Zang
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Gastrectomy
Gastric Cancer
Gastric Cancer
Lymphadenectomy
Gastrectomy
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08044-8

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