Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 6/2020

01-06-2020 | Gastrectomy | Original Article

The relationship between the number of examined lymph nodes and the efficacy of chemotherapy for gastric cancer

Authors: Lihu Gu, Bangsheng Chen, Zefeng Shen, Parikshit Asutosh Khadaroo, Xianfa Wang, Hepan Zhu, Junhai Pan, Xin Zhong, Feiyan Mao, Ping Chen

Published in: Surgery Today | Issue 6/2020

Login to get access

Abstract

Background

The purpose of this research was to investigate the relationship between the number of examined lymph nodes (eLNs) and the prognosis.

Methods

A retrospective examination of reports and studies carried out at two institutions was conducted. According to TNM stages, the relationship between the number of eLNs and the prognosis was analyzed.

Results

The 5-year disease-specific survival (DSS) of all enrolled patients was 66.3%. A multivariate analysis showed the type of gastrectomy, histologic type, perineural invasion, pT stage, pN stage, chemotherapy and eLNs to be independent prognostic markers. Additionally, with the exception of patients with stage I disease, the 5-year DSS of patients who had < 25 eLNs removed had a higher risk of having a worst prognosis compared to patients who had ≥ 25 eLNs removed. Through this study, a hypothetical TNM staging system was obtained for predicting the prognosis according to the number of eLNs. Chemotherapy was able to improve the prognosis of patients with stage III and < 25 eLNs in stage II.

Conclusions

Extended lymphadenectomy with a new goal of dissecting 25 LNs for the evaluation of stage II–III cancer cases is recommended. Our hypothetical TNM staging system may be able to stratify the risk more accurately compared to the current AJCC 8th system. Chemotherapy can improve the prognosis in advanced gastric cancer, but its benefit may be affected by the surgical quality.
Appendix
Available only for authorised users
Literature
1.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA: Cancer J Clin. 2015;65(2):87–108.
2.
Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA: Cancer J Clin. 2016;66(2):115–32.
3.
Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359(5):453–62.PubMedCrossRef
4.
Bando E, Makuuchi R, Irino T, Tanizawa Y, Kawamura T, Terashima M. Validation of the prognostic impact of the new tumor-node-metastasis clinical staging in patients with gastric cancer. Gastric Cancer. 2019;22(1):123–9.PubMedCrossRef
5.
Ajani JA, D'Amico TA, Almhanna K, Bentrem DJ, Chao J, Das P, et al. Gastric cancer, version 32.016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14(10):1286–312.CrossRefPubMed
6.
Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23(28):7114–24.PubMedCrossRef
7.
Lu J, Wang W, Zheng CH, Fang C, Li P, Xie JW, et al. Influence of total lymph node count on staging and survival after gastrectomy for gastric cancer: an analysis from a two-institution database in China. Ann Surg Oncol. 2017;24(2):486–93.PubMedCrossRef
8.
Deng J, Yamashita H, Seto Y, Liang H. Increasing the number of examined lymph nodes is a prerequisite for improvement in the accurate evaluation of overall survival of node-negative gastric cancer patients. Ann Surg Oncol. 2017;24(3):745–53.PubMedCrossRef
9.
Lee S, Choi KD, Han M, Na HK, Ahn JY, Jung KW, et al. Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including, undifferentiated-type tumors: a criteria-based analysis. Gastric Cancer. 2018;21(3):490–9.PubMedCrossRef
10.
Fukunaga S, Nagami Y, Shiba M, Ominami M, Tanigawa T, Yamagami H, et al. Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis. Gastrointest Endosc. 2017;85(1):143–52.PubMedCrossRef
11.
Mokdad AA, Yopp AC, Polanco PM, Mansour JC, Reznik SI, Heitjan DF, et al. Adjuvant chemotherapy vs postoperative observation following preoperative chemoradiotherapy and resection in gastroesophageal cancer: a propensity score-matched analysis. JAMA Oncol. 2018;4(1):31–8.PubMedCrossRef
12.
Ajani JA, Abramov M, Bondarenko I, Shparyk Y, Gorbunova V, Hontsa A, et al. A phase III trial comparing oral S-1/cisplatin and intravenous 5-fluorouracil/cisplatin in patients with untreated diffuse gastric cancer. Ann Oncol. 2017;28(9):2142–8.PubMedCrossRef
13.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.CrossRef
14.
Hsu JT, Lin CJ, Sung CM, Yeh HC, Chen TH, Chen TC, et al. Prognostic significance of the number of examined lymph nodes in node-negative gastric adenocarcinoma. Eur J Surg Oncol. 2013;39(11):1287–93.PubMedCrossRef
15.
Koizumi W, Takiuchi H, Yamada Y, Boku N, Fuse N, Muro K, Komatsu Y, Tsuburaya A. Phase II study of oxaliplatin plus S-1 as first-line treatment for advanced gastric cancer (G-SOX study). Ann Oncol. 2010;21:1001–5.PubMedCrossRef
16.
Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, Lee KW, Kim YH, Noh SI, Cho JY, Mok YJ, Kim YH, Ji J, Yeh TS, Button P, Sirzen F, Noh SH. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379:315–21.PubMedCrossRef
17.
Roth AD, Fazio N, Stupp R, Falk S, Bernhard J, Saletti P, Koberle D, Borner MM, Rufibach K, Maibach R, Wernli M, Leslie M, Glynne-Jones R, Widmer L, Seymour M, de Braud F. Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase II trial of the Swiss group for clinical cancer research. J Clin Oncol. 2007;25:3217–23.PubMedCrossRef
18.
Rao S, Starling N, Cunningham D, Sumpter K, Gilligan D, Ruhstaller T, Valladares-Ayerbes M, Wilke H, Archer C, Kurek R, Beadman C, Oates J. Matuzumab plus epirubicin, cisplatin and capecitabine (ECX) compared with epirubicin, cisplatin and capecitabine alone as first-line treatment in patients with advanced oesophago-gastric cancer: a randomised, multicentre open-label phase II study. Ann Oncol. 2010;21:2213–9.PubMedCrossRef
19.
Al-Batran SE, Hartmann JT, Hofheinz R, Homann N, Rethwisch V, Probst S, Stoehlmacher J, Clemens MR, Mahlberg R, Fritz M, Seipelt G, Sievert M, Pauligk C, Atmaca A, Jager E. Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol. 2008;19:1882–7.PubMedCrossRef
20.
Jeung HC, Rha SY, Shin SJ, Ahn JB, Noh SH, Roh JK, Chung HC. A phase II study of S-1 monotherapy administered for 2 weeks of a 3-week cycle in advanced gastric cancer patients with poor performance status. Br J Cancer. 2007;97:458–63.PubMedPubMedCentralCrossRef
21.
Edwards P, Davidson M, Calamai V, Cunningham D, Starling N. Third line treatment of advanced oesophagogastric cancer: a critical review of current evidence and evolving trends. Cancer Treat Rev. 2018;71:32–8.PubMedCrossRef
22.
Yoon SS, Yang HK. Lymphadenectomy for gastric adenocarcinoma: should west meet east? Oncologist. 2009;14(9):871–82.PubMedCrossRef
23.
Strong VE, Song KY, Park CH, Jacks LM, Gonen M, Shah M, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251(4):640–6.PubMedCrossRef
24.
Ikoma N, Blum M, Chiang YJ, Estrella JS, Roy-Chowdhuri S, Fournier K, et al. Race is a risk for lymph node metastasis in patients with gastric cancer. Ann Surg Oncol. 2017;24(4):960–5.PubMedCrossRef
25.
Gholami S, Janson L, Worhunsky DJ, Tran TB, Squires MH 3rd, Jin LX, et al. Number of lymph nodes removed and survival after gastric cancer resection: an analysis from the US gastric cancer collaborative. J Am Coll Surg. 2015;221(2):291–9.PubMedPubMedCentralCrossRef
26.
Okajima W, Komatsu S, Ichikawa D, Kosuga T, Kubota T, Okamoto K, et al. Prognostic impact of the number of retrieved lymph nodes in patients with gastric cancer. J Gastroenterol Hepatol. 2016;31(9):1566–71.PubMedCrossRef
27.
Jeon HK, Lee SJ, Kim GH. Endoscopic submucosal dissection for undifferentiated-type early gastric cancer: short- and long-term outcomes. Surg Endosc. 2018;32(4):1963–70.PubMedCrossRef
28.
Cho JH, Cha SW, Kim HG, Lee TH, Cho JY, Ko WJ, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a comparison study to surgery using propensity score-matched analysis. Surg Endosc. 2016;30(9):3762–73.PubMedCrossRef
29.
Zheng G, Feng F, Guo M, Xu G, Liu S, Liu Z, et al. Harvest of at least 23 lymph nodes is indispensable for stage N3 gastric cancer patients. Ann Surg Oncol. 2017;24(4):998–1002.PubMedCrossRef
30.
Liu YY, Fang WL, Wang F, Hsu JT, Tsai CY, Liu KH, et al. Does a higher cut-off value of lymph node retrieval substantially improve survival in patients with advanced gastric cancer?-time to embrace a new digit. Oncologist. 2017;22(1):97–106.PubMedCrossRef
31.
Woo Y, Goldner B, Ituarte P, Lee B, Melstrom L, Son T, et al. Lymphadenectomy with optimum of 29 lymph nodes retrieved associated with improved survival in advanced gastric cancer: a 25,000-patient international database study. J Am Coll Surg. 2017;224(4):546–55.PubMedCrossRef
32.
Yamashita K, Hosoda K, Ema A, Watanabe M. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol. 2016;42(9):1253–60.PubMedCrossRef
33.
Datta J, Lewis RS Jr, Mamtani R, Stripp D, Kelz RR, Drebin JA, et al. Implications of inadequate lymph node staging in resectable gastric cancer: a contemporary analysis using the national cancer data base. Cancer. 2014;120(18):2855–65.PubMedCrossRef
34.
Kulig J, Sierzega M, Kolodziejczyk P, Popiela T. Ratio of metastatic to resected lymph nodes for prediction of survival in patients with inadequately staged gastric cancer. Br J Surg. 2009;96(8):910–8.PubMedCrossRef
35.
Zhao B, Zhang J, Chen X, Sun T, Wang Z, Xu H, et al. The retrieval of at least 25 lymph nodes should be essential for advanced gastric cancer patients with lymph node metastasis: a retrospective analysis of single-institution database study design: cohort study. Int J Surg (London, England). 2017;48:291–9.CrossRef
36.
Gabriel E, Attwood K, Narayanan S, Brady M, Nurkin S, Hochwald S, et al. Does neoadjuvant/perioperative chemotherapy improve overall survival for T2N0 gastric adenocarcinoma? J Surg Oncol. 2018;117(4):659–70.PubMedCrossRef
37.
Yonemura Y, Endo Y, Hayashi I, Kawamura T, Yun HY, Bandou E. Proliferative activity of micrometastases in the lymph nodes of patients with gastric cancer. Br J Surg. 2007;94(6):731–6.PubMedCrossRef
38.
Huang JY, Xu YY, Li M, Sun Z, Zhu Z, Song YX, et al. The prognostic impact of occult lymph node metastasis in node-negative gastric cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2013;20(12):3927–34.PubMedCrossRef
39.
Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345(10):725–30.PubMedCrossRef
Metadata
Title
The relationship between the number of examined lymph nodes and the efficacy of chemotherapy for gastric cancer
Authors
Lihu Gu
Bangsheng Chen
Zefeng Shen
Parikshit Asutosh Khadaroo
Xianfa Wang
Hepan Zhu
Junhai Pan
Xin Zhong
Feiyan Mao
Ping Chen
Publication date
01-06-2020
Publisher
Springer Singapore
Published in
Surgery Today / Issue 6/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01925-3

Other articles of this Issue 6/2020

Surgery Today 6/2020 Go to the issue

Original Article

Long-term outcomes of colorectal cancer surgery for elderly patients: a propensity score-matched analysis

Review Article

Liver transplantation in elderly patients: what do we know at the beginning of 2020?

Review Article

Surgical intervention for ischemic mitral regurgitation: how can we achieve better outcomes?

Original Article

Stapler sizes optimized for pancreatic thickness can reduce pancreatic fistula incidence after distal pancreatectomy

Original Article

Clinical significance of an increased red blood cell distribution width in patients with rectal cancer undergoing chemoradiotherapy followed by surgery

Original Article

An increase in the peripheral lymphocyte-to-monocyte ratio after primary site resection is associated with a prolonged survival in unresectable colorectal carcinoma