Abstract
BackgroundThe TNM classification (sixth edition) requires at least 15 lymph nodes to be examined to allow an accurate staging. However, in our environment, only 20% of patients have the recommended minimum of 15 nodes removed.PurposeTo evaluate clinicopathological predictors of recurrence in patients with gastric cancer undergoing radical resection with an inadequate number of lymph nodes examined.Methods101 patients were included in this retrospective cohort. We evaluated age, gender, tumoral location, Borrmann type, Lauren histotype, type of gastrectomy, grade, invasion depth of tumor, lymph node involvement, ratio between metastatic and total number of excised lymph nodes keeping 20% as the cutoff value (LNR) and adjuvant treatment. The association between these variables and recurrence was investigated by using univariate methods and multivariate logistic regression analysis.ResultsMedian (range) age was 63 years (44-85). 63% males, 37% females. Median follow-up time for the whole patients population was 36 months (10-104). Median number of lymph nodes retrieved was 6 (0-14). Recurrence: 50 of 101 cases (49,6%); 41 hematogeneus dissemination, 9 locoregional recurrences. The following factors were found to be correlated with the recurrence risk: tumoral location, invasion depth of tumor, lymph node involvement and LNR. A multivariate analysis revealed that depth of invasion [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.03-7.58, P = 0.04] and LNR (OR 2.34, 95% CI 1.05-5.21, P = 0.03) were independent risk factors for recurrences of gastric cancer. Median time to recurrence: 16 months (2-50). 82% of recurrences occurred within the first two years after surgical treatment. The estimated cumulative risk of recurrence at five years: 61% in the whole patients population, with serosal invasion and LNR > and < 20% was 82% and 44%, without serosal invasion 73% and 39% respectively.ConclusionInvasion depth of tumor and LNR were independent predictors of recurrence in gastric cancer after potentially curative resection with an inadequate number of lymph nodes examined.
Highlights
The TNM classification requires at least 15 lymph nodes to be examined to allow an accurate staging
Aurello et al [2] have indicated that the number of nodes necessary to conclude N0 may vary according to the depth of tumor invasion (T), the TNM classification
Previous studies have indicated that the lymphnode ratio (LNR), which is defined as the ratio of the number of Metastasis of the lymph node (MLN) to the total number of nodes found during pathological examination, is a powerful independent prognostic factor [3,4] with significant superiority in minimizing "stage migration" for patients with more than 15 nodes evaluated, it remains controversial whether this result is applicable to patients with inadequate staging [5]
Summary
The TNM classification (sixth edition) requires at least 15 lymph nodes to be examined to allow an accurate staging. Conclusion: Invasion depth of tumor and LNR were independent predictors of recurrence in gastric cancer after potentially curative resection with an inadequate number of lymph nodes examined. Metastasis of the lymph node (MLN) is one of the most important prognostic factors in gastric cancer [1].
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