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Abstract
Negative lymph node (NLN) count has been validated as a protective predictor in various cancers after radical resection. However, the prognostic value of NLN count in the setting of stage IV gastric cancer patients who have received palliative resection has not been investigated. Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer patients were used for analysis in this study. Kaplan-Meier survival curves and multivariate Cox proportional hazards model were used to assess the risk factors for patients’ survivals. The results showed that NLN count and N stage were independently prognostic factors in patients with stage IV gastric cancer after palliative surgery (P< 0.001). X-tile plots identified 2 and 11 as the optimal cutoff values to divide the patients into high, middle and low risk subsets in term of cause-specific survival (CSS). And NLN count was proved to be an independently prognostic factor in multivariate Cox analysis (P< 0.001). The risk score of NLN counts demonstrated that the plot of hazard ratios (HRs) for NLN counts sharply increased when the number of NLN counts decreased. Collectively, our present study revealed that NLN count was an independent prognostic predictor in stage IV gastric cancer after palliative resection. Standard lymph node dissection, such as D2 lymphadectomy maybe still necessary during palliative resection for patients with metastatic gastric cancer.
Highlights
Gastric cancer is one of the most common and deadliest malignancies globally, especially in eastern Asian [1, 2]
To the best of our knowledge, this is the first study to systematically evaluate the clinical significance of Negative lymph node (NLN) counts in metastatic gastric cancer patients based on public available database
The results showed that increased NLNs count was an independently prognostic factor in stage IV gastric cancer after palliative resection
Summary
Gastric cancer is one of the most common and deadliest malignancies globally, especially in eastern Asian [1, 2]. For patients with resectable gastric cancer, surgical resection is the only potentially curative therapeutic modality, and the lymph node (LN) status turns to be the strongest prognostic indicator for survival after gastrectomy [3, 4]. The prognosis of gastric cancer patients with distant metastases is poor, and the 5-year overall survival (OS) rate rarely exceeds 5% if received palliative chemotherapy only [12]. The correlation between NLN count and prognosis in patients with stage IV gastric cancer is not clear. The aim of this retrospective study was to explore the effect of NLN counts on the survival outcomes in patients with stage IV gastric cancer after palliative resection
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