Abstract
Background: The number of retrieved lymph nodes (RLNs) affects the likelihood of detecting metastatic lymph nodes (MLNs) for gastric cancer (GC), but the retrieval of LNs is not satisfactory worldwide. There is no standard for LN examination.Methods: We retrospectively analyzed 2,163 patients diagnosed with GC who underwent surgery at Nanfang Hospital between October 2004 and September 2016. According to the methods of LN examination, patients were classified into two groups: LN detection by pathologists (pathologist group) and LN examination by surgicopathologic team (surgicopathologist group). The relationship between RLNs and LN staging accuracy as well as the factors influencing the detection of MLNs were evaluated.Results: There were 472 males in pathologist group and 467 males in surgicopathologist group. The number of RLNs and MLNs in surgicopathologist group was significantly higher than that in pathologist group (RLNs: 53.8 ± 20.9 vs. 18.8 ± 11.5, p < 0.001; MLNs: 5.6 ± 9.8 vs. 3.9 ± 5.7, p < 0.001). Notably, the detection of N3b node status was significantly improved in surgicopathologist group [83 (11.9%) vs. 34 (4.8%), p < 0.001]. Additionally, the detection rate of N3b status gradually increased from 0 in patients with 1-16 RLNs to 16.6% in patients with more than 49 RLNs. The MLNs detected increased gradually from 2.3 ± 3.0 in patients with 1-16 RLNs to 7.3 ± 11.7 in patients with more than 49 RLNs. Univariate and multivariate analyses indicated that LN examination by surgicopathologic team, more advanced pT, tumor size ≥5 cm and combined organ(s) resection were related to detecting more MLNs.Conclusions: The retrieval of nodes immediately postoperatively by the surgicopathologic team could significantly improve the number of RLNs, detect more MLNs, and screen more patients with N3b node status.
Highlights
Many studies have suggested that overall survival (OS) is associated with the number of retrieved lymph nodes (RLNs) [1,2,3]
The results of the retrieval of LNs in the Dutch Gastric Cancer Trial suggest that LN retrieval rather than the extent of surgical LN dissection was mainly responsible for the number of RLNs [9]. These findings suggest that the improper approach of LN examination could result in the insufficiency of RLNs and the underestimation of LN metastasis status, which could have an undesirable impact on prognostic evaluation and the strategy formulation of adjuvant therapy
Patients in the pathologist group were more inclined to undergo open surgery [345(48.7%) vs. 83(11.9%), p < 0.001]
Summary
Many studies have suggested that overall survival (OS) is associated with the number of retrieved lymph nodes (RLNs) [1,2,3]. Hayashi et al showed that the number of RLNs < 40 could be attributed to an inferior survival for stage III gastric cancer (GC) patients who underwent total gastrectomy [2] Another large international dataset analysis, including the SEER database (n = 13,932) and the Yonsei University Gastric Cancer database (n = 11,358), proposed that a greater number of RLNs (a minimum of 29) improves staging and OS in GC patients undergoing radical resection [3]. All of these quality studies proposed a higher number of RLNs than that recommended by the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system for GC (at least 16).
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