Abstract
The ratio of positive lymph nodes (LNs) to the total LN harvest is called the LN ratio (LNR). It is an independent prognostic factor in gastric cancer (GC). The aim of the current study was to evaluate the impact of neoadjuvant chemotherapy (NAC) on the LNR (ypLNR) in patients with advanced GC. We retrospectively analyzed the data of patients with advanced GC, who underwent gastrectomy with N1 and N2 (D2) lymphadenectomy between August 2011 and January 2019 in the Department of Surgical Oncology at the Medical University of Lublin. The exclusion criteria were a lack of preoperative NAC administration, suboptimal lymphadenectomy (<D2 and/or removal of less than 15 lymph nodes), and a lack of data on tumor regression grading (TRG) in the final pathological report. A total of 95 patients were eligible for the analysis. A positive correlation was found between the ypLNR and tumor diameter (p < 0.001), post treatment pathological Tumour (ypT) stage (p < 0.001), Laurén histological subtype (p = 0.0001), and the response to NAC (p < 0.0001). A multivariate analysis demonstrated that the ypLNR was an independent prognostic factor in patients with intestinal type GC (p = 0.0465) and in patients with no response to NAC (p = 0.0483). In the resection specimen, tumor diameter and depth of infiltration, Laurén histological subtype, and TRG may reflect the impact of NAC on LN status, as quantified by ypLNR in advanced GC.
Highlights
In 2018, gastric cancer (GC) was diagnosed in 1,000,000 patients
Since neoadjuvant chemotherapy (NAC) may significantly impact the lymph node status [17], whereas inadequate lymphadenectomy causes suboptimal pathological nodal staging [18], the ypLNR was not calculated in excluded patients
There were 44 patients (46.4%) who did not have tumor regression (TRG 4), 32 patients (33.7%) who presented with partial regression (TRG 3), 9 patients (9.4%) who presented with subtotal regression (TRG 2), and 10 patients (10.5%) who had complete response to NAC (TRG 1)
Summary
In 2018, gastric cancer (GC) was diagnosed in 1,000,000 patients. The cause of an estimated783,000 deaths, it was the fifth-most frequently diagnosed cancer and the third leading cause of cancer deaths worldwide [1]. In 2018, gastric cancer (GC) was diagnosed in 1,000,000 patients. 783,000 deaths, it was the fifth-most frequently diagnosed cancer and the third leading cause of cancer deaths worldwide [1]. Radical surgery involves gastrectomy and adequate regional lymph node dissection [2,3,4]. The latter has been suggested as the most important surgery-dependent prognostic factor in GC [5]. According to the fourth version of the Japanese Gastric Cancer Association guidelines, D1 lymphadenectomy is defined as lymph node (LN) removal from the perigastric area (stations 1–7, N1 tier), whereas N1 and N2
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