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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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aims to elucidate whether increasing the number of examined lymph nodes (NELN) is mandatory for the accurate prognosis of node-negative gastric cancer (GC) patients after curative gastrectomy in Eastern countries (China and Japan).

Methods

The clinicopathological data of 2455 GC patients (including 1137 node-negative cases) were included to demonstrate whether a minimum NELN is inevitable for guaranteeing the accurate prognosis of node-negative GC patients after curative gastrectomy.

Results

Survival analyses revealed that the NELN significantly positively correlated with overall survival (p < 0.001) and was an independent prognostic predictor (hazard ratio 0.447; p = 0.025) of 1137 node-negative GC patients. Stratum analysis within the Kaplan–Meier method showed that sex, tumor size, and extent of lymphadenectomy did not affect the NELN in predicting the prognosis of all node-negative GC patients. Stage migration was mainly detected in the subgroup of node-negative GC Chinese patients who presented considerably lower mean NELN and more advanced staging than patients from Japan. The NELN was identified as the most intensively independent predictor of prognosis of 600 node-negative GC patients from China, with the smallest Akaike information criterion (176.964) and Bayesian information criterion values (194.552). These findings indicate that increasing the NELN is a prerequisite to guaranteeing precise TNM classification.

Conclusions

The NELN should be considered a mandatory requirement for improving the accuracy of prognostic evaluation of GC patients, especially for advanced-stage patients.

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Funding

This study was supported in part by Grants from the Program of the National Natural Science Foundation of China (Number 81572372), the Application Foundation and Advanced Technology Program of Tianjin Municipal Science and Technology Commission (Number 15JCYBJC24800), and the National Key Clinical Specialist Construction Programs of China (Number 2013-544).

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Author notes

    Authors and Affiliations

    1. Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China

      Jingyu Deng & Han Liang

    2. Department of Stomach and Esophageal Surgery, The University of Tokyo Hospital, Tokyo, Japan

      Hiroharu Yamashita & Yasuyuki Seto

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    1. Jingyu Deng
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    2. Hiroharu Yamashita
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    3. Yasuyuki Seto
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    4. Han Liang
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    Correspondence to Yasuyuki Seto or Han Liang.

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    Jingyu Deng and Hiroharu Yamashita contributed equally to this work and should be considered as co-first authors.

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    Deng, J., Yamashita, H., Seto, Y. et al. 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 24, 745–753 (2017). https://doi.org/10.1245/s10434-016-5513-8

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    • DOI: https://doi.org/10.1245/s10434-016-5513-8

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