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Timing to Surgery and Lymph Node Upstaging in Gastric Cancer: An NCDB Analysis

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

Abstract

Background

Prior studies have shown tumor specificity on the impact of longer time interval from diagnosis to surgery, however in gastric cancer (GC) this remains unclear. We aimed to determine if a longer time interval from diagnosis to surgery had an impact on lymph node (LN) upstaging and overall survival (OS) outcomes among patients with clinically node negative (cN0) GC.

Patients and Methods

Patients diagnosed with cN0 GC undergoing surgery between 2004–2018 were identified in the National Cancer Database (NCDB) and divided into intervals between time of diagnosis and surgery [short interval (SI): ≥ 4 days to < 8 weeks and long interval (LI): ≥ 8 weeks]. Multivariable regression analysis evaluated the independent impact of surgical timing on LN upstaging and a Cox proportional hazards analysis and Kaplan–Meier curves evaluated survival outcomes.

Results

Of 1824 patients with cN0 GC, 71.8% had a SI to surgery and 28.1% had a LI to surgery. LN upstaging was seen more often in the SI group when compared to LI group (82% versus 76%, p = 0.004). LI to surgery showed to be an independent factor protective against LN upstaging [adjusted odds ratio = 0.62, 95% CI: (0.39–0.99)]. Multivariate Cox regression analysis indicated that time to surgery was not associated with a difference in overall survival [hazard ratio (HR) = 0.91, 95% CI: (0.71–1.17)], however uncontrolled Kaplan–Meier curves showed OS difference between the SI and LI to surgery groups (p = 0.037).

Conclusion

Timing to surgery was not a predictor of LN upstaging or overall survival, suggesting that additional medical optimization in preparation for surgery and careful preoperative staging may be appropriate in patients with node negative early stage GC without affecting outcomes.

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Data availability

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Acknowledgement

The Department of Surgery at Weill Cornell Medical College provided internal funding in support of this work. Colby Lewis V, Anjile An, and Paul Christos are partially supported by the following grant: Clinical and Translational Science Center at Weill Cornell Medical College (1-UL1-TR002384-01).

Funding

Clinical and Translational Science Center at Weill Cornell Medical College (1-UL1-TR002384-01).

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Authors and Affiliations

  1. Department of Surgery, Weill Cornell Medicine, New York, NY, USA

    Maria Cristina Riascos MD, Jacques A. Greenberg MD, Federico Palacardo BS, Haythem Najah MD, Hala Al Asadi MD, Parima Safe MD, Brendan M. Finnerty MD, Thomas J. Fahey III MD & Rasa Zarnegar MD, FACS

  2. Hospital Israelita Albert Einstein, São Paulo, Brazil

    Rodrigo Edelmuth MD & Paul J. Christos PhD

  3. Department of Population and Health Sciences, Weill Cornell Medicine, New York, NY, USA

    V. Colby Lewis BA & Anjile An BA

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  1. Maria Cristina Riascos MD
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  2. Jacques A. Greenberg MD
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Correspondence to Rasa Zarnegar MD, FACS.

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Riascos, M.C., Greenberg, J.A., Palacardo, F. et al. Timing to Surgery and Lymph Node Upstaging in Gastric Cancer: An NCDB Analysis. Ann Surg Oncol 31, 1714–1724 (2024). https://doi.org/10.1245/s10434-023-14536-7

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