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Reciprocity between lymphadenectomy quality and adjuvant chemotherapy compliance in gastric cancer: post hoc analysis of two randomized controlled trials

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Abstract

Objective

To investigate the effect of intraoperative lymph node (LN) dissection and postoperative adjuvant chemotherapy on the overall survival (OS) of gastric cancer (GC) patients and their reciprocity.

Methods

LN noncompliance was defined as the absence of more than one LN station, as described in the protocol for D2 lymphadenectomy in the Japanese Gastric Cancer Association. The definition of adjuvant chemotherapy (AC) noncompliance was that the chemotherapy planned dose does not meet the requirements.

Results

Kaplan–Meier survival curves showed that the OS of patients with major LN noncompliance was significantly lower than that of patients with nonmajor LN noncompliance, and the OS of AC noncompliance patients was significantly lower than that of AC compliance patients. If there was nonmajor LN noncompliance during surgery, the OS of patients with AC compliance was significantly higher than that of patients with AC noncompliance (P = 0.035). In the case of major LN noncompliance during surgery, there was no statistically significant difference in OS between those with AC compliance and those with AC noncompliance (P = 0.682). Multivariate Cox regression analysis including AC noncompliance indicated that major LN noncompliance was an independent prognostic factor for poor OS (P = 0.012), while AC noncompliance was not an independent prognostic factor for OS (P = 0.609).

Conclusion

Adequate lymph node dissection and adjuvant chemotherapy are both key steps to improve the awful prognosis of GC patients. Adjuvant chemotherapy may fail to remedy the poor prognosis caused by major LN noncompliance.

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Funding

Scientific and technological innovation joint capital projects of Fujian Province (2017Y9011, 2017Y9004, 2019Y9098); The general project of sailing fund of Fujian Medical University (2019QH1052).

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Author notes

  1. Guang-Tan Lin and Jun-Yu Chen contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Guang-Tan Lin, Jun-Yu Chen, Qi-Yue Chen, Qing Zhong, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-long Cao & Chang-Ming Huang

  2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China

    Guang-Tan Lin, Jun-Yu Chen, Qi-Yue Chen, Qing Zhong, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-long Cao & Chang-Ming Huang

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  1. Guang-Tan Lin
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Correspondence to Chang-Ming Huang.

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Disclosures

All authors such as Guang-Tan Lin, Jun-Yu Chen, Qi-Yue Chen, Qing Zhong, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-long Cao, and Chang-Ming Huang have no conflict of interest and no potential benefits.

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The institutional review boards of all the participating institutions approved the study.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Fig. 1 Distribution of total ExLNs in gastrectomy with D2 LN dissection (TIF 736 kb)

464_2022_9300_MOESM2_ESM.tif

Supplementary Fig. 2 Comparison of OS between A.compliance group, minor compliance and major compliance group; B.major compliance or no major compliance group (TIF 5271 kb)

464_2022_9300_MOESM3_ESM.tif

Supplementary Fig. 3 Comparison of OS between AC compliance and AC noncompliance group in A. LN major compliance (-) or B. LN major compliance (+) (TIF 4605 kb)

464_2022_9300_MOESM4_ESM.tif

Supplementary Fig. 4 Comparison of DFS between LN major compliance and nonmajor noncompliance group(A); between AC compliance and noncompliance group in all patients(B),LN major compliance (-)(C) or LN major compliance (+)(D) (TIF 4021 kb)

Supplementary file5 (DOCX 15 kb)

Supplementary file6 (DOCX 20 kb)

Supplementary file7 (DOCX 24 kb)

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Lin, GT., Chen, JY., Chen, QY. et al. Reciprocity between lymphadenectomy quality and adjuvant chemotherapy compliance in gastric cancer: post hoc analysis of two randomized controlled trials. Surg Endosc 36, 8774–8783 (2022). https://doi.org/10.1007/s00464-022-09300-z

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