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Impact of Lymph Nodes Examined on Survival in ypN0 Gastric Cancer Patients: a Population-Based Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Our aim was to evaluate the prognostic value of the number of lymph nodes examined (eLNs) on survival in ypN0 gastric cancer (GC) patients, and further to define the optimal number of lymph nodes needed to be examined during radical gastrectomy of ypN0 GC patients.

Methods

A total of 1127 ypN0 GC patients during 2004–2015 from the Surveillance, Epidemiology, and End Results (SEER) database were included. The number of eLNs cutoff points that determined the greatest actuarial survival difference was calculated by the X-tile program. Univariate and multivariate analyses were performed to assess the impact of eLNs on overall survival (OS).

Results

The optimal number of eLNs thresholds was determined to be 15 for ypN0 GC patients. Kaplan-Meier analysis revealed that ypN0 GC patients with ≥ 16 eLNs had a significantly better OS than those with ≤ 15 eLNs (5-year OS; 60.8 vs 45.4%, P < 0.001). Similarly, multivariate Cox analysis revealed that ypN0 GC patients with ≥ 16 eLNs experienced a significantly lower hazard of death than those with ≤ 15 eLNs (adjusted HR; 0.73, 95% CI, 0.60–0.90, P = 0.003).

Conclusions

The number of eLNs was an independent predictor of survival for ypN0 GC patients. A minimum of 15 eLNs is recommended as the cutoff point for the evaluation of the quality of postoperative or prognostic stratification in ypN0 GC patients.

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Acknowledgments

We would like to thank the SEER database for the collection of clinical data.

Funding

This project is supported by Hainan Provincial Natural Science Foundation of China (819QN375) and Hainan Provincial Key R&D Program (ZDYF2018101).

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Author notes

  1. Zhu MingHua and Zhang KeCheng contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China

    Zhu MingHua, Zhang KeCheng, Chang ZhenYu, Chen Lin, Wang ChunXi & Yang ZeLong

  2. Department of General Surgery, Hainan Branch of Chinese People’s Liberation Army General Hospital, Sanya, China

    Wang ChunXi & Yang ZeLong

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  1. Zhu MingHua
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  2. Zhang KeCheng
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  3. Chang ZhenYu
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  4. Chen Lin
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Contributions

Study conception and design: M.H.Z., Z.L.Y., C.X.W., and Z.K.C.; acquisition of data: M.H.Z., Z.L.Y.; analysis and interpretation of data: all authors; drafting of manuscript: all authors; critical revision: all authors.

Corresponding authors

Correspondence to Wang ChunXi or Yang ZeLong.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All patients in this study were collected from the SEER database, and we have got permission of using the data.

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Supplemental Fig. 1

Flowchart of ypN0 gastric cancer patients included process. ICD-O-3: M-8140/3, M-8142/3 to M-8145/3, M-8210/3, M-8211/3, M-8255/3, M-8260/3 to M-8263/3, M-8310/3, M-8323/3, M-8480/3, M-8481/3, M-8490/3. eLNs lymph nodes examined (PNG 114 kb)

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MingHua, Z., KeCheng, Z., ZhenYu, C. et al. Impact of Lymph Nodes Examined on Survival in ypN0 Gastric Cancer Patients: a Population-Based Study. J Gastrointest Surg 25, 919–925 (2021). https://doi.org/10.1007/s11605-020-04579-6

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  • DOI: https://doi.org/10.1007/s11605-020-04579-6

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