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Prognostic impact of anatomical extent of metastatic lymph node on gastric cancer: a propensity score matching study

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Abstract

Purpose

Current gastric cancer staging systems overlook the anatomic extent of metastatic lymph nodes (AEMLNs). This study aimed to analyze the prognostic impact of AEMLNs on gastric cancer (GC).

Methods

GC patients with metastatic lymph nodes (MLNs) undergoing curative surgery were retrospectively reviewed and assigned to perigastric (MLNs in station 1–6, PG) and extraperigastric group (7-12, with or without MLNs in PG area, EPG). Overall survival (OS), disease-free survival (DFS) and recurrence patterns were compared before and after 1:1 propensity score matching (PSM).

Results

662 patients were enrolled, 341 (51.5%) and 321 (48.5%) of whom were in the PG and EPG, respectively. After PSM (n = 195), EPG showed poorer 5-year OS (43.4% vs 54.5%, p = 0.014) and DFS (65.0% vs 73.4%, p = 0.068) than PG. EPG had higher incidence of peritoneal recurrence (PR) than PG (19.4% vs 7.4%, p = 0.002). Multivariate analysis identified AEMLNs as prognostic factor for OS [HR = 1.409, 95% confidence interval (CI) 1.062–1.868), DFS (HR = 1.600, 95% CI 1.059–2.416) and PR (HR = 3.708, 95% CI 1.685–8.160).

Conclusions

The anatomic extent of metastatic lymph nodes has an independent prognostic role for GC. Including this element may improve the accuracy of current staging systems.

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by grants from the National Natural Science Foundation of China (No. 81772579) and Sanming Project of Medicine in Shenzhen (No. SZSM201911010).

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Author notes

  1. L.J. Cheng, W.J. Zhou and T.L. An contributed equally as co-first authors.

Authors and Affiliations

  1. Digestive Disease Center, Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Road, Shenzhen, 518107, China

    L. J. Cheng, W. J. Zhou, T. L. An, C. Yuan, X. Xiao, T. F. Hao, S. C. Yin, C. H. Zhang & Y. L. He

  2. Gastrointestinal Surgery Center, First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China

    L. J. Cheng, W. J. Zhou, Z. W. Wei, T. F. Hao & Y. L. He

Authors
  1. L. J. Cheng
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  2. W. J. Zhou
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  3. T. L. An
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  4. Z. W. Wei
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  5. C. Yuan
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Contributions

YLH, CHZ, LJC, WJZ and TLA were responsible for the study concept and design. LJC, WJZ, TLA, ZWW, CY, XX, TFH and SCY contributed to the acquisition of data. LJC, WJZ and TLA analyzed the data and wrote the initial draft. YLH and CHZ critically reviewed the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Y. L. He.

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The authors declare that they have no conflict of interest.

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Ethical committees of the First Affiliated Hospital of Sun Yat-sen University and the Seventh Affiliated Hospital of Sun Yat-sen University approved this study.

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Written consent was obtained from all individual participants included in the study.

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Cheng, L.J., Zhou, W.J., An, T.L. et al. Prognostic impact of anatomical extent of metastatic lymph node on gastric cancer: a propensity score matching study. Clin Transl Oncol 23, 773–782 (2021). https://doi.org/10.1007/s12094-020-02468-7

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  • DOI: https://doi.org/10.1007/s12094-020-02468-7

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