Does Noncompliance in Lymph Node Dissection Affect Oncological Efficacy in Gastric Cancer Patients Undergoing Radical Gastrectomy?
Few reports have examined the prognosis of or possible remedial treatments for patients with noncompliant D2 lymphadenectomy. We investigated the effect of noncompliance in lymph node (LN) dissection on long-term survival in gastric cancer (GC) patients after radical gastrectomy and explored intervention measures.
Clinicopathological data were retrospectively analyzed in 2401 patients who underwent radical gastrectomy for GC. Noncompliance was defined as patients with more than one empty LN station, as described in the protocol of the Japanese GC Association.
The overall noncompliance rate was 49.1%. The 3-year overall survival (OS) rate was significantly better in compliant than noncompliant patients (74.0% vs. 60.1%, P < 0.001). Univariate and multivariate analyses revealed that noncompliance was an independent risk factor for OS. Logistic regression analysis demonstrated that extent of gastrectomy, primary tumor site, history of intraperitoneal surgery, body mass index, and open gastrectomy were independent preoperative predictive factors for noncompliance. Cox analysis demonstrated that age, pT, pN, and extent of gastrectomy independently affected OS in patients with noncompliant lymphadenectomy. However, OS was significantly better in the compliant than noncompliant group regardless of the recommendation for chemotherapy. Stratified analysis demonstrated that OS was significantly better in chemotherapy patients than in patients without chemotherapy and stage II patients (pT1N2/N3M0 and pT3N0M0) in whom chemotherapy was not recommended.
Noncompliance is an independent risk factor after radical gastrectomy for GC. Adjuvant chemotherapy improved the prognosis of patients with pT1N2/N3M0 and pT3N0M0 disease who underwent noncompliant D2 lymphadenectomy.
Sponsored by Scientific and Technological Innovation Joint Capital Projects of Fujian Province (2016Y9031), Construction Project of Fujian Province Minimally Invasive Medical Center (No. 171), the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013), general project of Miaopu Scientific Research Fund of Fujian Medical University (2015MP021), Youth Project of Fujian Provincial Health and Family Planning Commission (2016-1-41), and Nature Fund Health Joint Fund Project of Fujian Province (2015J01464).
QYC, QZ, ZYL and JWX conceived of the study, analyzed the data, and drafted the manuscript; WBW, JXL, PL, CHZ, CMH, JL, LLC and ML helped revise the manuscript critically for important intellectual content; RHT, ZNH and JLL helped collect data and design the study. All authors read and approved the final manuscript.
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