Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2022; 14(11): 1230-1249
Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1230
Metastatic lymph nodes and prognosis assessed by the number of retrieved lymph nodes in gastric cancer
Hao Wang, Xin Yin, Sheng-Han Lou, Tian-Yi Fang, Bang-Ling Han, Jia-Liang Gao, Yu-Fei Wang, Dao-Xu Zhang, Xi-Bo Wang, Zhan-Fei Lu, Jun-Peng Wu, Jia-Qi Zhang, Yi-Min Wang, Yao Zhang, Ying-Wei Xue
Hao Wang, Xin Yin, Sheng-Han Lou, Tian-Yi Fang, Bang-Ling Han, Jia-Liang Gao, Yu-Fei Wang, Dao-Xu Zhang, Xi-Bo Wang, Zhan-Fei Lu, Jun-Peng Wu, Jia-Qi Zhang, Yi-Min Wang, Yao Zhang, Ying-Wei Xue, Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Author contributions: Wang H and Yin X designed and conceived the project together, and they made the same contribution to the work; Wang H, Yin X, Lou SH, Fang TY, Han BL, and Gao JL interpreted and analyzed the data; Professor Xue YW revised the important key content of the manuscript; Wang H, Yin X, Lou SH, Fang TY, Han BL, Gao JL, Wang YF, Zhang DX, Wang XB, Lu ZF, Wu JP, Zhang JQ, Wang YM, and Zhang Y participated in patient information collection; and the final manuscript was read and approved by all authors.
Supported by the Nn 10 Program of Harbin Medical University Cancer Hospital, No. Nn 10 PY 2017-03.
Institutional review board statement: The study was approved by the Ethics Committee of the Affiliated Tumor Hospital of Harbin Medical University.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Patients’ data were saved in the Gastric Cancer Information Management System v1.2 of Harbin Medical University Cancer Hospital (Copyright No. 2013SR087424, http:www.sgihmu.com).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Wei Xue, PhD, Chief Doctor, Professor, Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Harbin 150081, Heilongjiang Province, China. xueyingwei@hrbmu.edu.cn
Received: July 20, 2022
Peer-review started: July 20, 2022
First decision: September 12, 2022
Revised: September 17, 2022
Accepted: October 19, 2022
Article in press: October 19, 2022
Published online: November 27, 2022
Processing time: 127 Days and 18.8 Hours
Abstract
BACKGROUND

The prognostic value of quantitative assessments of the number of retrieved lymph nodes (RLNs) in gastric cancer (GC) patients needs further study.

AIM

To discuss how to obtain a more accurate count of metastatic lymph nodes (MLNs) based on RLNs in different pT stages and then to evaluate patient prognosis.

METHODS

This study retrospectively analyzed patients who underwent GC radical surgery and D2/D2+ LN dissection at the Cancer Hospital of Harbin Medical University from January 2011 to May 2017. Locally weighted smoothing was used to analyze the relationship between RLNs and the number of MLNs. Restricted cubic splines were used to analyze the relationship between RLNs and hazard ratios (HRs), and X-tile was used to determine the optimal cutoff value for RLNs. Patient survival was analyzed with the Kaplan-Meier method and log-rank test. Finally, HRs and 95% confidence intervals were calculated using Cox proportional hazards models to analyze independent risk factors associated with patient outcomes.

RESULTS

A total of 4968 patients were included in the training cohort, and 11154 patients were included in the validation cohort. The smooth curve showed that the number of MLNs increased with an increasing number of RLNs, and a nonlinear relationship between RLNs and HRs was observed. X-tile analysis showed that the optimal number of RLNs for pT1-pT4 stage GC patients was 26, 31, 39, and 45, respectively. A greater number of RLNs can reduce the risk of death in patients with pT1, pT2, and pT4 stage cancers but may not reduce the risk of death in patients with pT3 stage cancer. Multivariate analysis showed that RLNs were an independent risk factor associated with the prognosis of patients with pT1-pT4 stage cancer (P = 0.044, P = 0.037, P = 0.003, P < 0.001).

CONCLUSION

A greater number of RLNs may not benefit the survival of patients with pT3 stage disease but can benefit the survival of patients with pT1, pT2, and pT4 stage disease. For the pT1, pT2, and pT4 stages, it is recommended to retrieve 26, 31 and 45 LNs, respectively.

Keywords: Gastric cancer; Metastatic lymph nodes; Number of retrieved lymph nodes; Prognosis

Core Tip: The prognostic value of quantitative assessments of the number of retrieved lymph nodes (RLNs) in gastric cancer (GC) patients needs further study. The purpose of this study was to discuss how to obtain a more accurate count of metastatic LNs based on RLNs according to different pT stages and then to evaluate the prognosis of patients. Our results showed that the optimal number of RLNs for pT1-pT4 stage GC patients were 26, 31, 39 and 45, respectively. A greater number of RLNs can reduce the risk of death in patients with pT1, pT2, and pT4 stage cancers but may not pT3 stage.