J Gastric Cancer.  2017 Dec;17(4):319-330. 10.5230/jgc.2017.17.e36.

Extensive Lymph Node Dissection Improves Survival among American Patients with Gastric Adenocarcinoma Treated Surgically: Analysis of the National Cancer Database

• Naffouje S
• Salti GI

• KMID: 2398798
• DOI: http://doi.org/10.5230/jgc.2017.17.e36

Abstract

INTRODUCTION
The extent of lymphadenectomy in the surgical treatment of gastric cancer is a topic of controversy among surgeons. This study was conducted to analyze the American National Cancer Database (NCDB) and conclude the optimal extent of lymphadenectomy for gastric adenocarcinoma.
METHODS
The NCDB for gastric cancer was utilized. Patients who received at least a partial gastrectomy were included. Patients with metastatic disease, unknown TNM stages, R1/R2 resection, or treated with a palliative intent were excluded. Joinpoint regression was used to identify the extent of lymphadenectomy that reflects the optimal survival. Cox regression analysis and Bayesian information criterion were used to identify significant survival predictors. Kaplan-Meier was applied to study overall survival and stage migration.
RESULTS
40,281 patients of 168,377 met the inclusion criteria. Joinpoint analysis showed that dissection of 29 nodes provides the optimal median survival for the overall population. Regression analysis reported the cutoff ≥29 to have a better fit in the prognostic model than that of ≥15. Dissection of ≥29 nodes in the higher stages provides a comparable overall survival to the immediately lower stage. Nonetheless, the retrieval of ≥15 nodes proved to be adequate for staging without a significant stage migration compared to ≥29 nodes.
CONCLUSION
The extent of lymphadenectomy in gastric adenocarcinoma is a marker of improved resection which reflects in a longer overall survival. Our analysis concludes that the dissection of ≥15 nodes is adequate for staging. However, the dissection of 29 nodes might be needed to provide a significantly improved survival.

Keyword

Gastric cancer; Lymphadenectomy; Survival; Cancer staging

MeSH Terms

Adenocarcinoma*
Gastrectomy
Humans
Lymph Node Excision*
Lymph Nodes*
Neoplasm Staging
Stomach Neoplasms
Surgeons

Figure

• 

  Fig. 1 Kaplan-Meier for OS according to the AJCC stage. (A) Stage I (median, 79.64±1.66 months); stage II (median, 50.01±0.98 months); and stage III (median, 22.57±0.37 months). (B) Stage IA (median, 89.07±2.80 months); stage IB (median, 72.74±2.02 months); stage IIA (median, 63.47±1.59 months); stage IIB (median, 37.32±0.89 months); stage IIIA (24.25±0.54 months); stage IIIB (median, 20.73±0.58 months); and stage IIIC (median, 17.81±1.06 months). OS = overall survival; AJCC = American Joint Committee on Cancer.

• 

  Fig. 2 Joinpoint analysis to determine the optimal node resection for median survival. (A) Overall: Joinpoint determined at 29 nodes. (B) Stage I: Joinpoint determined at 16 nodes. (C) Stage II: Joinpoint determined at 28 nodes. (D) Stage III: Joinpoint determined at 29 nodes.

• 

  Fig. 3 Kaplan-Meier curves demonstrating the survival benefit for each TNM stage based on the cutoff of retrieved nodes. TNM = tumor, node, and metastasis.

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