TY - JOUR
T1 - Benchmarks for nodal yield and ratio for node-positive gastric cancer
AU - Erstad, Derek J.
AU - Blum, Mariela
AU - Estrella, Jeannelyn S.
AU - Das, Prajnan
AU - Minsky, Bruce D.
AU - Ajani, Jaffer A.
AU - Mansfield, Paul F.
AU - Ikoma, Naruhiko
AU - Badgwell, Brian D.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/10
Y1 - 2021/10
N2 - Background: We aimed to elucidate prognostic markers of node-positive gastric cancers with a focus on examined lymph nodes and lymph node ratio. Methods: Patients treated with curative-intent gastrectomy at The University of Texas MD Anderson Cancer Center from 1995–2019 were evaluated. Patients with non-metastatic, node-positive gastric cancers were considered for analysis. Results: Of 775 patients, 281 met the inclusion criteria. The mean age was 58 years, 61% were male, 51% were White, 65% received preoperative therapy, and 71% of tumors were located in the gastric body. The median overall survival was 3.6 years, and 1-, 5-, and 10-year overall survival rates were 91%, 41%, and 29%, respectively. pN3 category was associated with worse overall survival (hazard ratio 1.79, P = .001) and recurrence-free survival (hazard ratio 1.92, P = .004). Nodal burden was associated with aggressive biologic traits in primary tumors, including higher rates of lymphovascular and perineural invasion and lower preoperative therapy response rates. By receiver-operative characteristic analysis, threshold values of ≥30 examined lymph nodes and <30% lymph node ratio were most discriminant for overall survival. On adjusted analysis, positive margins, additional organ resection, <30 examined lymph nodes, and ≥30% lymph node ratio were associated with worse recurrence-free survival and overall survival. Among patients with high node burden (pN3), <30 examined lymph nodes remained significant on adjusted survival analysis. Conclusion: Greater than or equal to 30 examined lymph nodes and <30% lymph node ratio were significantly associated with longer recurrence-free survival and overall survival, independent of lymphadenectomy type. These prognostic benchmarks should be considered in the surgical management of gastric cancer in the United States.
AB - Background: We aimed to elucidate prognostic markers of node-positive gastric cancers with a focus on examined lymph nodes and lymph node ratio. Methods: Patients treated with curative-intent gastrectomy at The University of Texas MD Anderson Cancer Center from 1995–2019 were evaluated. Patients with non-metastatic, node-positive gastric cancers were considered for analysis. Results: Of 775 patients, 281 met the inclusion criteria. The mean age was 58 years, 61% were male, 51% were White, 65% received preoperative therapy, and 71% of tumors were located in the gastric body. The median overall survival was 3.6 years, and 1-, 5-, and 10-year overall survival rates were 91%, 41%, and 29%, respectively. pN3 category was associated with worse overall survival (hazard ratio 1.79, P = .001) and recurrence-free survival (hazard ratio 1.92, P = .004). Nodal burden was associated with aggressive biologic traits in primary tumors, including higher rates of lymphovascular and perineural invasion and lower preoperative therapy response rates. By receiver-operative characteristic analysis, threshold values of ≥30 examined lymph nodes and <30% lymph node ratio were most discriminant for overall survival. On adjusted analysis, positive margins, additional organ resection, <30 examined lymph nodes, and ≥30% lymph node ratio were associated with worse recurrence-free survival and overall survival. Among patients with high node burden (pN3), <30 examined lymph nodes remained significant on adjusted survival analysis. Conclusion: Greater than or equal to 30 examined lymph nodes and <30% lymph node ratio were significantly associated with longer recurrence-free survival and overall survival, independent of lymphadenectomy type. These prognostic benchmarks should be considered in the surgical management of gastric cancer in the United States.
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U2 - 10.1016/j.surg.2021.04.026
DO - 10.1016/j.surg.2021.04.026
M3 - Article
C2 - 34059344
AN - SCOPUS:85107060278
SN - 0039-6060
VL - 170
SP - 1231
EP - 1239
JO - Surgery (United States)
JF - Surgery (United States)
IS - 4
ER -