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Anatomic extent of metastatic lymph nodes: Still important for gastric cancer prognosis

 Taeil Son  ;  Woo Jin Hyung  ;  Jong Won Kim  ;  Hyoung-Il Kim  ;  Ji Yeong An  ;  Jae-Ho Cheong  ;  Seung Ho Choi  ;  Sung Hoon Noh 
 Annals of Surgical Oncology, Vol.21(3) : 899-907, 2014 
Journal Title
 Annals of Surgical Oncology 
Issue Date
BACKGROUND: Currently, gastric cancer staging systems do not consider the anatomic extent of metastatic lymph nodes (mLNs) as a prognostic factor. We therefore investigated the prognostic impact of the anatomic extent of mLNs on gastric cancer. METHODS: The prognoses of 4,043 gastric cancer patients who underwent curative resection were analyzed. Patients with mLNs in lymph node (LN) stations 1-6 (n = 1,980) comprised the perigastric LN-positive (PLN) group, and patients with mLNs in LN stations 7-12 and 14 (n = 2,063) were assigned to the extraperigastric LN-positive (ELN) group. Overall survival was estimated using the Kaplan-Meier method, and hazard ratios (HRs) were calculated by the Cox proportional hazard model. RESULTS: The ELN group exhibited worse survival than the PLN group (p < 0.001), although there were differences in their clinicopathological features. When patients were stratified according to tumor-node-metastasis stage, the ELN groups had unfavorable prognoses compared with the PLN groups (p < 0.05). There were significant differences in long-term survival when the nodal stage of the current staging systems were subdivided according to anatomic nodal extent (p < 0.05), although there was a strong association between the probability of having extraperigastric mLNs and N classification. In multivariate analysis using age, gender, tumor size, tumor location, histology, T classification, and the extent of mLNs as covariates, presence of extraperigastric mLNs was an independent prognostic factor (HR 1.89, 95 % CI 1.73-2.07), along with age, tumor size, tumor location, and T classification. CONCLUSIONS: The anatomic extent of mLNs significantly affects patient prognosis. Including the anatomic extent of mLNs in the current staging system may predict gastric cancer prognosis more accurately in patients with the same stage of cancer.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
김종원(Kim, Jong Won)
김형일(Kim, Hyoung Il) ORCID logo https://orcid.org/0000-0002-6134-4523
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
손태일(Son, Tae Il) ORCID logo https://orcid.org/0000-0002-0327-5224
정재호(Cheong, Jae Ho) ORCID logo https://orcid.org/0000-0002-1703-1781
최승호(Choi, Seung Ho) ORCID logo https://orcid.org/0000-0002-9872-3594
형우진(Hyung, Woo Jin) ORCID logo https://orcid.org/0000-0002-8593-9214
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