Qi-Yue Chen1,2,3,4, Qing Zhong1,2,3,4, Zhi-Yu Liu1,2,3,4, Jian-Wei Xie1,2,3,4, Jia-Bin Wang1,2,3,4, Jian-Xian Lin1,2,3,4, Jun Lu1,2,3,4, Long-Long Cao1,2,3,4, Mi Lin1,2,3,4, Ru-Hong Tu1,2,3,4, Ze-Ning Huang1,2,3,4, Ju-Li Lin1,2,3,4, Ping Li5,6,7,8, Chao-Hui Zheng9,10,11,12, Chang-Ming Huang13,14,15,16. 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. 2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. 3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. 4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. 5. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. pingli811002@163.com. 6. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. pingli811002@163.com. 7. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. pingli811002@163.com. 8. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. pingli811002@163.com. 9. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. wwkzch@163.com. 10. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. wwkzch@163.com. 11. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. wwkzch@163.com. 12. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. wwkzch@163.com. 13. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. hcmlr2002@163.com. 14. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. hcmlr2002@163.com. 15. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. hcmlr2002@163.com. 16. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. hcmlr2002@163.com.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.