Yinping Dong1, Yiran Qiu2, Jingyu Deng3, Wei Wang4, Zhe Sun5, Zhenning Wang5, Zhiwei Zhou6, Huimian Xu7, Han Liang8. 1. Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China. 2. Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. 3. Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China. dengery@126.com. 4. Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. 5. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China. 6. Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. zhouzhw@sysucc.org.cn. 7. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China. xuhuimian@126.com. 8. Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China. tjlianghan@126.com.
Abstract
PURPOSE: The present study aims to validate possible stage migration of lymph node metastasis related to the insufficient examined lymph node (ELN) count in pN3a gastric cancer (GC) patients. METHODS: 1976 pN3 patients who underwent the R0 surgery in three high-capacity institutions in China were enrolled to explore the stage migration of nodal involvement, and 3146 pN3 cases from the Surveillance, Epidemiology, and End Results (SEER) Program Registry were used as an external validation cohort. RESULTS: After the propensity score matching of the Chinese cohort, the ELN count, as an independent predictor for GC outcome, was confirmed to be associated with the stage migration of lymph node metastasis in pN3a patients based on the univariate and multivariate survival analyses. Logistic regress was adopted to elucidate that the ELN count was an independent factor related to the long-term survival status of GC patients after curative surgery. Likelihood ratio test showed that the ELN count had the smallest Bayesian information criterion value among the clinicopathologic variables, corresponding to an efficient model to predict outcomes. Subsequently, stage migration of lymph node metastasis was predominantly detected in pN3a patient sub-group with insufficient (less than 16) ELN count, who presented with similar prognosis as the pN3b patients (P = 0.463) as per the stratum analysis with Kaplan-Meier. These methods were further validated using data from the SEER cohort, and the similar promising results were obtained. CONCLUSION: pN3a patients with insufficient ELN count should be considered as pN3b cases to achieve accurate prognostic evaluation after curative gastrectomy.
PURPOSE: The present study aims to validate possible stage migration of lymph node metastasis related to the insufficient examined lymph node (ELN) count in pN3a gastric cancer (GC) patients. METHODS: 1976 pN3 patients who underwent the R0 surgery in three high-capacity institutions in China were enrolled to explore the stage migration of nodal involvement, and 3146 pN3 cases from the Surveillance, Epidemiology, and End Results (SEER) Program Registry were used as an external validation cohort. RESULTS: After the propensity score matching of the Chinese cohort, the ELN count, as an independent predictor for GC outcome, was confirmed to be associated with the stage migration of lymph node metastasis in pN3a patients based on the univariate and multivariate survival analyses. Logistic regress was adopted to elucidate that the ELN count was an independent factor related to the long-term survival status of GCpatients after curative surgery. Likelihood ratio test showed that the ELN count had the smallest Bayesian information criterion value among the clinicopathologic variables, corresponding to an efficient model to predict outcomes. Subsequently, stage migration of lymph node metastasis was predominantly detected in pN3a patient sub-group with insufficient (less than 16) ELN count, who presented with similar prognosis as the pN3b patients (P = 0.463) as per the stratum analysis with Kaplan-Meier. These methods were further validated using data from the SEER cohort, and the similar promising results were obtained. CONCLUSION: pN3a patients with insufficient ELN count should be considered as pN3b cases to achieve accurate prognostic evaluation after curative gastrectomy.
Authors: Takeshi Sano; Daniel G Coit; Hyung Ho Kim; Franco Roviello; Paulo Kassab; Christian Wittekind; Yuko Yamamoto; Yasuo Ohashi Journal: Gastric Cancer Date: 2016-02-20 Impact factor: 7.370