Refining gastric cancer staging: examining the interplay between number and anatomical location of metastatic lymph nodes - a retrospective multi-institutional study

• Published in: BMC cancer Vol. 23; no. 1; p. 1192
• Main Authors: Jeon, Chul-Hyo, Park, Ki Bum, Lee, Hayemin, Kim, Dong Jin, Seo, Ho Seok, Lee, Junhyun, Jun, Kyung Hwa, Kim, Jin Jo, Lee, Han Hong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.12.2023; BioMed Central; BMC
• Subjects: Analysis; Body mass index; Cancer; Care and treatment; Chemotherapy; Development and progression; Diagnosis; Gastrectomy; Gastric cancer; Gastrointestinal surgery; Hospitals; Humans; Information management; Lymph Node Excision; Lymph nodes; Lymph Nodes - pathology; Lymphatic metastasis; Lymphatic system; Medical centers; Medical prognosis; Metastases; Metastasis; Metastatic lymph nodes stomach neoplasms; Methods; Multivariate analysis; Neoplasm Staging; Nodal stage; Patients; Prognosis; Retrospective Studies; Staging system; Stomach cancer; Stomach Neoplasms - pathology; Surgery; Survival; TNM; Tumor staging; South Korea; TNM; Nodal stage; Staging system; Metastatic lymph nodes stomach neoplasms; Gastrectomy; Gastric cancer; Lymph node excision
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-023-11653-0

The current gastric cancer staging system relies on the number of metastatic lymph nodes (MLNs) for nodal stage determination. However, incorporating additional information such as topographic status may help address uncertainties. This study evaluated the appropriateness of the current staging system and relative significance of MLNs based on their anatomical location. Patients who underwent curative gastrectomy for gastric cancer between 2000 and 2019 at six Catholic Medical Center-affiliated hospitals were included. Lymph node-positive patients were classified into the perigastric (stations 1-6, group P) or extragastric (stations 7-12) groups. The extragastric group was further subdivided into the near-extragastric (stations 7-9, group NE) and far-extragastric (stations 10-12, group FE) groups. We analyzed the data of 3,591 patients with positive lymph node metastases. No significant survival differences were found between group P and the extragastric group in each N stage. However, in N1 and N2, group FE showed significantly worse survival than the other groups (p = 0.013 for N1, p < 0.001 for N2), but not in N3. In the subgroup analysis, group FE had a significantly lower overall survival in N2, regardless of the cancer location. Our large-scale multi-institutional big data analysis confirmed the superiority of the current numerical nodal staging system for gastric cancer. Nonetheless, in N1 and N2 in which there is an upper limit on metastatic nodes, attention should be paid to the potential significance of topographic information for specific nodal stations.