Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection: An Analysis from the US Gastric Cancer Collaborative

Sepideh Gholami, Lucas Janson, David J. Worhunsky, Thuy B. Tran, Malcolm Hart Squires, Linda X. Jin, Gaya Spolverato, Konstantinos I. Votanopoulos, Carl Schmidt, Sharon M. Weber, Mark Bloomston, Clifford S. Cho, Edward A. Levine, Ryan C. Fields, Timothy M. Pawlik, Shishir K. Maithel, Bradley Efron, Jeffrey A. Norton, George A. Poultsides

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background Examination of at least 16 lymph nodes (LNs) has been traditionally recommended during gastric adenocarcinoma resection to optimize staging, but the impact of this strategy on survival is uncertain. Because recent randomized trials have demonstrated a therapeutic benefit from extended lymphadenectomy, we sought to investigate the impact of the number of LNs removed on prognosis after gastric adenocarcinoma resection. Study Design We analyzed patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012, at 7 US academic institutions. Patients with M1 disease or R2 resections were excluded. Disease-specific survival (DSS) was calculated using the Kaplan-Meier method and compared using log-rank and Cox regression analyses. Results Of 742 patients, 257 (35%) had 7 to 15 LNs removed and 485 (65%) had ≥16 LNs removed. Disease-specific survival was not significantly longer after removal of ≥16 vs 7 to 15 LNs (10-year survival, 55% vs 47%, respectively; p = 0.53) for the entire cohort, but was significantly improved in the subset of patients with stage IA to IIIA (10-year survival, 74% vs 57%, respectively; p = 0.018) or N0-2 disease (72% vs 55%, respectively; p = 0.023). Similarly, for patients who were classified to more likely be "true N0-2," based on frequentist analysis incorporating both the number of positive and of total LNs removed, the hazard ratio for disease-related death (adjusted for T stage, R status, grade, receipt of neoadjuvant and adjuvant therapy, and institution) significantly decreased as the number of LNs removed increased. Conclusions The number of LNs removed during gastrectomy for adenocarcinoma appears itself to have prognostic implications for long-term survival.

Original languageEnglish (US)
Pages (from-to)291-299
Number of pages9
JournalJournal of the American College of Surgeons
Volume221
Issue number2
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Stomach Neoplasms
Lymph Nodes
Survival
Adenocarcinoma
Stomach
Gastrectomy
Neoadjuvant Therapy
Lymph Node Excision
Regression Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection : An Analysis from the US Gastric Cancer Collaborative. / Gholami, Sepideh; Janson, Lucas; Worhunsky, David J.; Tran, Thuy B.; Squires, Malcolm Hart; Jin, Linda X.; Spolverato, Gaya; Votanopoulos, Konstantinos I.; Schmidt, Carl; Weber, Sharon M.; Bloomston, Mark; Cho, Clifford S.; Levine, Edward A.; Fields, Ryan C.; Pawlik, Timothy M.; Maithel, Shishir K.; Efron, Bradley; Norton, Jeffrey A.; Poultsides, George A.

In: Journal of the American College of Surgeons, Vol. 221, No. 2, 01.01.2015, p. 291-299.

Research output: Contribution to journalArticle

Gholami, S, Janson, L, Worhunsky, DJ, Tran, TB, Squires, MH, Jin, LX, Spolverato, G, Votanopoulos, KI, Schmidt, C, Weber, SM, Bloomston, M, Cho, CS, Levine, EA, Fields, RC, Pawlik, TM, Maithel, SK, Efron, B, Norton, JA & Poultsides, GA 2015, 'Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection: An Analysis from the US Gastric Cancer Collaborative', Journal of the American College of Surgeons, vol. 221, no. 2, pp. 291-299. https://doi.org/10.1016/j.jamcollsurg.2015.04.024
Gholami, Sepideh ; Janson, Lucas ; Worhunsky, David J. ; Tran, Thuy B. ; Squires, Malcolm Hart ; Jin, Linda X. ; Spolverato, Gaya ; Votanopoulos, Konstantinos I. ; Schmidt, Carl ; Weber, Sharon M. ; Bloomston, Mark ; Cho, Clifford S. ; Levine, Edward A. ; Fields, Ryan C. ; Pawlik, Timothy M. ; Maithel, Shishir K. ; Efron, Bradley ; Norton, Jeffrey A. ; Poultsides, George A. / Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection : An Analysis from the US Gastric Cancer Collaborative. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 2. pp. 291-299.
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abstract = "Background Examination of at least 16 lymph nodes (LNs) has been traditionally recommended during gastric adenocarcinoma resection to optimize staging, but the impact of this strategy on survival is uncertain. Because recent randomized trials have demonstrated a therapeutic benefit from extended lymphadenectomy, we sought to investigate the impact of the number of LNs removed on prognosis after gastric adenocarcinoma resection. Study Design We analyzed patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012, at 7 US academic institutions. Patients with M1 disease or R2 resections were excluded. Disease-specific survival (DSS) was calculated using the Kaplan-Meier method and compared using log-rank and Cox regression analyses. Results Of 742 patients, 257 (35{\%}) had 7 to 15 LNs removed and 485 (65{\%}) had ≥16 LNs removed. Disease-specific survival was not significantly longer after removal of ≥16 vs 7 to 15 LNs (10-year survival, 55{\%} vs 47{\%}, respectively; p = 0.53) for the entire cohort, but was significantly improved in the subset of patients with stage IA to IIIA (10-year survival, 74{\%} vs 57{\%}, respectively; p = 0.018) or N0-2 disease (72{\%} vs 55{\%}, respectively; p = 0.023). Similarly, for patients who were classified to more likely be {"}true N0-2,{"} based on frequentist analysis incorporating both the number of positive and of total LNs removed, the hazard ratio for disease-related death (adjusted for T stage, R status, grade, receipt of neoadjuvant and adjuvant therapy, and institution) significantly decreased as the number of LNs removed increased. Conclusions The number of LNs removed during gastrectomy for adenocarcinoma appears itself to have prognostic implications for long-term survival.",
author = "Sepideh Gholami and Lucas Janson and Worhunsky, {David J.} and Tran, {Thuy B.} and Squires, {Malcolm Hart} and Jin, {Linda X.} and Gaya Spolverato and Votanopoulos, {Konstantinos I.} and Carl Schmidt and Weber, {Sharon M.} and Mark Bloomston and Cho, {Clifford S.} and Levine, {Edward A.} and Fields, {Ryan C.} and Pawlik, {Timothy M.} and Maithel, {Shishir K.} and Bradley Efron and Norton, {Jeffrey A.} and Poultsides, {George A.}",
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T1 - Number of Lymph Nodes Removed and Survival after Gastric Cancer Resection

T2 - An Analysis from the US Gastric Cancer Collaborative

AU - Gholami, Sepideh

AU - Janson, Lucas

AU - Worhunsky, David J.

AU - Tran, Thuy B.

AU - Squires, Malcolm Hart

AU - Jin, Linda X.

AU - Spolverato, Gaya

AU - Votanopoulos, Konstantinos I.

AU - Schmidt, Carl

AU - Weber, Sharon M.

AU - Bloomston, Mark

AU - Cho, Clifford S.

AU - Levine, Edward A.

AU - Fields, Ryan C.

AU - Pawlik, Timothy M.

AU - Maithel, Shishir K.

AU - Efron, Bradley

AU - Norton, Jeffrey A.

AU - Poultsides, George A.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background Examination of at least 16 lymph nodes (LNs) has been traditionally recommended during gastric adenocarcinoma resection to optimize staging, but the impact of this strategy on survival is uncertain. Because recent randomized trials have demonstrated a therapeutic benefit from extended lymphadenectomy, we sought to investigate the impact of the number of LNs removed on prognosis after gastric adenocarcinoma resection. Study Design We analyzed patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012, at 7 US academic institutions. Patients with M1 disease or R2 resections were excluded. Disease-specific survival (DSS) was calculated using the Kaplan-Meier method and compared using log-rank and Cox regression analyses. Results Of 742 patients, 257 (35%) had 7 to 15 LNs removed and 485 (65%) had ≥16 LNs removed. Disease-specific survival was not significantly longer after removal of ≥16 vs 7 to 15 LNs (10-year survival, 55% vs 47%, respectively; p = 0.53) for the entire cohort, but was significantly improved in the subset of patients with stage IA to IIIA (10-year survival, 74% vs 57%, respectively; p = 0.018) or N0-2 disease (72% vs 55%, respectively; p = 0.023). Similarly, for patients who were classified to more likely be "true N0-2," based on frequentist analysis incorporating both the number of positive and of total LNs removed, the hazard ratio for disease-related death (adjusted for T stage, R status, grade, receipt of neoadjuvant and adjuvant therapy, and institution) significantly decreased as the number of LNs removed increased. Conclusions The number of LNs removed during gastrectomy for adenocarcinoma appears itself to have prognostic implications for long-term survival.

AB - Background Examination of at least 16 lymph nodes (LNs) has been traditionally recommended during gastric adenocarcinoma resection to optimize staging, but the impact of this strategy on survival is uncertain. Because recent randomized trials have demonstrated a therapeutic benefit from extended lymphadenectomy, we sought to investigate the impact of the number of LNs removed on prognosis after gastric adenocarcinoma resection. Study Design We analyzed patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012, at 7 US academic institutions. Patients with M1 disease or R2 resections were excluded. Disease-specific survival (DSS) was calculated using the Kaplan-Meier method and compared using log-rank and Cox regression analyses. Results Of 742 patients, 257 (35%) had 7 to 15 LNs removed and 485 (65%) had ≥16 LNs removed. Disease-specific survival was not significantly longer after removal of ≥16 vs 7 to 15 LNs (10-year survival, 55% vs 47%, respectively; p = 0.53) for the entire cohort, but was significantly improved in the subset of patients with stage IA to IIIA (10-year survival, 74% vs 57%, respectively; p = 0.018) or N0-2 disease (72% vs 55%, respectively; p = 0.023). Similarly, for patients who were classified to more likely be "true N0-2," based on frequentist analysis incorporating both the number of positive and of total LNs removed, the hazard ratio for disease-related death (adjusted for T stage, R status, grade, receipt of neoadjuvant and adjuvant therapy, and institution) significantly decreased as the number of LNs removed increased. Conclusions The number of LNs removed during gastrectomy for adenocarcinoma appears itself to have prognostic implications for long-term survival.

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