The online version of this article (https://doi.org/10.1186/s12885-017-3872-6) contains supplementary material, which is available to authorized users.
Greater lymph node retrieval in gastric cancer improves staging accuracy and may improve survival from increased clearance of nodal micrometastasis. This retrospective cohort study investigated if more lymph nodes removed in gastric cancer increases survival and if such effect is stage-specific due to differential risks of nodal micrometastasis and systemic disease.
The prospectively collected database of curatively resected gastric cancer patients in National Cancer Center, South Korea between 2000 and 2009 was reviewed. Disease-free survival (DFS) and overall survival (OS) for all patients and for each stage according to number of lymph nodes examined (1–30, 31–45, > 45) were analyzed.
Of 4049 patients, 96.6% and 98.4% underwent D2 (perigastric and extragastric) lymphadenectomy and had ≥ 15 lymph nodes examined. Mean number of nodes examined was 43. Five-year OS & DFS rates were 83.3% and 80.7%. Patients with > 45 nodes examined had significantly lower DFS (p = 0.002) and OS (p = 0.007) compared to those with 1–30 and 31–45 nodes. However, proportion of patients with > 45 nodes examined increased with stage (p = 0.0005). Per stage, there was no significant difference in DFS and OS according to number of nodes examined except for stage IIIA favoring more nodes (p = 0.018 and p = 0.044, respectively). Similar trend was seen in stage IIB. Number of examined nodes positively correlated with number of pathologic nodes for all patients (r = 0.144, p < .001) but not for stage IIB and IIIA. Number of nodes examined was a significant survival predictor in stage IIIA.
Greater lymph node harvest showed improved survival in intermediate-stage gastric cancer.
Additional file 1: Figure S1. Kaplan-Meier disease-free survival curves according to total number of lymph nodes examined (≤ 30, 31-45, > 45) for all patients and for each stage subgroup. (A) All patients; (B) stage IA; (C) stage IB; (D) stage IIA; (E) stage IIB; (F) stage IIIA; (G) stage IIIB; (H) stage IIIC. (DOCX 327 kb)
Additional file 2: Figure S2. Kaplan-Meier overall survival curves according to total number of lymph nodes examined (≤ 30, 31-45, >45) for all patients and for each stage subgroup. (A) All patients; (B) stage IA; (C) stage IB; (D) stage IIA; (E) stage IIB; (F) stage IIIA; (G) stage IIIB; (H) stage IIIC. (DOCX 698 kb)
Additional file 3: Figure S3. Scatterplot and linear regression analysis of number of positive pathologic lymph nodes versus number of harvested lymph nodes for all patients and for each stage subgroup (r Spearman correlation value; p Spearman correlation test value). (A) All patients; (B) stage IA; (C) stage IB; (D) stage IIA; (E) stage IIB; (F) stage IIIA; (G) stage IIIB; (H) stage IIIC. (DOCX 1162 kb)
Additional file 4: Table S1. Univariate and Multivariate Analysis of Clinicopathologic Factors Associated with Overall Survival. (DOCX 42 kb)
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