Abstract
Abstract
Background
In gastric cancer (GC), the pN-stage is an important prognostic factor influencing treatment. Along with the depth of invasion of the tumor, the presence of nodal metastases is one of the most important prognostic factors guiding treatment strategies in gastric cancer. Examining a small number of lymph nodes may lead to understaging of the disease; hence, it is essential for the nodal status to be precisely assessed. In this study, we explored whether dissecting lymph node stations into separate samples by the surgeon from the gastric cancer surgical specimen affects the quality of nodal status evaluation and patient outcome.
Methods
The clinical data of 130 GC patients treated at the Helsinki University Hospital between 2016 and 2019 was reviewed. The performed operations included 59 total and 71 subtotal gastrectomies. The processing of the surgical specimen before the pathological examination was assessed from the operation records and pathology reports.
The association of the number of examined lymph nodes with other variables was assessed, and multivariate survival analysis was performed to explore the independent prognostic factors in disease-specific survival.
Results
Dissecting lymph node stations into separate specimens before pathological evaluation yielded a significantly greater number of examined lymph nodes compared with a specimen without intervention (median 34.5 vs 21.0, p < 0.001). The pT-stage, the pN-stage, and the extent of lymphadenectomy were identified as independent prognostic factors, whereas dissecting the specimen’s lymph node stations did not associate with survival.
Conclusions
Dissecting lymph node stations into separate specimens results in a greater number of examined lymph nodes, which has the potential to lead to a more reliable pN-stage assessment.
Funder
Helsinki University Hospital Research Funding
University of Helsinki including Helsinki University Central Hospital
Publisher
Springer Science and Business Media LLC
Reference31 articles.
1. World Health Organization International Agency for Research on Cancer (IARC). GLOBOCAN 2020: estimated cancer incidence, mortality and prevalence worldwide in 2020. 2020. https://www.uicc.org/news/globocan-2020-new-global-cancer-data. Accessed 14 Dec 2022.
2. Pitkäniemi J, Malila N, Tanskanen T, Degerlund H, Heikkinen S, Seppä K. Finnish cancer registry, report on cancer in Finland in the year 2019. 2019. https://syoparekisteri.fi/assets/files/2021/07/Cancer_in_Finland_2019.pdf. Accessed 14 Dec 2022.
3. Sexton RE, Al Hallak MN, Diab M, Azmi AS. Gastric cancer: a comprehensive review of current and future treatment strategies. Cancer Metastasis Rev. 2020;39(4):1179–203.
4. Siewert JR, Bottcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. 1998;228(4):449–61.
5. Park JM, Ryu WS, Kim JH, Park SS, Kim SJ, Kim CS, et al. Prognostic factors for advanced gastric cancer: stage-stratified analysis of patients who underwent curative resection. Cancer Res Treat. 2006;38(1):13–8.