Implications of inadequate lymph node staging in resectable gastric cancer: A contemporary analysis using the National Cancer Data Base
Open Access
- 22 May 2014
- Vol. 120 (18), 2855-2865
- https://doi.org/10.1002/cncr.28780
Abstract
BACKGROUND National guidelines recommend examination of ≥ 15 lymph nodes for adequate staging of resectable gastric adenocarcinoma (GA). The relevance of these guidelines, which were established before the increasing use of multimodality therapy, and the impact of inadequate lymph node staging (LNS) in a contemporary cohort have not been extensively explored. METHODS Stage I-III GA patients who underwent gastrectomy from 1998 to 2011 were identified using the National Cancer Data Base. Trends in LNS adequacy, predictors of inadequate LNS (< 15 LN examined) and the relationship between LNS and overall survival (OS) were analyzed. RESULTS In 22,409 patients, compliance with LNS guidelines was poor (inadequate LNS in 61.2% of cases, median LN harvested in 11.0%). Subtotal/partial gastrectomy was the strongest predictor of inadequate LNS (OR = 2.01, P < .001). Survival analyses included 9139 patients with minimum 5 years follow-up; median, 1-year, and 5-year survival was 35.6 months, 75.5%, and 39.7%, respectively. LN positivity (HR = 1.90) and age > 76 years (HR = 1.73) were the strongest predictors of worse OS (both P < .001). Inadequate LNS was independently associated with worse OS (HR = 1.33, P < .001). Median OS after inadequate compared to adequate LNS was significantly worse (33.3 months versus 42.0 months, P < .001), regardless of AJCC clinical stage subgroup or tumor T classification (both P < .001). CONCLUSIONS Adequate LNS is achieved in a minority of patients. Inadequate LNS was independently associated with worse OS. Examination of ≥ 15 LN is a reproducible prognosticator of gastric cancer outcomes in the United States and should continue to serve as a benchmark for quality of care. Cancer 2014;120:2855–2865. © 2014 American Cancer Society.Keywords
This publication has 26 references indexed in Scilit:
- Treatment of resectable gastric cancerTherapeutic Advances in Gastroenterology, 2011
- Lymph nodes and gastric cancerJournal of Surgical Oncology, 2009
- The National Cancer Data Base: A Powerful Initiative to Improve Cancer Care in the United StatesAnnals of Surgical Oncology, 2008
- Significant regional variation in adequacy of lymph node assessment and survival in gastric cancerCancer, 2006
- Presalvage prostate‐specific antigen (PSA) and PSA doubling time as predictors of biochemical failure of salvage cryotherapy in patients with locally recurrent prostate cancer after radiotherapyCancer, 2006
- Inadequacy of Lymph Node Staging in Gastric Cancer Patients: A Population-Based StudyAnnals of Surgical Oncology, 2005
- How many nodes must be examined to accurately stage gastric carcinomas?Cancer, 2002
- Influence of the number of lymph nodes examined on staging of gastric cancerBritish Journal of Surgery, 2001
- Outcome of Patients With Proximal Gastric Cancer Depends on Extent of Resection and Number of Resected Lymph NodesAnnals of Surgical Oncology, 2000
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958