Association Between the Number of Harvested Lymph Nodes and Overall Survival After Gastrectomy for Gastric Cancer: A Retrospective Cohort Study

Abstract

Gastric cancer remains one of the most prevalent and lethal malignancies globally. Continual advancements in staging modalities aim to optimize prognostic stratification and survival prediction. Among the highly useful approaches that have consistently garnered the attention of researchers is the examination of the lymph nodes of patients undergoing gastrectomy. Studies have shown a strong correlation between the number of involved lymph nodes and patient prognosis; however, other studies have reported insufficient sensitivity and specificity for these findings, which may be attributed to inadequate numbers of lymph nodes being removed during surgery. In this retrospective cohort study, patients diagnosed with gastric adenocarcinoma who were admitted to Sina Hospital between 2017 and 2023 and underwent gastrectomy were included. Demographic information, tumor pathology data, the number of excised lymph nodes, and the number of metastatic lymph nodes were collected. The survival status of the patients was assessed through telephone contact. A total of 118 patients were included in the study. The mean age was 62.59 years, and 78% of the patients were male. The most common tumor location was at the cardia and the gastroesophageal junction. The median tumor size was approximately 3 centimeters, with around 44% of the tumors being poorly differentiated. Approximately 70% of the patients had received neoadjuvant chemotherapy prior to surgery. The median number of resected lymph nodes was 14.0, which did not predict mortality in the analysis. However, the number of positive lymph nodes and the ratio of positive lymph nodes were significantly associated with mortality. Based on the results of this study, the number of positive lymph nodes and the ratio of positive lymph nodes to the total number of excised lymph nodes can be used to predict patient survival. The removal of a sufficient number of lymph nodes aids in accurately staging the disease and facilitates better treatment planning.