National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Lanzhou University Second Hospital, Lanzhou, China.
BMC Cancer. 2023 Sep 21;23(1):892. doi: 10.1186/s12885-023-11138-0.
The current National Comprehensive Cancer Network (NCCN) guidelines recommend that at least 16 lymph nodes should be examined for gastric cancer patients to reduce staging migration. However, there is still debate regarding the optimal management of examined lymph nodes (ELNs) for gastric cancer patients. In this study, we aimed to develop and test the minimum number of ELNs that should be retrieved during gastrectomy for optimal survival in patients with gastric cancer.
We used the restricted cubic spline (RCS) to identify the optimal threshold of ELNs that should be retrieved during gastrectomy based on the China National Cancer Center Gastric Cancer (NCCGC) database. Northwest cohort, which sourced from the highest gastric cancer incidence areas in China, was used to verify the optimal cutoff value. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.
In this study, 12,670 gastrectomy patients were included in the NCCGC cohort and 4941 patients in the Northwest cohort. During 1999-2019, the average number of ELNs increased from 17.88 to 34.45 nodes in the NCCGC cohort, while the number of positive lymph nodes remained stable (5-6 nodes). The RCS model showed a U-curved association between ELNs and the risk of all-cause mortality, and the optimal threshold of ELNs was 24 [Hazard ratio (HR) = 1.00]. The ELN ≥ 24 group had a better overall survival (OS) than the ELN < 24 group clearly (P = 0.003), however, with respect to the threshold of 16 ELNs, there was no significantly difference between the two groups (P = 0.101). In the multivariate analysis, ELN ≥ 24 group was associated with improved survival outcomes in total gastrectomy patients [HR = 0.787, 95% confidence interval (CI): 0.711-0.870, P < 0.001], as well as the subgroup analysis of T2 patients (HR = 0.621, 95%CI: 0.399-0.966, P = 0.035), T3 patients (HR = 0.787, 95%CI: 0.659-0.940, P = 0.008) and T4 patients (HR = 0.775, 95%CI: 0.675-0.888, P < 0.001).
In conclusion, the minimum number of ELNs for optimal survival of gastric cancer with pathological T2-4 was 24.
目前，国家综合癌症网络（NCCN）指南建议胃癌患者至少应检查 16 个淋巴结，以减少分期迁移。然而，对于胃癌患者检查淋巴结（ELNs）的最佳管理仍存在争议。在这项研究中，我们旨在确定在胃癌患者行胃切除术中应切除的 ELNs 的最小数量，以获得最佳生存。
我们使用限制性立方样条（RCS）基于中国国家癌症中心胃癌（NCCGC）数据库确定应在胃切除术中切除的 ELNs 的最佳阈值。来自中国胃癌发病率最高地区的西北队列用于验证最佳截断值。通过 Kaplan-Meier 估计和 Cox 比例风险模型进行生存分析。
本研究纳入了 NCCGC 队列的 12670 例胃切除术患者和西北队列的 4941 例患者。在 1999 年至 2019 年期间，NCCGC 队列中 ELNs 的平均数量从 17.88 个增加到 34.45 个，而阳性淋巴结的数量保持稳定（5-6 个）。RCS 模型显示 ELNs 与全因死亡率之间呈 U 型关联，ELNs 的最佳阈值为 24 [风险比（HR）= 1.00]。ELN≥24 组的总生存（OS）明显优于 ELN<24 组（P=0.003），然而，对于 16 个 ELNs 的阈值，两组之间没有显著差异（P=0.101）。在多变量分析中，ELN≥24 组与全胃切除术患者的生存结局改善相关[HR=0.787，95%置信区间（CI）：0.711-0.870，P<0.001]，以及 T2 患者亚组分析[HR=0.621，95%CI：0.399-0.966，P=0.035]、T3 患者[HR=0.787，95%CI：0.659-0.940，P=0.008]和 T4 患者[HR=0.775，95%CI：0.675-0.888，P<0.001]。
总之，病理 T2-4 期胃癌患者最佳生存的 ELNs 最少数量为 24 个。
