Zhao Fucheng, Wang Pengliang, Wang Wei, Sun Zhe, Wang Zhenning, Xu Huimian, Zhou Zhiwei, Liang Han, Deng Jingyu
Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin Key Laboratory of Digestive Cancer; Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
Surg Today. 2025 May 12. doi: 10.1007/s00595-025-03053-7.
More examined lymph nodes (ELN) are correlated with better staging and a better prognosis of gastric cancer, although the optimal number of ELNs remains under dispute. This study explored the optimal number of ELNs for resectable advanced gastric cancer (AGC).
Clinicopathological characteristics and survival data of 4739 AGC patients were collected from 3 GC centers in China. The series of odds ratios (ORs) for negative-to-positive node stage migration and hazard ratios (HRs) for the disease-specific survival with more ELNs were fitted using locally weighted scatterplot smoothing (LOWESS). The structural breakpoints were determined using the Chow test. A Kaplan-Meier survival analysis was used to validate the cutoff ELN count.
With increasing numbers of ELNs, the cohort exhibited significant proportional increases in stage migration (OR = 1.006, p = 0.024) and serial improvements in survival (HR = 0.979, p < 0.001) per additional ELN after adjusting for covariates. The optimal ELN count was identified as 36, which was further validated with good discrimination for survival stratification in an external cohort that included 5796 patients from the SEER database.
Having more than 35 LNs to examine could achieve more accurate staging and a better survival for AGC patients with stage N0-N2 disease.
尽管检查的淋巴结数量（ELN）的最佳值仍存在争议，但更多的ELN与胃癌更好的分期及预后相关。本研究探讨了可切除的进展期胃癌（AGC）的ELN最佳数量。
收集来自中国3个胃癌中心的4739例AGC患者的临床病理特征和生存数据。使用局部加权散点图平滑法（LOWESS）拟合更多ELN时阴性至阳性淋巴结分期迁移的系列比值比（OR）和疾病特异性生存的风险比（HR）。使用Chow检验确定结构断点。采用Kaplan-Meier生存分析验证ELN计数的临界值。
随着ELN数量的增加，在调整协变量后，每增加一个ELN，队列的分期迁移显著成比例增加（OR = 1.006，p = 0.024），生存情况持续改善（HR = 0.979，p < 0.001）。确定最佳ELN计数为36，在一个包含来自SEER数据库的5796例患者的外部队列中，通过对生存分层的良好区分度进一步验证了这一结果。
对于N0-N2期的AGC患者，检查超过35个淋巴结可实现更准确的分期和更好的生存。
