Prognostic role of the number of resected and negative lymph nodes in Spanish patients with gastric cancer

• Published in: Annals of diagnostic pathology 2023-12, Vol.67, p.152209-152209, Article 152209
• Main Authors: Díaz del Arco, Cristina, Ortega Medina, Luis, Estrada Muñoz, Lourdes, Molina Roldán, Elena, García Gómez de las Heras, Soledad, Fernández Aceñero, M. Jesús
• Format: Article
• Language: English
• Subjects: Gastric cancer; Humans; Lymph Node Count; Lymph Node Excision; Lymph Nodes; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Negative; Neoplasm Staging; Prognosis; Retrospective Studies; Stomach Neoplasms - pathology; Total; Western
• ISSN: 1092-9134; 1532-8198
• DOI: 10.1016/j.anndiagpath.2023.152209

Lymph node (LN) involvement is one of the most critical prognostic factors in resected gastric cancer (GC). Some analyses, mainly conducted in Asian populations, have found that patients with a higher number of total lymph nodes (NTLN) and/or negative lymph nodes (NNLN) have a better prognosis, although other authors have failed to confirm these results. Retrospective study including all patients with GC resected in a tertiary hospital in Spain between 2001 and 2019 (n = 315). Clinicopathological features were collected and patients were categorized according to the NTLN and the NNLN. Statistical analyses were performed. Mean NNLN was 17. The NNLN was significantly related to multiple clinicopathological variables, including recurrence and tumor-related death. The classification based on the NNLN (N1: ≥16, N2: 8–15, N3: ≤7) effectively stratified the entire cohort into three distinct prognostic groups and maintained its prognostic value within both the pN0 and pN+ patient subsets. Furthermore, it was an independent prognostic indicator for both overall and disease-free survival. Conversely, the mean NTLN was 21.9. Patients with ≤16 LN retrieved exhibited distinct clinicopathological features compared to those with >16 LN, but no significant differences were observed in terms of recurrence or disease-associated death. The application of alternative cut-off points for NTLN (10, 20, 25, 30, and 40) showed no prognostic significance. In Spanish patients with resected GC the NNLN hold prognostic significance, while the NTLN does not appear to be prognostically significant. Incorporating the NNLN into GC staging may enhance the accuracy of the TNM system. •A negative lymph node count (NNLN)-based system independently predicted prognosis.•The total lymph node count (NTLN) was not significantly associated with prognosis.•The prognostic role of the NTLN is offset by its association with metastatic lymph nodes.•The NNLN may be a better predictor of a suitable surgical/pathological examination.•It is advisable to incorporate the NNLN into the staging of gastric cancer.