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Impact of Removal of Lymph Nodes on Survival in Stage I–III Gastric Signet-Ring Cell Cancer: The More, the Better?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is an ongoing debate over the prognostic value of the number of examined lymph nodes (ELNs) in cases of gastric signet-ring cell cancer (GSRCC). In this study, we sought to evaluate the correlation between the number of ELNs and the prognosis of GSRCC and identify the optimal number of ELNs.

Methods

A total of 1020 patients diagnosed with GSRCC between 2011 and 2018 in the National Cancer Center database were identified. Clinicopathological characteristics were retrospectively collected, and optimal cutoff values of ELNs were calculated by using X-tile. The impact of different ELNs on overall survival (OS) was compared by using Kaplan–Meier curves. We used univariate and multivariate Cox and subgroup analyses to explore the relationship between ELNs and OS. Furthermore, nonlinear correlations were investigated by using restricted cubic splines (RCSs).

Results

X-tile showed that the optimal cutoff value of ELNs was 22. The 5-year OS was higher for patients with ELNs > 22 (vs. ELNs ≤ 22, 66.9% vs. 74.9%, P = 0.026). Multivariate Cox analyses showed that high ELNs were associated with superior OS (hazard ratio = 0.56, 95% confidence interval 0.43–0.74, P < 0.001). In subgroup analyses, the significant association between tumor size > 4 cm, and TNM III stage was still observed. The RCS regression model showed a U-shaped dose–response nonlinear relationship between ELNs and OS; the inflection point, as well as the lowest risk points, corresponded to 44–52 ELNs.

Conclusions

A U-shaped, nonlinear correlation with inflection points of 44–52 ELNs between ELNs and prognosis in GSRCC was identified.

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Funding

This work was supported by the National Natural Science Foundation of China (82072734).

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Author notes

  1. Yujuan Jiang and Xinxin Shao have contributed equally to this work.

Authors and Affiliations

  1. Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yujuan Jiang MM, Xinxin Shao MM, Weikun Li MM, Haitao Hu MM, Yiming Lu MM & Yantao Tian MD

  2. Senior Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China

    Yang Li MD

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Contributions

YJJ and XXS designed and conceived this project. HTH, WKL, and YML analyzed the data. YL and YTT revised the manuscript for important intellectual content. YJJ and XXS participated in the patient information collection. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Yang Li MD or Yantao Tian MD.

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The authors have declared that no competing interests exist.

Ethics Approval and Consent to Participate

The study was approved by the Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences (NCC2023C-657), and informed consent was not needed.

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Jiang, Y., Shao, X., Li, W. et al. Impact of Removal of Lymph Nodes on Survival in Stage I–III Gastric Signet-Ring Cell Cancer: The More, the Better?. Ann Surg Oncol 31, 783–791 (2024). https://doi.org/10.1245/s10434-023-14590-1

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