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Prognostic Value of Lymph Node Yield After Neoadjuvant Chemoradiation for Gastric Cancer

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

Abstract

Background

Optimal lymphadenectomy (LAD) for gastric cancer (GC) after neoadjuvant chemoradiation (NACXRT) is not defined. This study assessed the prognostic value of LAD extent after modern preoperative therapy for GC.

Methods

The study analyzed patients who underwent resection after NACXRT for GC at the authors’ institution. Survival of the patients was compared between D1 and D2 resections and between lymph node (LN) yields (LNY) of fewer than 15 LNs and 15 or more LNs. The patients with early clinical nodal disease (cN0-1) were separately analyzed. Kaplan-Meier survival analyses were used to assess overall survival (OS) and disease-free survival (DFS).

Results

Resection of GC was performed for 345 patients after NACXRT. Of these patients, 269 (78%) received a D2 resection, and 277 (80%) had an LNY of 15 LNs or more. There were no differences in length of stay (12[10–16] days vs. 12[10–15] days, p = 0.917) or in any major complication including leak rates, intraabdominal infections, and bleeding (all p > 0.05). There was a significant difference in DFS (p = 0.050) and an OS trend (p = 0.085) based on D1 versus D2. Those who had 15 LNs removed showed a trend toward improved survival (DFS, p = 0.082; OS, p = 0.096). Among the patients with early clinical N stage disease (cN0-1), those who underwent D2 resections had better survival (DFS, p = 0.040; OS, p = 0.030).

Conclusions

Patients with GC who underwent resection after NACXRT showed evidence of improved survival after an extended LAD, particularly those with early N stage disease. Perioperative morbidity did not differ based on extent of LAD. Despite the potential effects of tumor downstaging with preoperative therapy, a thorough locoregional lymphatic resection is recommended.

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Acknowledgment

Funding for this study was provided by the National Institutes of Health and the National Cancer Institute (Grant no. P30CA016672).

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Casey J. Allen MD, Timothy J. Vreeland MD, Timothy E. Newhook MD, Naruhiko Ikoma MD, Paul F. Mansfield MD & Brian D. Badgwell MD

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Prajnan Das MD & Bruce D. Minsky MD

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela Blum MD & Jaffer Ajani MD

Authors
  1. Casey J. Allen MD
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  2. Timothy J. Vreeland MD
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  3. Timothy E. Newhook MD
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  4. Prajnan Das MD
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  5. Bruce D. Minsky MD
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Correspondence to Brian D. Badgwell MD.

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Fig. S1

Cox regression survival analyses (n = 345). Overall survival: D1 vs D2, cN0-1 (JPEG 39 kb)

Fig. S2

Kaplan-Maier survival analyses (n = 345). A Overall survival: D1 vs D2, distal gastric tumors. B Overall survival: D1 vs D2, proximal gastric tumors (JPEG 80 kb)

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Allen, C.J., Vreeland, T.J., Newhook, T.E. et al. Prognostic Value of Lymph Node Yield After Neoadjuvant Chemoradiation for Gastric Cancer. Ann Surg Oncol 27, 534–542 (2020). https://doi.org/10.1245/s10434-019-07840-8

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  • DOI: https://doi.org/10.1245/s10434-019-07840-8

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