Determination of the extent of dissection in early gastric cancer based on lymph node station power index. Issue 5 (8th September 2022)

• Record Type: Journal Article
• Authors: Jeon, Chul-Hyo; Park, Ki Bum; Kim, Sojung; Seo, Ho Seok; Kim, In-Ho; Song, Kyo Young; Lee, Han Hong
• Is Part Of: BJS open. Volume 6:Issue 5(2022)
• Publication Date: 2022-09-08
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjsopen/zrac104
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: The relative prognostic value of each lymph node (LN) station remains undefined in the treatment of gastric cancer. This study aimed to develop a new method to evaluate LN station ranking and define the optimal extent of lymphadenectomy for early gastric cancer. Methods: Clinical and histopathological information from patients who underwent curative gastrectomy with lymphadenectomy between 1989 and 2018 was reviewed. The LN station power index (LNPI) of each station was estimated using a LN retrieval frequency and the 5-year overall survival of patients with absence of LN at each station. External validation was conducted to evaluate the relevance of the LNPI. Results: A training set was developed from examination of 7009 patient records. For most nodal stations, the absence of LN was significantly associated with a poor prognosis. For the perigastric stations, the prognostic value assessed using the LNPI was in the following order: LN 4 (LNPI = 19.68), LN 3 (LNPI = 17.58), LN 6 (LNPI = 15.16), LN 1 (LNPI = 6.71), LN 2 (LNPI = 4.64) and LN 5 (LNPI = 2.86). The value rank of the extra-gastric stations was in the following order: LN 8a (LNPI = 12.93), LN 7 (LNPI = 10.51) and LN 9 (LNPI = 9.70), but the index of LN 12a (LNPI = 4.79) was higher than that of LN 11 (LNPI = 4.78). These trends in the LNPI were similar in the validation patient cohort. Conclusions: The LNPI is a simple tool to rank the priority of each LN station dissection. The optimal extent of D1 + lymphadenectomy using LNPI was determined to be D1 with LNs 7, 8a and 9. Abstract : Determination of the extent of dissection in early gastric cancer based on lymph node station power index.