How many lymph nodes should be assessed in patients with gastric cancer? A systematic review

Rajini Seevaratnam, Alina Bocicariu, Roberta Cardoso, Lavanya Yohanathan, Matthew Dixon, Calvin Law, Lucy Helyer, Natalie G. Coburn

Research output: Contribution to journalReview article

52 Citations (Scopus)

Abstract

Background: Nodal status is one of the most important prognostic factors in gastric adenocarcinoma (GC). As such, it is important to assess an appropriate number of lymph nodes (LNs) in order to accurately stage patients. However, the number of LNs assessed in each GC case varies, and in many cases the number examined per gastric specimen is less than current recommendations. Purpose: We aimed to identify and synthesize findings from all articles evaluating the association of clinicopathological features and long-term outcomes with the number of LNs assessed among GC patients. Methods: Systematic electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1998 to 2009. Results: Twenty-five articles were included in this review. Extensive resection, increased tumor size, and greater TNM staging were all associated with a greater number of LNs assessed. The disease-free survival was longer and recurrence rate was lower in patients with more LNs assessed. Overall survival, as well as survival by TNM and clinical stage, was improved among patients with an increased number of LNs assessed, but much of this appears to be due to stage migration, with the effect more pronounced in more advanced disease. Conclusion: More LNs assessed resulted in less stage migration and possibly better long-term outcomes. Although current guidelines suggest 16 LNs to be assessed, especially in advanced GC, a higher number of LNs should be assessed.

Original languageEnglish (US)
Pages (from-to)S70-S88
JournalGastric Cancer
Volume15
Issue numberSUPPL.1
DOIs
StatePublished - Sep 2012

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Stomach Neoplasms
Lymph Nodes
Stomach
Adenocarcinoma
Survival
Neoplasm Staging
Disease-Free Survival
Guidelines
Recurrence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Seevaratnam, R., Bocicariu, A., Cardoso, R., Yohanathan, L., Dixon, M., Law, C., ... Coburn, N. G. (2012). How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. Gastric Cancer, 15(SUPPL.1), S70-S88. https://doi.org/10.1007/s10120-012-0169-y
Seevaratnam, Rajini ; Bocicariu, Alina ; Cardoso, Roberta ; Yohanathan, Lavanya ; Dixon, Matthew ; Law, Calvin ; Helyer, Lucy ; Coburn, Natalie G. / How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. In: Gastric Cancer. 2012 ; Vol. 15, No. SUPPL.1. pp. S70-S88.
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abstract = "Background: Nodal status is one of the most important prognostic factors in gastric adenocarcinoma (GC). As such, it is important to assess an appropriate number of lymph nodes (LNs) in order to accurately stage patients. However, the number of LNs assessed in each GC case varies, and in many cases the number examined per gastric specimen is less than current recommendations. Purpose: We aimed to identify and synthesize findings from all articles evaluating the association of clinicopathological features and long-term outcomes with the number of LNs assessed among GC patients. Methods: Systematic electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1998 to 2009. Results: Twenty-five articles were included in this review. Extensive resection, increased tumor size, and greater TNM staging were all associated with a greater number of LNs assessed. The disease-free survival was longer and recurrence rate was lower in patients with more LNs assessed. Overall survival, as well as survival by TNM and clinical stage, was improved among patients with an increased number of LNs assessed, but much of this appears to be due to stage migration, with the effect more pronounced in more advanced disease. Conclusion: More LNs assessed resulted in less stage migration and possibly better long-term outcomes. Although current guidelines suggest 16 LNs to be assessed, especially in advanced GC, a higher number of LNs should be assessed.",
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Seevaratnam, R, Bocicariu, A, Cardoso, R, Yohanathan, L, Dixon, M, Law, C, Helyer, L & Coburn, NG 2012, 'How many lymph nodes should be assessed in patients with gastric cancer? A systematic review', Gastric Cancer, vol. 15, no. SUPPL.1, pp. S70-S88. https://doi.org/10.1007/s10120-012-0169-y

How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. / Seevaratnam, Rajini; Bocicariu, Alina; Cardoso, Roberta; Yohanathan, Lavanya; Dixon, Matthew; Law, Calvin; Helyer, Lucy; Coburn, Natalie G.

In: Gastric Cancer, Vol. 15, No. SUPPL.1, 09.2012, p. S70-S88.

Research output: Contribution to journalReview article

TY - JOUR

T1 - How many lymph nodes should be assessed in patients with gastric cancer? A systematic review

AU - Seevaratnam, Rajini

AU - Bocicariu, Alina

AU - Cardoso, Roberta

AU - Yohanathan, Lavanya

AU - Dixon, Matthew

AU - Law, Calvin

AU - Helyer, Lucy

AU - Coburn, Natalie G.

PY - 2012/9

Y1 - 2012/9

N2 - Background: Nodal status is one of the most important prognostic factors in gastric adenocarcinoma (GC). As such, it is important to assess an appropriate number of lymph nodes (LNs) in order to accurately stage patients. However, the number of LNs assessed in each GC case varies, and in many cases the number examined per gastric specimen is less than current recommendations. Purpose: We aimed to identify and synthesize findings from all articles evaluating the association of clinicopathological features and long-term outcomes with the number of LNs assessed among GC patients. Methods: Systematic electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1998 to 2009. Results: Twenty-five articles were included in this review. Extensive resection, increased tumor size, and greater TNM staging were all associated with a greater number of LNs assessed. The disease-free survival was longer and recurrence rate was lower in patients with more LNs assessed. Overall survival, as well as survival by TNM and clinical stage, was improved among patients with an increased number of LNs assessed, but much of this appears to be due to stage migration, with the effect more pronounced in more advanced disease. Conclusion: More LNs assessed resulted in less stage migration and possibly better long-term outcomes. Although current guidelines suggest 16 LNs to be assessed, especially in advanced GC, a higher number of LNs should be assessed.

AB - Background: Nodal status is one of the most important prognostic factors in gastric adenocarcinoma (GC). As such, it is important to assess an appropriate number of lymph nodes (LNs) in order to accurately stage patients. However, the number of LNs assessed in each GC case varies, and in many cases the number examined per gastric specimen is less than current recommendations. Purpose: We aimed to identify and synthesize findings from all articles evaluating the association of clinicopathological features and long-term outcomes with the number of LNs assessed among GC patients. Methods: Systematic electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1998 to 2009. Results: Twenty-five articles were included in this review. Extensive resection, increased tumor size, and greater TNM staging were all associated with a greater number of LNs assessed. The disease-free survival was longer and recurrence rate was lower in patients with more LNs assessed. Overall survival, as well as survival by TNM and clinical stage, was improved among patients with an increased number of LNs assessed, but much of this appears to be due to stage migration, with the effect more pronounced in more advanced disease. Conclusion: More LNs assessed resulted in less stage migration and possibly better long-term outcomes. Although current guidelines suggest 16 LNs to be assessed, especially in advanced GC, a higher number of LNs should be assessed.

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U2 - 10.1007/s10120-012-0169-y

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JF - Gastric Cancer

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