Central Lymph Node Metastasis is Predictive of Survival in Advanced Gastric Cancer Patients Treated with D2 Lymphadenectomy

Abstract BackgroundThe number of positive lymph nodes, which was defined as “N stage”, is mostly used to predict the survival of D2-resected gastric cancer patients, not the location. A “central lymph node” (CnLN) was defined by Ikoma et al, included common hepatic, celiac and proximal splenic artery LNs. CnLNs located in the extraperigastric area are included in the D2 LN station for gastric cancer. We speculate that CnLNs can be regarded as a predictor of survival.Methods Eligible advanced gastric cancer patients who underwent curative resection and D2 lymph node dissection between 2004 and 2012 at our institution were identified. The frequency of CnLN metastases and risk factors affecting DFS were examined. Survival differences were assessed by log-rank tests and Kaplan–Meier curves.ResultsThe study identified 1178 patients who underwent curative surgery or D2 or more extensive lymphadenectomy. A total of 342 patients had been proven to have CnLN metastasis. Larger tumor size (p<0.001), more frequent lymphatic vessel invasion (p<0.001), signet ring cell histology (p=0.014), and more advanced pathological T stage (p=0.013) were significantly related to CnLNs metastasis. The patients with CnLN metastasis had a poor prognosis (HR for DFS of 1.366, 95%CI=1.138-1.640, p=0.001). For the pN2/3 patients, CnLN metastasis was associated with shorter 5-year DFS (for pN2 patients: 25.9% vs 39.3%, p=0.017; for pN3 patients: 11.5% vs 23.4%, p=0.005).ConclusionGastric cancer patients with CnLN metastasis who underwent D2 resection had a poor prognosis. With the same N stage, the patients with positive CnLNs had shorter survival. CnLNs metastasis could be a supplement to N stage and a predictor of survival in gastric cancer patients. Large sample, multicenter, randomized clinical trials are still needed in the future.