Clinical characteristics of hepatoduodenal lymph node metastasis in gastric cancer

Table 1 Comparison of the clinicopathological features between patients with and without hepatoduodenal lymph node metastasis n (%)

	n	HDLN metastasis		Univariate	Multivariate
		Positive	Negative	P value	OR (95%CI)	P value
Total	276	26	250
Sex
Male	186	16 (62)	170 (68)
Female	90	10 (38)	80 (32)	0.509	-
Age (yr)
< 65	134	10 (38)	124 (50)
≥ 65	142	16 (62)	126 (50)	0.277	-
Tumor location
U	64	2 (8)	62 (25)
M and L	212	24 (92)	188 (75)	0.029	5.88 (1.61-38.1)	0.005
CA 19-9 (U/mL)
< 10	132	9 (35)	123 (49)
≥ 10	144	17 (65)	127 (51)	0.153	-
CEA (ng/mL)
< 3	195	16 (62)	179 (72)
≥ 3	81	10 (38)	71 (28)	0.295	-
Histopathological type
Differentiated	135	10 (38)	125 (50)
Undifferentiated	141	16 (62)	125 (50)	0.260	-
Venous invasion
(-)	173	12 (46)	161 (64)
(+)	103	14 (54)	89 (36)	0.072	-
Lymphatic invasion
(-)	105	3 (12)	102 (42)
(+)	171	23 (88)	148 (58)	0.002	-
Tumor size (mm)
< 45	119	5 (19)	114 (46)
≥ 45	157	21 (81)	136 (54)	0.007	-
T category
T1 and T2	127	3 (12)	124 (50)
T3 and T4	149	23 (88)	126 (50)	< 0.0001	4.45 (1.28-21.3)	0.017

HDLN: Hepatoduodenal lymph node; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; U: Upper gastric body; M: Middle gastric body; L: Lower gastric body.

Table 2 Complications after gastrectomy with extended lymphadenectomy

Complications	n (%)
Anastomotic leakage	12 (4.3)
Pancreatic fistula	8 (2.9)
Intra-abdominal abscess	4 (1.4)
Surgical site infection	26 (9.4)
Pneumonia	4 (1.4)
Cholecystitis	3 (1.1)
Pancreatitis	6 (2.2)
Hepatic dysfunction	2 (0.7)
Stenosis at anastomotic site	10 (3.6)
Ileus	11 (4.0)
Post-operative hemorrhage	2 (0.7)

Table 3 Univariate and multivariate analyses of the prognostic factors in patients with hepatoduodenal lymph node metastasis

	n	5-yr OS (%)	MST (mo)	Univariate	Multivariate
				P value	HR (95%CI)	P value
	26	28.7	14.1
Sex
Male	16	27.1	12.2
Female	10	25.7	16.9	0.753	-
Age (yr)
< 65	10	38.1	14.1
≥ 65	16	0	12.2	0.483	-
CA 19-9 (U/mL)
< 10	17	35.7	16.9
≥ 10	9	0	12.2	0.327	-
CEA (ng/mL)
< 3	16	35.8	14.1
≥ 3	10	0	9.1	0.382	-
Tumor location
U	2	0	8.7
M and L	24	30.0	14.1	0.569	-
Histopathological type
Differentiated	10	0	16.9
Undifferentiated	16	40.9	14.1	0.529	-
Venous invasion
(-)	12	0	14.1
(+)	14	16.7	16.9	0.411	-
Lymphatic invasion
(-)	3	0	9.1
(+)	23	26.9	14.1	0.624	-
Tumor size (mm)
< 45	5	0	9.1
≥ 45	21	31.4	14.1	0.274	-
T-category
T1 and T2	3	0	9.1
T3 and T4	23	31.5	16.9	0.222	-
N-category
N1 or N2	10	62.5	16.8
N3	16	0	8.8	0.002	5.17 (1.8-292.7)	0.021

OS: Overall survival; MST: Median survival time; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; U: Upper gastric body; M: Middle gastric body; L: Lower gastric body.

Table 4 Index of estimated benefit from hepatoduodenal lymph node dissection

Nodal station		Incidence of LNM (%)	5-yr OS of patients with LNM (%)	Index
No. 1		41.0	43.9	18.0
No. 2		16.2	45.8	7.4
No. 3		32.2	56.4	18.2
No. 4sa		8.1	75.0	6.1
No. 4sb		6.6	40.6	2.7
No. 4d		22.9	59.8	13.7
No. 5		12.5	53.2	6.7
No. 6		19.2	60.6	11.6
No. 7		12.8	47.5	6.1
No. 8a		13.3	55.9	7.4
No. 9		19.7	32.1	6.3
No. 10		1.2	100.0	1.2
No. 11p		23.7	56.5	13.4
No. 11d		0.0	NA	NA
No. 12a (HDLN)		9.4	28.7	2.7
	Tumor location
No. 12a (HDLN)	U	3.1	0.0	0.0
No. 12a (HDLN)	M and L	11.3	30.0	3.4

The index of therapeutic value of lymph node dissection was calculated by multiplying the incidence of metastasis by the 5-year survival rate of patients with metastasis at each nodal station and then dividing by 100¹². OS: Overall survival; LNM: Lymph node metastasis; HDLN: Hepatoduodenal lymph node; U: Upper gastric body; M: Middle gastric body; L: Lower gastric body; NA: Not applicable.