Chen PF, Qian JJ, Zhang L, Chen ZM, Han WX. Prognostic impact of lesser curvature lymph node count in stage I/II gastric cancer: A retrospective study. World J Gastrointest Oncol 2026; 18(11): 123356 [DOI: 10.4251/wjgo.123356]
Corresponding Author of This Article
Wen-Xiu Han, PhD, Chief Physician, Professor, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Avenue, Shushan District, Hefei 230022, Anhui Province, China. yfy104613@fy.ahmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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World J Gastrointest Oncol. Nov 15, 2026; 18(11): 123356 Published online Nov 15, 2026. doi: 10.4251/wjgo.123356
Prognostic impact of lesser curvature lymph node count in stage I/II gastric cancer: A retrospective study
Pei-Feng Chen, Jia-Jun Qian, Lei Zhang, Zhang-Ming Chen, Wen-Xiu Han
Pei-Feng Chen, Jia-Jun Qian, Lei Zhang, Zhang-Ming Chen, Department of Gastrointestinal and Hernia Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Wen-Xiu Han, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Co-first authors: Pei-Feng Chen and Jia-Jun Qian.
Co-corresponding authors: Zhang-Ming Chen and Wen-Xiu Han.
Author contributions: Chen PF and Qian JJ performed the study design, data collection, statistical analysis, manuscript drafting, and they contributed equally to this manuscript and are co-first authors; Zhang L participated in data interpretation and manuscript revision; Chen ZM provided funding support and participated in study supervision and manuscript revision; Han WX provided overall supervision of the study and final approval of the manuscript; Chen ZM and Han WX contributed equally to this manuscript and are co-corresponding authors. All authors have read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using DeepSeek for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by Natural Science Research Project of Universities in Anhui Province, No. 2023AH053317.
Institutional review board statement: This retrospective study was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval No. PJ 2024-11-66).
Informed consent statement: The requirement for informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Wen-Xiu Han, PhD, Chief Physician, Professor, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Avenue, Shushan District, Hefei 230022, Anhui Province, China. yfy104613@fy.ahmu.edu.cn
Received: May 18, 2026 Revised: July 4, 2026 Accepted: September 8, 2026 Published online: November 15, 2026 Processing time: 165 Days and 6.2 Hours
Abstract
BACKGROUND
Current lymph node (LN) staging for gastric cancer relies primarily on total LN count. The number of LNs retrieved from specific anatomical regions may carry additional prognostic value.
AIM
To evaluate the prognostic impact of the lesser curvature LN count in patients with clinical stage I/II gastric cancer.
METHODS
A total of 254 patients with clinical stage I/II lesser curvature gastric adenocarcinoma who underwent curative total gastrectomy with D2 lymphadenectomy were retrospectively analyzed. The optimal cutoff was identified using a systematic threshold-searching approach based on the log-rank test and univariate Cox regression. This threshold was further assessed in key pathological subgroups and evaluated in multivariate Cox models adjusted for established prognostic factors.
RESULTS
The retrieval of ≤ 7 lesser curvature LNs was identified as the optimal cutoff, independently associated with worse overall survival (hazard ratio = 2.37, 95% confidence interval: 1.44-3.90, P = 0.0005). This prognostic significance was consistently validated in key subgroups including node-negative (N0), node-positive (N+), and T3 patients. In multivariate analysis, ≤ 7 lesser curvature LNs remained an independent adverse prognostic factor after adjusting for age, T stage, N stage, lymphovascular invasion, and perineural invasion (hazard ratio = 2.20, 95% confidence interval: 1.27-3.82, P = 0.005).
CONCLUSION
In this study, a lesser curvature LN count of ≤ 7 was associated with poorer overall survival, suggesting a potential risk of stage migration.
Core Tip: Current gastric cancer staging guidelines emphasize total lymph node (LN) count but may overlook the anatomical distribution of nodal metastases. This exploratory study investigated the prognostic impact of the lesser curvature LN count in 254 patients with stage I/II lesser curvature gastric cancer who underwent total gastrectomy. The retrieval of ≤ 7 lesser curvature LNs (stations 1, 3, 5, 7, 8, and 9) was independently associated with significantly poorer overall survival after adjusting for established prognostic factors. This region-specific threshold offers a potential anatomical complement to total LN count standards.
