Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Long-term survival of patients with stage II and III gastric cancer who underwent gastrectomy with inadequate nodal assessment
Jacopo Desiderio, Andrea Sagnotta, Irene Terrenato, Eleonora Garofoli, Claudia Mosillo, Stefano Trastulli, Federica Arteritano, Federico Tozzi, Vito D'Andrea, Yuman Fong, Yanghee Woo, Sergio Bracarda, Amilcare Parisi
Jacopo Desiderio, Stefano Trastulli, Federica Arteritano, Amilcare Parisi, Department of Digestive Surgery, St. Mary’s Hospital, Terni 05100, Italy
Jacopo Desiderio, Vito D'Andrea, Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
Andrea Sagnotta, Department of General Surgery and Surgical Oncology, San Filippo Neri Hospital, Rome 00135, Italy
Irene Terrenato, Biostatistics and Bioinformatic Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
Eleonora Garofoli, Claudia Mosillo, Sergio Bracarda, Department of Medical Oncology, St. Mary’s Hospital, Terni 05100, Italy
Federico Tozzi, Division of Surgical Oncology and Endocrine Surgery, Mays Cancer Center, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, United States
Yuman Fong, Yanghee Woo, Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, LA, 91010, United States
Author contributions: Desiderio J, Sagnotta A and Terrenato I designed the study, conducted the research, collected the data, analyzed the results and drafted the manuscript; Terrenato I performed the statistics; Parisi A, D'Andrea V, Bracarda S, Woo Y and Fong Y supervised the study, and revised the manuscript; Trastulli S, Garofoli E, Mosillo C, Tozzi F confirmed the statistics, interpreted the data, and revised the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This is a study using a population-based registry, so institutional review board was not applicable.
Informed consent statement: This is a study using a population-based registry, so informed consent was not applicable.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Data sharing statement: Further information is available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jacopo Desiderio, PhD, Academic Research, Surgeon, Surgical Oncologist, Department of Digestive Surgery, St. Mary’s Hospital, Via Tristano di Joannuccio 1, Terni 05100, Italy.
j.desiderio@aospterni.it
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: June 17, 2021
Revised: June 30, 2021
Accepted: October 22, 2021
Article in press: October 22, 2021
Published online: November 27, 2021
Processing time: 211 Days and 22.8 Hours
ARTICLE HIGHLIGHTS
Research background
Lymphadenectomy in gastric cancer remains a relevant issue because of its impact on survival. The SEER database is one of the largest Western cancer databases. Patients were assigned to three groups depending on the number of analyzed lymph nodes (LNs) to evaluate survival differences and the stage migration effect.
Research motivation
Gastric cancer should be treated in dedicated centers to offer the patient both optimal surgery and a correct pathological assessment and to avoid improper staging.
Research objectives
We aimed to analyze the survival of patients with inadequate numbers of assessed LNs and to quantify the effect vs correctly staged patients, based on the stage definitions in the AJCC staging manual.
Research methods
Eligible gastric cancer patients were identified in the SEER database and assigned of three groups, inadequate LN assessment (< 16 LNs), adequate LN assessment (16-29 LNs), and optimal LN assessment (≥ 30 LNs).
Research results
The ILA group had the worst survival. The finding was confirmed in by univariate and multivariate analysis. OLA gave the best chance of both correct staging and proper surgery performed as demonstrated after propensity score matching.
Research conclusions
Inadequate staging led to a significant reduction in the expected survival associated with the formally attributed stage. An analysis of at least > 16 LNs should be offered to all patients treated with curative intent.
Research perspectives
The role of referral centers for gastric cancer should be strengthened to obtain optimal treatment and accurate patient staging.
