Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jun 24, 2025; 16(6): 106228
Published online Jun 24, 2025. doi: 10.5306/wjco.v16.i6.106228
Swollen lymph node metastasis and survival in gastric cancer: Multi-institutional post-resection analysis
Jing-Li Cui, Kai Zhao, Xiang-Li Li, Fei Wang, Yong-Sheng Yang, Xiao Zheng
Jing-Li Cui, Xiao Zheng, Department of Gastrointestinal Surgery, The Affiliated Tai’an City Central Hospital of Qingdao University, Tai’an 271000, Shandong Province, China
Jing-Li Cui, Medical Center for Gastrointestinal Surgery, Weifang People's Hospital, Weifang 261000, Shandong Province, China
Kai Zhao, Yong-Sheng Yang, Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Xiang-Li Li, Department of Health Checkup Center, Weifang People's Hospital, Weifang 261000, Shandong Province, China
Fei Wang, Department of Endocrinology, Weifang People's Hospital, Weifang 261041, Shandong Province, China
Co-first authors: Jing-Li Cui and Kai Zhao.
Author contributions: Cui JL and Zhao K contributed equally to this work as co-first authors; Cui JL, Zhao K, and Li XL designed the study; Cui JL, Wang F, and Yang YS performed data collection and analysis; Zheng X and Yang YS supervised the study and revised the manuscript; all authors approved the final version.
Supported by The Shandong Provincial Medical and Health Science and Technology Youth Project, China, No. 202304081355; The Weifang Youth Medical Talent Lift Project, China; and The Science and Technology Development Project of Affiliated Hospital of Shandong Second Medical University, China, No. 2023FYQ004.
Institutional review board statement: This multi-center retrospective study was conducted in accordance with the Declaration of Helsinki and approved by the following institutional review boards: (1) Ethics Committee of Weifang People's Hospital, No. KYLL20240729-8, Date: July 29, 2024; (2) Ethics Committee of Tai’an Central Hospital, Affiliated to Qingdao University, No. TACKYLL-24000322, Date: August 30, 2024; and (3) Ethics Committee of The Second Hospital of Jilin University, No. LLJDE240092212, Date: September 26, 2024.
Informed consent statement: Retrospective Data Use Declaration: Formal written informed consent was not required for this study. The ethics committees of all participating institutions (Weifang People's Hospital, Tai’an Central Hospital, and The Second Hospital of Jilin University) waived the need for individual consent because: (1) The research utilized de-identified historical patient data, collected between 2010–2016; (2) No additional diagnostic/therapeutic procedures were performed beyond standard clinical care; and (3) Patient confidentiality was rigorously maintained through anonymization and secure data management protocols. Compliance with Ethical Standards: This exemption complies with article 39 of China's Ethical Review Measures, which permits retrospective studies using anonymized data to proceed without individual consent when obtaining consent is impracticable and privacy risks are minimized.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data presented in this study are available on request from the corresponding authors.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao Zheng, MD, PhD, Professor, Department of Gastrointestinal Surgery, The Affiliated Tai’an City Central Hospital of Qingdao University, No. 29 Longtan Road, Tai’an 271000, Shandong Province, China. zhengxiao@qdu.edu.cn
Received: February 27, 2025
Revised: April 8, 2025
Accepted: April 27, 2025
Published online: June 24, 2025
Processing time: 121 Days and 0.4 Hours
Abstract
BACKGROUND

Gastric cancer (GC) is frequently diagnosed at advanced stages, often with lymph node metastasis (LNM), which complicates prognosis. Swollen LNM (SLNM) in GC has been linked to poor outcomes, yet its prognostic value requires validation.

AIM

To evaluate the prognostic significance of SLNM in GC patients undergoing curative-intent gastrectomy.

METHODS

A retrospective analysis included 507 GC patients with LNM, categorized by SLNM status into positive (SLNM present) and negative (SLNM absent) groups. Survival outcomes were compared between groups, including propensity score matching and multivariate analysis to assess the role of SLNM as an independent prognostic factor.

RESULTS

One hundred and thirty-nine (27.4%) patients exhibited SLNM, associated with significantly lower 5-year overall survival (OS) compared to non-SLNM patients (13.6% vs 35.8%, P < 0.001). After matching, SLNM-positive patients maintained worse OS rates (13.4% vs 21.2%, P = 0.006). Multivariate analysis confirmed SLNM as an independent prognostic factor (hazard ratio = 1.318, P = 0.031). Additionally, T4 stage, N3 stage, and neoadjuvant chemotherapy independently influenced survival outcomes for SLNM-positive patients. Those who received neoadjuvant chemotherapy demonstrated better prognosis.

CONCLUSION

SLNM is an independent predictor of poor prognosis in GC. Neoadjuvant chemotherapy followed by D2 gastrectomy and adjuvant chemotherapy may offer survival benefits for patients with SLNM.

Keywords: Gastric cancer; Swollen lymph node metastasis; Neoadjuvant chemotherapy; Prognosis; Survival

Core Tip: This multi-center retrospective study of 1532 gastric cancer patients demonstrates that swollen lymph node (LN) metastasis (SLNM) is an independent prognostic factor, particularly in N0-1 stage patients. Using propensity score matching and Cox regression, SLNM was associated with a 48% increased mortality risk (hazard ratio = 1.48). Findings suggest integrating SLNM into tumor–node–metastasis staging could refine prognosis prediction and guide adjuvant therapy decisions, emphasizing the clinical value of meticulous LN dissection and pathological evaluation.