Parang K, Shirazi AN. Swollen lymph node metastasis in gastric cancer: A forgotten prognostic signal in need of clinical action. World J Clin Oncol 2025; 16(9): 109711 [PMID: 41024851 DOI: 10.5306/wjco.v16.i9.109711]
Corresponding Author of This Article
Keykavous Parang, PhD, PharmD, Tenured Professor, Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, 9401 Jeronimo Road, Irvine, CA 92618, United States. parang@chapman.edu
Research Domain of This Article
Oncology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Clin Oncol. Sep 24, 2025; 16(9): 109711 Published online Sep 24, 2025. doi: 10.5306/wjco.v16.i9.109711
Swollen lymph node metastasis in gastric cancer: A forgotten prognostic signal in need of clinical action
Keykavous Parang, Amir Nasrolahi Shirazi
Keykavous Parang, Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA 92618, United States
Amir Nasrolahi Shirazi, Department of Pharmaceutical Sciences, Marshall B. Ketchum University, Fullerton, CA 92831, United States
Author contributions: Parang K contributed to this paper; Parang K designed the overall concept and outline of the manuscript; Parang K and Shirazi AN contributed to the writing and editing of the manuscript and reviewed the literature.
Conflict-of-interest statement: Both authors have nothing to disclose.
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: Keykavous Parang, PhD, PharmD, Tenured Professor, Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, 9401 Jeronimo Road, Irvine, CA 92618, United States. parang@chapman.edu
Received: May 19, 2025 Revised: June 15, 2025 Accepted: July 9, 2025 Published online: September 24, 2025 Processing time: 127 Days and 12.6 Hours
Abstract
Gastric cancer (GC) remains a leading cause of cancer mortality. While the extent of nodal involvement is a well-known prognostic factor, the specific entity of swollen lymph node metastasis (SLNM), bulky nodal tumor deposits detectable radiologically or pathologically, has received little attention in staging. Recent data from a study by Cui et al demonstrated that SLNM is an independent predictor of very poor survival in GC. Through robust data and rigorous propensity-matched analyses, SLNM emerged not merely as an anatomical finding but as an independent predictor of poor prognosis, even among patients undergoing curative resection. As precision oncology advances, the findings by Cui et al urge a fundamental rethinking of how SLNM is incorporated into clinical decision-making for GC management. In this editorial, we critically examine the prognostic significance of SLNM, challenge its omission from traditional staging frameworks, and advocate for its formal integration into preoperative risk stratification and treatment planning. Recognizing SLNM at diagnosis could unlock intensified neoadjuvant therapy strategies and optimize outcomes for a historically high-risk patient subgroup.
Core Tip: Swollen lymph node metastasis (SLNM), defined by bulky nodal tumor deposits (> 3 cm on imaging or multiple > 1.5 cm nodes) in gastric cancer, confers a dramatically worse outcome. In a large recent cohort, SLNM was independently associated with approximately 50% higher mortality risk. This editorial emphasizes SLNM’s under-recognized prognostic value. Formally incorporating SLNM into gastric cancer staging and treatment algorithms (for example, prioritizing neoadjuvant chemotherapy) may improve risk stratification. Recognizing SLNM as a biomarker can enhance precision oncology approaches by identifying patients for intensified multimodal therapy.
