J Cancer 2019; 10(23):5646-5653. doi:10.7150/jca.30979 This issue

Research Paper

Effect of lymph nodes count in node-positive gastric cancer

Wenjie Zhang1,2,3*, Guangyan Zhangyuan1,3*, Jincheng Wang1,2,3*, Kangpeng Jin1, Yang Liu1,2, Fei Wang1,2, Weiwei Yu1,2, Haitian Zhang1,2, Guoqiang Li1, Decai Yu1, Huihui Chen1, Qingxiang Xu1,2✉, Beicheng Sun1,2,3✉

1. Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China
2. Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China.
3. Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China.
*The authors contributed equally to this work

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Zhang W, Zhangyuan G, Wang J, Jin K, Liu Y, Wang F, Yu W, Zhang H, Li G, Yu D, Chen H, Xu Q, Sun B. Effect of lymph nodes count in node-positive gastric cancer. J Cancer 2019; 10(23):5646-5653. doi:10.7150/jca.30979. Available from https://www.jcancer.org/v10p5646.htm

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Background: The retrieved lymph node (LN) count has been confirmed as a prognostic indicator in various cancers. However, the correlation between LN counts and patient prognosis in gastric cancer with node-positive is not fully studied.

Methods: A total of 8475 patients undergoing gastrectomy in Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer were analyzed. Kaplan-Meier methods and multivariable Cox regression models were used to analyze long-term outcomes and risk factors. Moreover, nomograms including LN counts were established to predict overall survival (OS) and cancer-specific survival (CSS), and Harrell's concordance index (c-index) was adopted to evaluate prediction accuracy.

Results: Patients were stratified into 1-6, 7-14, and > 14 subgroups according to the optimal cutoff for retrieved LNs in terms of 5-year CSS. Further analysis indicated that higher LN counts were an independent predictor of longer survival in each N category. Nomograms on CSS and OS were established according to all significant factors, and c-indexes were 0.663 and 0.654 (P< 0.001), respectively.

Conclusions: These results indicated that the more the LNs retrieved, the better the survival would be. Nomograms incorporating LN counts can be recommended as practical models to provide more accurate prognostic information for GC patients.

Keywords: nomograms, lymph nodes, gastric cancer