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ACSO GI - Gastric Cancer Survival
.....Linked to Number of Nodes Dissected
Prognosis in patients who survive gastric cancer is linked to the number of lymph nodes that are dissected, according to results of a database analysis presented here January 22nd at the First Annual Symposium on Gastrointestinal Cancer, sponsored jointly by the American Society of Clinical Oncology and other societies.
Roderich Schwarz, MD, of the Cancer Institute of New Jersey, New Brunswick, New Jersey, presented findings of an analysis of data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, a source of information on cancer incidence and survival in the United States.
The number of nodes examined significantly predicts survival after resection of gastric cancer, Dr. Schwarz said. For fewer than 10 nodes dissected, compared to more than ten, the P value was .0002 for the difference in 5 year survival rates. A 7.6% increase in 5 year survival appeared for each additional node examined in one subgroup, he said, and by 5% to 11% in the others studied.
Of 3 million patients in the SEER database who were entered between 1973 and 1999, investigators identified a cohort of 15,738 patients. Of these, 5,109 had gastric adenocarcinoma with at least one node examined, and enough information to allow analysis. Most had fewer than 10 nodes dissected. Only 20% of patients met the current recommendations for 50 nodes to be examined.
Staging of gastric cancer culled from the database was by American Joint Committee on Cancer (AJCC) TNM criteria, which is based on the extent of the tumor (T), spread to lymph nodes (N), and metastasis (M).
Stages among patients in the SEER database were T1/2NO, T1/2N1, T3N0, and T3N1. All stages showed better overall survival with increasing number of nodes examined, Dr. Schwarz said.
"The bottom line is, each subgroup analyzed had an improvement, stepwise, in survival, that persisted to more than 40 nodes [removed]," he explained.
"It should be mandatory to look at least 10 nodes," he added, "and the more nodes you get, the better. Ask your pathologist to find as many lymph nodes as possible."
"Extended lymph node may impact on strategy choices" for treating the cancer, said Dr. Schwarz. Yet the number of nodes removed may serve as "a surrogate for a different pattern of care," Dr. Schwarz said in response to comment from the audience.