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Inadequacy of Lymph Node Staging in Gastric Cancer Patients: A Population-Based Study

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Abstract

Background

In 1997, examination of at least 15 lymph nodes was recommended for adequate gastric cancer staging. However, the proportion of patients undergoing an adequate lymph node examination (LNE) has not been studied in a population-based manner.

Methods

We used Surveillance, Epidemiology, and End Results cancer registry data to assess LNE adequacy in adults with nonmetastatic gastric adenocarcinoma. We selected patients aged 18 through 80 years whose disease was diagnosed from 1998 through 2001 and who underwent at least partial gastrectomy. We evaluated the overall number of nodes, estimated the likelihood of adequate LNE (i.e., ≥15 nodes examined), and determined the influence of selected tumor and patient characteristics on LNE.

Results

In this 4-year period, 3593 patients met our study’s selection criteria. The median number of nodes examined was 10: 32% of patients underwent adequate LNE, and 9% of patients had no nodes examined. Node-positive patients were more likely to have undergone an adequate LNE than node-negative patients (42% vs. 23%; P < .0001). Younger age, female sex, and more radical surgery were associated with adequate LNE in both univariate and multivariate analysis (P < .0001). Geographical site was an important predictor; patients from one registry (Hawaii) were significantly more likely to have undergone adequate LNE than patients from all other registries (56% vs. 30%; P < .0001).

Conclusions

Our 4-year review of the Surveillance, Epidemiology, and End Results database revealed that only a third of patients with gastric cancer underwent adequate LNE, i.e., had the recommended minimum of 15 nodes examined for gastric cancer staging. Better results at one registry (Hawaii) indicate that substantial improvements could be made.

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Acknowledgments

The authors thank Dr. Mary Knatterud for her helpful editorial suggestions. Supported, in part, by the University of Minnesota Comprehensive Cancer Center. Both authors are supported by University of Minnesota Cancer Center Clinical Scholar Awards. N.N.B. is supported by an American Society of Clinical Oncology Career Development Award.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of Minnesota, 420, Delaware Street S.E., Minneapolis, Minnesota, 55455

    Nancy N. Baxter MD, PhD & Todd M. Tuttle MD, MS

  2. University of Minnesota Comprehensive Cancer Center, University of Minnesota, 420 Delaware Street S.E., Minneapolis, Minnesota, 55455

    Todd M. Tuttle MD, MS

Authors
  1. Nancy N. Baxter MD, PhD
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  2. Todd M. Tuttle MD, MS
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Correspondence to Todd M. Tuttle MD, MS.

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Baxter, N.N., Tuttle, T.M. Inadequacy of Lymph Node Staging in Gastric Cancer Patients: A Population-Based Study. Ann Surg Oncol 12, 981–987 (2005). https://doi.org/10.1245/ASO.2005.03.008

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  • DOI: https://doi.org/10.1245/ASO.2005.03.008

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