AIM: To investigate the long-term effect of the number of resected

AIM: To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate (< 0.01). The post-operative complication rate was 10.9% and was not significantly correlated with the number of dissected LNs (> 0.05). CONCLUSION: For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the post-operative complication rate. the Kaplan-Meier method, with univariate comparisons between groups through the log-rank test. Cox regression was used for multivariate analysis, with a backward elimination model for all covariates. Spearman rank correlation coefficient was used to analyze the relationship between the number of dissected LNs and recurrence rate. The correlation between the number of resected LNs and post-operative complication rate was analyzed with logistic regression model. Significance of differences was assumed at < 0.05. RESULTS Univariate survival analysis The five-year overall survival rate of the entire cohort was 82.2%. The clinicopathological variables tested in the univariate analysis are shown in Table ?Table1.1. Factors influencing the 5-year survival rate were tumor size (= 0.033), depth of invasion (< 0.001) and number of resected LNs (< 0.001). The covariates age (= 0.431), gender (= 0.170), tumor location (= 0.432), TP53 pathological types (= 0.645) and type of gastrectomy (= 0.640) had no significant influence on the survival. Table 1 Univariate analysis of variables in patients with node-negative gastric cancer Multivariate survival analysis Multiple survival analysis was calculated by the Coxs proportional hazard regression model. The prognostic factors considered at univariate analysis were analyzed first by stepwise regression, including tumor size, depth of invasion and number of resected LNs. As a result, there were two independent, statistically significant prognostic parameters: depth of invasion (= 0.032) and number of resected LNs (< 0.001). The risk ratios and their 95% confident interval were listed in Table ?Table22. Table 2 Multiple stepwise 154652-83-2 supplier regression analysis with the Cox proportional hazards model Impact of total LN counts by univariate survival analysis The five-year survival, based on T category, showed considerable variations with increasing counts of resected LNs. An obvious trend toward better survival was observed for higher numbers of resected LN (Table ?(Table33). Table 3 Five-year overall survival by stage subgroups and total number of resected LNs (%) Cut-point survival analysis A cut-point analysis was performed to determine the numeric LN value that determines the greatest actuarial survival difference between pT1-2 and pT3-4 subgroups. We selected the ability to detect differences between groups based on the magnitude of the log-rank test 2 statistic. Results for all relevant cut points and stage subgroups are listed in Table ?Table4.4. The cut-point analysis yielded the greatest survival difference at the levels of 15 (pT1-2), 20 (pT3-4) and 15 (entire cohort). Table 4 Overall survival by total LN count and cut-point analysis per each stage subgroup Impact of the number of resected LNs on recurrence rate Within 5 years after surgery, a recurrence was confirmed by clinical, radiological examination or reoperation in 62 patients, with an overall recurrence rate of 29.4%. The number of patients with peritoneal and lymph nodes recurrence were 28 and 13 respectively. The most common site of haematogenous recurrence was the liver, occurring in 12 patients. Other patterns of recurrence were bone recurrence in 5 patients and lung recurrence in 4 154652-83-2 supplier patients. The relationship between the number of resected LNs and recurrence rate was analyzed by Spearman rank correlation coefficient (Table ?(Table5).5). For either 154652-83-2 supplier pT1-2 or pT3-4 subgroups, there was a statistically significant, negative correlation between the number of dissected LNs and the recurrence rate (< 0.01). Table 5 Impact of.