Implications of inadequate lymph node staging in resectable gastric cancer: A contemporary analysis using the National Cancer Data Base

Abstract

BACKGROUND: National guidelines recommend examination of ≥15 lymph nodes for adequate staging of resectable gastric adenocarcinoma (GA). The relevance of these guidelines, which were established before the increasing use of multimodality therapy, and the impact of inadequate lymph node staging (LNS) in a contemporary cohort have not been extensively explored. METHODS: Stage I-III GA patients who underwent gastrectomy from 1998 to 2011 were identified using the National Cancer Data Base. Trends in LNS adequacy, predictors of inadequate LNS (<15 LN examined) and the relationship between LNS and overall survival (OS) were analyzed. RESULTS: In 22,409 patients, compliance with LNS guidelines was poor (inadequate LNS in 61.2% of cases, median LN harvested in 11.0%). Subtotal/partial gastrectomy was the strongest predictor of inadequate LNS (OR52.01, P 76 years (HR51.73) were the strongest predictors of worse OS (both P