There is no conclusion regarding the indications for No.10 LND in advanced proximal gastric cancer (PGC). We aimed to explore the best candidates for splenic hilar lymph node dissection (No.10 LND) from the perspective of long-term survival.
Data of 995 patients who underwent laparoscopic radical gastrectomy from January 2008 to December 2014 were analyzed. Five hundred sixty-four patients underwent No.10 LND (No.10D+ group); the other 431 patients did not receive No.10 LND (No.10D- group). Propensity score matching was applied to reduce the effects of observed confounding. Study end points were overall survival (OS) and disease-free survival (DFS).
No.10 LN metastasis was associated with pT or pN in multivariate logistic analysis (P<0.05). Recursive partitioning analysis obtained 3 groups of patients with different risks of No.10 LN metastasis: low-risk group (pT1-3N0-1), the No.10 LN metastasis rate was 0; intermediate-risk group (pT4aN0-1, pTanyN2, pT1-3N3a), the rate was 6.5%; and high-risk group (pT1-3N3b, pT4aN3), the rate was 30.5%. After matching, stepwise stratification survival analysis showed that for stage IIIA PGC, the No.10D+ group had significantly better survival than the No.10D- group (5-year OS: 68.9% vs. 48.1%%, P=0.001; 5-year DFS: 66.3% vs. 41.2%, P=0.001). Comparison of recurrence patterns in stage IIIA PGC showed that the No.10D+ group had a significantly lower overall recurrence rate (26.4% vs. 50.6%, P=0.004) and distant metastasis rate (11.1% vs. 38.1%, P<0.001) than the No.10D- group.
Stage IIIA PGC may achieve the benefit of long-term survival from No.10 LND. For PGC with stage IIIB and IIIC, although the No.10 LN metastasis rate is high, No.10 LND does not result in survival benefits, and neoadjuvant therapy before surgery is recommended.
Technological Innovation Joint Capital Projects of Fujian Province.
All authors have declared no conflicts of interest.