Revisiting lymph node guidelines: limited lymph node examination might be sufficient for elderly gastric cancer...

Whether limited examined lymph node (ELN) number is comparable to recommended ELN number for long-term outcomes remains controversial in elderly gastric cancer (GC) patients. The purpose of this study was to assess the long-term survival between limited ELN number and recommended ELN number in elderly GC patients.

Elderly GC patients over 75 years old from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively reviewed. The long-term cancer-specific survival (CSS) and overall survival (OS) were compared between the limited ELN number group (ELN <15, limited group) and recommended ELN number (ELN ≥15, recommended group).

In total, 1,521 elderly GC patients were divided into the limited group (793 patients, 52.1%) and recommended group (728 patients, 47.9%). The 1-, 3-, and 5-year CSS in the limited group and recommended group were 76.5% vs. 78.6%, 55.0% vs. 58.5%, 47.8% vs. 50.4%. The 1-, 3-, and 5-year OS in the limited group and recommended group were 70.7% vs. 74.8%, 45.1% vs. 50.7%, 33.7% vs. 39.4%. The Kaplan-Meier survival curve analysis of CSS demonstrated no statistical significance between the two groups (P=0.31). Moreover, the OS was similar between the two groups in the elderly GC patients who underwent total gastrectomy (P=0.16). However, the OS were significant shorter in the limited group in elderly GC patients who underwent proximal and distal gastrectomy (both P<0.001).

Limited ELN number might be sufficient for elderly GC patients with total gastrectomy. Prospective studies with a larger sample size are required to validated these results.