The minimum number of lymph node retrieval in gastric cancer patients after neoadjuvant therapy: An international multi-institute cohort study

Zhi-Quan Zhang ¹, Qing Zhong ¹, Yu-Qin Sun ²

¹Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China.
²Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China.
³Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, China.
⁴General Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China.
⁵Public Health School, Fujian Medical University, Fuzhou, Fujian, China.
⁶Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy.
⁷Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Department of General Surgery, The Quzhou Affiliated Hospital of Wenzhou University, Quzhou, China.
⁸Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.

⁰Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China.

Surgery +

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May 6, 2025

View abstract on PubMed

Summary

For gastric cancer patients receiving neoadjuvant therapy, retrieving at least 24 lymph nodes is crucial. This threshold improves survival prediction and reduces stage migration, enhancing prognostic accuracy after gastrectomy.

Area Of Science

Oncology
Surgical Oncology
Gastrointestinal Cancer Research

Background

The optimal number of lymph nodes to retrieve after neoadjuvant therapy for gastric cancer is debated.
Accurate staging and prognosis are essential for guiding treatment decisions.

Purpose Of The Study

To establish the minimum lymph node retrieval threshold for accurate staging and prognosis in gastric cancer patients post-neoadjuvant therapy.
To investigate the impact of lymph node count on survival outcomes and stage migration.

Main Methods

Analysis of clinicopathological data from 2,490 international gastric cancer patients.
Multivariate models to assess the correlation between lymph node count, survival, and stage migration.
LOWESS smoother and Chow test to identify structural break points in hazard ratio curves.

Main Results

A higher number of retrieved lymph nodes correlated with increased detection of positive lymph nodes and improved survival.
Cutoff analysis identified 24 retrieved lymph nodes as the minimum threshold.
Patients with ≥24 lymph nodes showed significantly better 5-year survival rates and superior predictive performance for survival outcomes.

Conclusions

A minimum of 24 retrieved lymph nodes is recommended for evaluating prognosis and reducing stage migration in gastric cancer patients.
This threshold aids in more accurate staging and improved patient outcomes after neoadjuvant therapy and gastrectomy.