Pattern of lymph node spread in gastric cancer: Western multicenter retrospective study
Francesca Blasa1, Giuseppe Verlato2, Hidde Overtoom3,4
1General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy.
BJS Open
|July 3, 2026
Summary
Gastric cancer lymph node metastasis patterns vary by tumor location and biology. Understanding these patterns, including microsatellite status, aids in tailoring surgical strategies for better patient outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Gastric cancer exhibits heterogeneous lymph node (LN) metastasis patterns influenced by tumor biology and location.
- Limited contemporary Western data exists on LN dissemination in gastric adenocarcinoma.
Purpose of the Study:
- To analyze lymph node metastasis patterns in resectable gastric adenocarcinoma.
- To investigate the influence of tumor location, histotype, and molecular features on LN spread.
Main Methods:
- Retrospective multicenter study of 950 patients with resectable gastric adenocarcinoma undergoing curative gastrectomy.
- Analysis of LN retrieval and metastatic involvement based on tumor location, Lauren histotype, p stage, neoadjuvant chemotherapy, and microsatellite status (MSI/MSS).
- Lymph node stations categorized into three anatomical tiers per Japanese Gastric Cancer Association classification.
Main Results:
- Diffuse and mixed histotypes showed approximately double the LN metastasis incidence compared to intestinal-type tumors.
- Anatomical pattern of lymphatic spread was site-specific; neoadjuvant chemotherapy reduced nodal burden but not distribution.
- Microsatellite instability (MSI) tumors had lower nodal involvement than microsatellite stable (MSS) tumors.
Conclusions:
- Tumor location dictates the anatomical pattern of LN spread, while histology and molecular features correlate with metastatic risk.
- Integrating biological and anatomical factors can refine surgical strategies for gastric cancer treatment.
