Gastric Cancer

, Volume 22, Issue 4, pp 853–863 | Cite as

Number of retrieved lymph nodes is an independent prognostic factor after total gastrectomy for patients with stage III gastric cancer: propensity score matching analysis of a multi-institution dataset

  • Shogo Hayashi
  • Mitsuro KandaEmail author
  • Seiji Ito
  • Yoshinari Mochizuki
  • Hitoshi Teramoto
  • Kiyoshi Ishigure
  • Toshifumi Murai
  • Takahiro Asada
  • Akiharu Ishiyama
  • Hidenobu Matsushita
  • Chie Tanaka
  • Daisuke Kobayashi
  • Michitaka Fujiwara
  • Kenta Murotani
  • Yasuhiro Kodera
Original Article



The prognostic significance of the number of retrieved lymph nodes (RLNs) in gastric cancer remains controversial. Therefore, we designed a multicenter collaborative database to investigate the correlation between the number of RLNs and prognosis of patients with advanced gastric cancer after curative resection.


We retrospectively analyzed 1103 patients who underwent gastrectomy for stage II/III gastric cancer between 2010 and 2014. Lymph nodes, which were retrieved by surgeons from surgically resected specimens, were validated by pathologists. A target population and the optimal cutoff were determined using receiver operating characteristic (ROC) curve analysis. After propensity score matching of eight variables, including splenectomy and adjuvant chemotherapy, the prognostic significance of RLNs was evaluated.


According to ROC curve analysis, the optimum cutoff score for predicting postoperative survival was 40. After matching, the backgrounds of patients in the RLN < 40 and RLN ≥ 40 groups (n = 87 each) became well-balanced. The RLN < 40 group experienced significantly shorter relapse-free and overall survival. The prevalence of peritoneal recurrence was significantly increased in the RLN < 40 group. RLN < 40 was an independent prognostic factor in multivariable analysis, although pathological N status was not. A forest plot revealed that the RLN < 40 group was at greater risk of recurrence in most subgroups.


RLN < 40 was associated with an adverse prognosis of patients with stage III gastric cancer who underwent total gastrectomy.


Gastric cancer Number of retrieved LNs Prognosis Total gastrectomy 



We thank Edanz Group ( for editing a draft of this manuscript.

Compliance with ethical standards

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study, or the equivalent, was obtained from all patients.

Conflict of interest

All Authors declare that they have no conflict of interest.

Supplementary material

10120_2018_902_MOESM1_ESM.tif (5.9 mb)
Supplemental Fig. 1. Receiver operating characteristic curve analysis of the numbers of RLNs associated with 2-year mortality after surgery in each category by type of gastrectomy and disease stage (TIF 6034 KB)
10120_2018_902_MOESM2_ESM.tif (5.9 mb)
Supplemental Fig. 2. Subgroup analyses of relapse-free survival associated with splenectomy (TIF 6033 KB)
10120_2018_902_MOESM3_ESM.tif (5.9 mb)
Supplemental Fig. 3. Subgroup analyses of relapse-free survival according to pathological N stage (TIF 6033 KB)
10120_2018_902_MOESM4_ESM.tif (5.9 mb)
Supplemental Fig. 4. Subgroup analyses of relapse-free survival according to the administration of postoperative adjuvant chemotherapy (TIF 6033 KB)
10120_2018_902_MOESM5_ESM.docx (14 kb)
Supplementary material 5 (DOCX 14 KB)


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Shogo Hayashi
    • 1
  • Mitsuro Kanda
    • 2
    Email author
  • Seiji Ito
    • 3
  • Yoshinari Mochizuki
    • 4
  • Hitoshi Teramoto
    • 5
  • Kiyoshi Ishigure
    • 6
  • Toshifumi Murai
    • 7
  • Takahiro Asada
    • 8
  • Akiharu Ishiyama
    • 9
  • Hidenobu Matsushita
    • 1
  • Chie Tanaka
    • 2
  • Daisuke Kobayashi
    • 2
  • Michitaka Fujiwara
    • 2
  • Kenta Murotani
    • 10
  • Yasuhiro Kodera
    • 2
  1. 1.Department of SurgeryTosei General HospitalSetoJapan
  2. 2.Department of Gastroenterological Surgery (Surgery II)Nagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Department of Gastroenterological SurgeryAichi Cancer CenterNagoyaJapan
  4. 4.Department of SurgeryKomaki Municipal HospitalKomakiJapan
  5. 5.Department of SurgeryYokkaichi Municipal HospitalYokkaichiJapan
  6. 6.Department of SurgeryKonan Kosei HospitalKonanJapan
  7. 7.Department of SurgeryIchinomiya Municipal HospitalIchinomiyaJapan
  8. 8.Department of SurgeryGifu Prefectural Tajimi HospitalTajimiJapan
  9. 9.Department of SurgeryOkazaki City HospitalOkazakiJapan
  10. 10.Biostatistics Center, Graduate School of MedicineKurume UniversityKurumeJapan

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