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Randomized Controlled Trial
. 2022 Nov;25(6):1060-1072.
doi: 10.1007/s10120-022-01329-2. Epub 2022 Sep 14.

Pattern of lymph node metastases in gastric cancer: a side-study of the multicenter LOGICA-trial

Cas de Jongh  1   2 , Lianne Triemstra  3 , Arjen van der Veen  3 , Lodewijk A A Brosens  3   4 , Misha D P Luyer  5 , Jan H M B Stoot  6 , Jelle P Ruurda  3 , Richard van Hillegersberg  3 ; LOGICA Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Pattern of lymph node metastases in gastric cancer: a side-study of the multicenter LOGICA-trial

Cas de Jongh et al. Gastric Cancer. 2022 Nov.

Abstract

Background: The relation between gastric cancer characteristics and lymph node (LN) metastatic patterns is not fully clear, especially following neoadjuvant chemotherapy (NAC). This study analyzed nodal metastatic patterns.

Methods: Individual LN stations were analyzed for all patients from the LOGICA-trial, a Dutch multicenter randomized trial comparing laparoscopic versus open D2-gastrectomy for gastric cancer. The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC.

Results: Between 2015-2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 120 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; p < 0.05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR > 1, p > 0.05). However, distal tumors also metastasized to proximal LN stations, and vice versa. Despite NAC, each LN station (no. 1-9, 11 and 12a) showed metastases, regardless of tumor location, cT-stage, histological subtype and NAC treatment, including station 12a for cT1N0-tumors. LN metastases were present more frequently in diffuse versus intestinal tumors (66% versus 52%; p = 0,048), but not for cT3-4- versus cT1-2-stage (59% versus 51%; p = 0.259). However, the pattern of LN metastases was similar for these subgroups.

Conclusions: The extent of lymphadenectomy cannot be reduced after NAC for gastric cancer. Although the pattern of LN metastases is related to tumor location, all LN stations contained metastases regardless of tumor location, cT-stage (including cT1N0-tumors), histological subtype, or NAC treatment. Therefore, D2-lymphadenectomy should be routinely performed during gastrectomy in Western patients.

Keywords: Gastric cancer; Lymph node metastasis; Lymphadenectomy; Personalized medicine.

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Conflict of interest statement

Richard van Hillegersberg: consulting or advisory role: Intuitive Surgical, Medtronic. Jelle Ruurda: consulting or advisory role: Intuitive Surgical. Lodewijk Brosens: advisory role: Bristol Myers Squibb. Misha Luyer: consulting or advisory role: Galvani, Medtronic. Research Funding: Dutch Cancer Foundation. Travel, Accommodations, and Expenses: Medtronic.

Figures

Fig. 1
Fig. 1
Lymph node stations for total and distal gastrectomy according to the 5th classification of the Japanese Gastric Cancer Association (JGCA) (10). The dissection of individual lymph node stations is displayed separately for total (left) and distal (right) gastrectomy, and also for D1- (blue stations), D1+ (blue and orange stations), and D2-lymphadenectomy. Of note: stations no. 13–20 and 110–112 are not depicted in this image. The original image was published by JGCA and can be found here: https://link.springer.com/article/10.1007/s10120-020-01042-y. No changes were made
Fig. 2
Fig. 2
Study flowchart
Fig. 3
Fig. 3
Incidence of lymph node metastases per tumor location, cT-stage, Lauren classification and treatment with or without neoadjuvant chemotherapy. The exact numbers for all incidences of lymph node metastases in this figure are displayed in Supplementary Table 1, which contains the same information, but numeric
See this image and copyright information in PMC

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