Efficacy of nodal dissection for locoregional gastric neuroendocrine carcinoma: a multicenter retrospective observational study

Yukinori Yamagata¹, Mitsuhiro Furuta², Akifumi Notsu³, Hirofumi Yasui⁴, Rie Makuuchi⁵, Takanobu Yamada⁶, Michihiro Ishida⁷, Kunihiro Tsuji⁸, Shigeaki Baba⁹, Noriaki Tokumoto¹⁰, Shusuke Haruta¹¹, Masaya Watanabe¹², Takuya Hamakawa¹³, Yasuyuki Kawachi¹⁴, Norihiko Sugisawa¹⁵, Hiroshi Yabusaki¹⁶, Ryohei Kawabata¹⁷, Yukinori Kurokawa¹⁸, Narikazu Boku¹⁹, Masanori Terashima²⁰, Nozomu Machida², Takaki Yoshikawa²¹

Affiliations

¹ Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. yuyamaga@ncc.go.jp.
² Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa, Japan.
³ Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.
⁴ Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
⁵ Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
⁶ Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
⁷ Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
⁸ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
⁹ Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan.
¹⁰ Department of Gastroenterological Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan.
¹¹ Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
¹² Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan.
¹³ Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁴ Department of Surgery, Nagaoka Chuo General Hospital, Niigata, Japan.
¹⁵ Department of Surgery, Miyagi Cancer Center, Miyagi, Japan.
¹⁶ Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
¹⁷ Department of Gastroenterological Surgery, Sakai City Medical Center, Osaka, Japan.
¹⁸ Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
¹⁹ Department of Oncology and General Medicine, Institute of Medical Science Hospital, University of Tokyo, Tokyo, Japan.
²⁰ Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
²¹ Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.

PMID: 40587056
DOI: 10.1007/s10120-025-01636-4

Observational Study

Efficacy of nodal dissection for locoregional gastric neuroendocrine carcinoma: a multicenter retrospective observational study

Yukinori Yamagata et al. Gastric Cancer. 2025 Sep.

. 2025 Sep;28(5):1004-1016.

doi: 10.1007/s10120-025-01636-4. Epub 2025 Jun 30.

Authors

Affiliations

¹ Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. yuyamaga@ncc.go.jp.
² Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa, Japan.
³ Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.
⁴ Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
⁵ Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
⁶ Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
⁷ Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
⁸ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
⁹ Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan.
¹⁰ Department of Gastroenterological Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan.
¹¹ Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
¹² Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan.
¹³ Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁴ Department of Surgery, Nagaoka Chuo General Hospital, Niigata, Japan.
¹⁵ Department of Surgery, Miyagi Cancer Center, Miyagi, Japan.
¹⁶ Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
¹⁷ Department of Gastroenterological Surgery, Sakai City Medical Center, Osaka, Japan.
¹⁸ Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
¹⁹ Department of Oncology and General Medicine, Institute of Medical Science Hospital, University of Tokyo, Tokyo, Japan.
²⁰ Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
²¹ Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.

PMID: 40587056
DOI: 10.1007/s10120-025-01636-4

Abstract

Background: Gastric neuroendocrine carcinoma (NEC) is a rare and aggressive malignancy for which no standard treatment has been established for locoregional disease. This multicenter retrospective study aimed to evaluate the prognostic relevance and therapeutic efficacy of lymph node dissection in this setting.

Methods: A total of 118 patients with gastric NEC or mixed adenoneuroendocrine carcinoma (MANEC) who underwent gastrectomy with lymph node dissection were analyzed. Survival outcomes, clinicopathological factors, and the therapeutic value index of each lymph node station were assessed. Lymph node involvement was classified using both the pathological N category and the extent of nodal involvement based on the dissection area (pND).

Results: The 5-year overall survival and 3-year recurrence-free survival rates were 56.7% and 63.4%, respectively. Prognostic stratification using pND provided clearer separation than using the conventional pN category. Multivariate analysis identified older age, female sex, and pND2 (metastasis to D2 area nodes) as independent unfavorable prognostic factors. The therapeutic value index for lymph nodes in the D1 area was high (35.0, based on 5-year overall survival), whereas the index for D2 nodes was markedly lower (6.8). Notably, these indices remained consistent across histological subtypes, showing similar values between NEC and MANEC. Postoperative chemotherapy and surgical complications did not significantly affect survival outcomes.

Conclusions: Perigastric (D1) lymph node dissection appears to provide meaningful survival benefit in locoregional gastric NEC, whereas the additional value of D2 dissection is limited. These findings support consideration of a more selective surgical approach, though further validation is needed.

Keywords: Gastrectomy; Gastric neuroendocrine carcinoma; Lymph node dissection; Therapeutic value index.

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Conflict of interest statement

Declarations. Conflict of interests: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

References

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Efficacy of nodal dissection for locoregional gastric neuroendocrine carcinoma: a multicenter retrospective observational study

Affiliations

Efficacy of nodal dissection for locoregional gastric neuroendocrine carcinoma: a multicenter retrospective observational study

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical