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. 2025 Jul 24;23(1):301.
doi: 10.1186/s12957-025-03951-7.

Characteristics and prognosis of skip lymph node metastasis in gastric cancer: a retrospective study

Kuang-Hua Lo  1 , Kuo-Hung Huang  1   2 , Wen-Liang Fang  1   2 , Shih-Chieh Lin  2   3 , Yi-Ping Hung  2   4 , Ming-Huang Chen  2   4 , Chew-Wen Wu  1   2 , Ching-Yun Kung  5   6
Affiliations

Characteristics and prognosis of skip lymph node metastasis in gastric cancer: a retrospective study

Kuang-Hua Lo et al. World J Surg Oncol. .

Abstract

Background: Lymph node dissection is a standardized procedure in gastric cancer surgery. Typically, lymph node metastasis begins in the perigastric (PG) region and then extends to the extraperigastric (EP) region. However, in some circumstances, skip lymph node metastasis occurs in the EP region without involvement of the PG lymph nodes. This study aims to investigate the clinical significance of skip lymph node metastasis in gastric cancer.

Methods: A total of 1,055 patients who underwent curative gastrectomy for primary gastric cancer with pathological lymph node metastasis were analyzed. Patients were categorized into three groups: the PG-only group, the PG + EP group, and the skip group. The clinicopathologic characteristics and prognosis were analyzed.

Results: The incidence of skip lymph node metastasis was 3.9% (41 of 1,055 patients). The skip group had a higher proportion of females compared to both the PG-only group (43.9% vs. 27.5%, p = 0.025) and the PG + EP group (43.9% vs. 26.5%, p = 0.017). Additionally, the skip group showed a higher proportion of intestinal-type tumors compared to the PG-only group (68.3% vs. 50.6%, p = 0.029) and the PG + EP group (68.3% vs. 40.2%, p = 0.001). Disease-free survival and overall survival in the skip group were similar to those in the PG-only group but significantly better than those in the PG + EP group.

Conclusions: Skip lymph node metastasis is uncommon, and it is associated with a higher proportion of females and intestinal-type tumors. The prognosis of the skip group was comparable to the PG-only group and significantly better than that of the PG + EP group.

Keywords: Gastric cancer; Lymph node metastasis; Skip metastasis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board of Taipei Veterans General Hospital (IRB-TPEVGH no. 2024-07-014BC#1). Consent for publication: We have obtained consent from all authors, and they have agreed to publish the results of this study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patient selection. RSG = radical subtotal gastrectomy, RTG = radical total gastrectomy, EP = extraperigastric, PG = perigastric, LN = lymph node
Fig. 2
Fig. 2
Overall survival (OS) and disease-free survival (DFS) of each group before matching. (A) OS of the skip group versus the PG-only group and PG + EP group, (B) DFS of the skip group versus the PG-only group and PG + EP group
Fig. 3
Fig. 3
Overall survival (OS) and disease-free survival (DFS) of the skip group and the PG-only group after matching. (A) OS of the skip group versus the PG-only group, (B) DFS of the skip group versus the PG-only group
Fig. 4
Fig. 4
Overall survival (OS) of each status of lymph node metastasis with Kaplan–Meier curves after matching, stratified by prior to 2007 and post 2007. (A) Prior to 2007, (B) Post 2007
See this image and copyright information in PMC

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