Scholarlink

Background <p>Stations 5, 6, and 12a lymph nodes—designated as key distal lymph nodes (KDLN)—fall outside the routine dissection scope of proximal gastrectomy (PG). Assessment of metastasis risk and therapeutic value index (TVI) contributes to improved curative resection rates in proximal gastric cancer (PGC).</p> Methods <p>We retrospectively collected 1,301 patients with PGC, and after screening, ultimately included 695 patients with advanced PGC who underwent radical total gastrectomy (TG) with D2 lymph node dissection. Logistic regression analyses were used to identify independent risk factors for KDLN metastasis. Based on these independent risk factors, the TVI for dissecting KDLN was calculated for both the overall cohort and relevant subgroups.</p> Results <p>Pathological examination confirmed metastasis to KDLN in 15.8% of patients. Multivariate analysis identified tumor size &gt; 5.5&#xa0;cm (<i>P</i> &lt; 0.001), neural invasion (NI) (<i>P</i> = 0.045), and lymphovascular invasion (LVI) (<i>P</i> = 0.027) as independent high-risk factors for such metastasis. The TVI for dissecting these KDLN increased in patients with any of these risk factors (tumor size &gt; 5.5&#xa0;cm: 8.8% vs. ≤ 5.5&#xa0;cm: 2.1%; LVI positive: 3.4% vs. LVI negative: 1.8%; NI positive: 3.4% vs. NI negative: 1.2%), suggesting thorough dissection might confer a significant survival benefit in high-risk cases. Notably, the TVI was markedly higher when station 4 was positive (10.9%) compared to negative (1.2%), indicating its potential utility in preoperative or intraoperative risk stratification.</p> Conclusion <p>Tumor size, NI, and LVI are independent risk factors for KDLN metastasis in PGC.Dissection of KDLN offers a survival benefit in patients exhibiting high-risk features (Tumor size &gt; 5.5&#xa0;cm) or Station 4 metastasis. For patients in whom postoperative pathology reveals LVI or NI, intensified follow‑up surveillance of the KDLN is recommended.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Therapeutic Value of Dissecting Distal Lymph Nodes in Proximal Gastric Cancer: A TVI-Based Risk Stratification

  • 期刊论文

  • 发表日期：

    2026年3月9日

查看全文
  • Jintao He,
  • Yanqiang Zhang,
  • Ruixin Xu,
  • Ruolan Zhang,
  • Mengxuan Cao,
  • Weiwei Zhu,
  • Yizhou Wei,
  • Qing Yang,
  • Ke Shen,
  • Mengya Zhou,
  • Can Hu,
  • Siwei Pan,
  • Rongwei Ruan,
  • Zhiyuan Xu

摘要

Background

Stations 5, 6, and 12a lymph nodes—designated as key distal lymph nodes (KDLN)—fall outside the routine dissection scope of proximal gastrectomy (PG). Assessment of metastasis risk and therapeutic value index (TVI) contributes to improved curative resection rates in proximal gastric cancer (PGC).

Methods

We retrospectively collected 1,301 patients with PGC, and after screening, ultimately included 695 patients with advanced PGC who underwent radical total gastrectomy (TG) with D2 lymph node dissection. Logistic regression analyses were used to identify independent risk factors for KDLN metastasis. Based on these independent risk factors, the TVI for dissecting KDLN was calculated for both the overall cohort and relevant subgroups.

Results

Pathological examination confirmed metastasis to KDLN in 15.8% of patients. Multivariate analysis identified tumor size > 5.5 cm (P < 0.001), neural invasion (NI) (P = 0.045), and lymphovascular invasion (LVI) (P = 0.027) as independent high-risk factors for such metastasis. The TVI for dissecting these KDLN increased in patients with any of these risk factors (tumor size > 5.5 cm: 8.8% vs. ≤ 5.5 cm: 2.1%; LVI positive: 3.4% vs. LVI negative: 1.8%; NI positive: 3.4% vs. NI negative: 1.2%), suggesting thorough dissection might confer a significant survival benefit in high-risk cases. Notably, the TVI was markedly higher when station 4 was positive (10.9%) compared to negative (1.2%), indicating its potential utility in preoperative or intraoperative risk stratification.

Conclusion

Tumor size, NI, and LVI are independent risk factors for KDLN metastasis in PGC.Dissection of KDLN offers a survival benefit in patients exhibiting high-risk features (Tumor size > 5.5 cm) or Station 4 metastasis. For patients in whom postoperative pathology reveals LVI or NI, intensified follow‑up surveillance of the KDLN is recommended.