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Ann Surg Oncol. 2013 Nov;20(12):3927-34. doi: 10.1245/s10434-013-3021-7. Epub 2013 Jul 27.

The prognostic impact of occult lymph node metastasis in node-negative gastric cancer: a systematic review and meta-analysis.

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1
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China.

Abstract

PURPOSE:

To conduct a meta-analysis to clarify whether occult lymph node metastasis (OLNM), which is identified by molecular detection techniques but is not detected by routine histological examination within regional lymph nodes, represents a prognostic factor for patients with node-negative gastric cancer.

METHODS:

PubMed, Embase, and the Cochrane Library were searched from their inception to November 2012. The published studies that investigated the association between OLNM and the prognosis of patients with node-negative gastric cancer were included. We extracted hazard ratios (HRs) and associated standard errors from the identified studies and performed random-effects model meta-analyses on overall survival and disease-specific survival. Subgroup analyses were also conducted.

RESULTS:

A total of 14 eligible studies that included 1,478 patients were identified. Meta-analyses revealed that OLNM was associated with poor overall survival [HR 2.72; 95% confidence interval (CI) 1.61-4.60], and disease-specific survival (HR 2.91; 95% CI 1.25-6.79). Subgroup analyses suggested that OLNM was associated with poor survival in early gastric cancer (HR 3.57; 95% CI 1.23-10.33). However, subgroup analyses of studies that exclusively enrolled patients with D2 lymph node dissection demonstrated that OLNM did not have an influence on the prognosis (HR 1.97; 95% CI 0.82-4.70).

CONCLUSIONS:

OLNM correlates with poor prognosis for patients with node-negative gastric cancer, and D2 lymph node dissection could eliminate this correlation. For OLNM-positive patients with node-negative gastric cancer, D2 lymph node dissection is necessary.

PMID:
23892524
DOI:
10.1245/s10434-013-3021-7
[Indexed for MEDLINE]
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