Inadequacy of lymph node staging in gastric cancer patients: A population-based study

Nancy N. Baxter, Todd M. Tuttle

Research output: Contribution to journalReview articlepeer-review

69 Scopus citations


Background: In 1997, examination of at least 15 lymph nodes was recommended for adequate gastric cancer staging. However, the proportion of patients undergoing an adequate lymph node examination (LNE) has not been studied in a population-based manner. Methods: We used Surveillance, Epidemiology, and End Results cancer registry data to assess LNE adequacy in adults with nonmetastatic gastric adenocarcinoma. We selected patients aged 18 through 80 years whose disease was diagnosed from 1998 through 2001 and who underwent at least partial gastrectomy. We evaluated the overall number of nodes, estimated the likelihood of adequate LNE (i.e., ≥15 nodes examined), and determined the influence of selected tumor and patient characteristics on LNE. Results: In this 4-year period, 3593 patients met our study's selection criteria. The median number of nodes examined was 10: 32% of patients underwent adequate LNE, and 9% of patients had no nodes examined. Node-positive patients were more likely to have undergone an adequate LNE than node-negative patients (42% vs. 23%; P < .0001). Younger age, female sex, and more radical surgery were associated with adequate LNE in both univariate and multivariate analysis (P < .0001). Geographical site was an important predictor; patients from one registry (Hawaii) were significantly more likely to have undergone adequate LNE than patients from all other registries (56% vs. 30%; P < .0001). Conclusions: Our 4-year review of the Surveillance, Epidemiology, and End Results database revealed that only a third of patients with gastric cancer underwent adequate LNE, i.e., had the recommended minimum of 15 nodes examined for gastric cancer staging. Better results at one registry (Hawaii) indicate that substantial improvements could be made.

Original languageEnglish (US)
Pages (from-to)981-987
Number of pages7
JournalAnnals of Surgical Oncology
Issue number12
StatePublished - Dec 2005

Bibliographical note

Funding Information:
The authors thank Dr. Mary Knatterud for her helpful editorial suggestions. Supported, in part, by the University of Minnesota Comprehensive Cancer Center. Both authors are supported by University of Minnesota Cancer Center Clinical Scholar Awards. N.N.B. is supported by an American Society of Clinical Oncology Career Development Award.


  • Gastric cancer
  • Pathology
  • Patterns of care
  • Staging
  • Standard of care
  • Surgery


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