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<p>This study evaluated the impact of retrieved lymph nodes (rLNs) and negative lymph nodes (NLNs) on the prognosis of gastric cancer under different surgical approaches and determined optimal thresholds. A total of 764 patients from our center (2016–2020) were divided into radical subtotal gastrectomy (RSG) and radical total gastrectomy (RTG) groups, while 6,474 patients from the SEER database (2018–2022) were used for N0–N3 stratification. Restricted cubic spline analysis identified optimal rLN thresholds, and NLN thresholds were derived from institutional data. Kaplan–Meier analysis, log-rank tests, propensity score matching (PSM), and external validation were applied. The optimal rLN thresholds for RSG were 19, 19, 20, and 24 for N0–N3, respectively, and for RTG were 22 for N0–N2 and 29 for N3. After PSM, patients exceeding these thresholds showed significantly lower risk of death compared with those below the thresholds, with hazard ratios (HRs) of 0.534 (95% CI, 0.386–0.737; N0), 0.596 (95% CI, 0.431–0.824; N1), 0.572 (95% CI, 0.399–0.820; N2), and 0.740 (95% CI, 0.546–1.001; N3) in RSG, and 0.559 (95% CI, 0.313–1.000; N0), 0.562 (95% CI, 0.335–0.942; N1), 0.483 (95% CI, 0.237–0.981; N2), and 0.560 (95% CI, 0.369–0.849; N3) in RTG. The optimal NLN thresholds were 18 for RSG and 19 for RTG, both associated with improved overall survival in internal and external cohorts (all log-rank <i>P</i> &lt; 0.05). These findings suggest that optimal lymph node targets vary by surgical approach and nodal stage, and stratified thresholds provide quantitative reference for surgical quality control and prognostic evaluation.</p>

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The impact of the number of retrieved lymph nodes and negative lymph nodes on the prognosis of gastric cancer patients under different surgical approaches

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Linjun Hu,
  • Ziyang Bao,
  • Xiaoge Geng

摘要

This study evaluated the impact of retrieved lymph nodes (rLNs) and negative lymph nodes (NLNs) on the prognosis of gastric cancer under different surgical approaches and determined optimal thresholds. A total of 764 patients from our center (2016–2020) were divided into radical subtotal gastrectomy (RSG) and radical total gastrectomy (RTG) groups, while 6,474 patients from the SEER database (2018–2022) were used for N0–N3 stratification. Restricted cubic spline analysis identified optimal rLN thresholds, and NLN thresholds were derived from institutional data. Kaplan–Meier analysis, log-rank tests, propensity score matching (PSM), and external validation were applied. The optimal rLN thresholds for RSG were 19, 19, 20, and 24 for N0–N3, respectively, and for RTG were 22 for N0–N2 and 29 for N3. After PSM, patients exceeding these thresholds showed significantly lower risk of death compared with those below the thresholds, with hazard ratios (HRs) of 0.534 (95% CI, 0.386–0.737; N0), 0.596 (95% CI, 0.431–0.824; N1), 0.572 (95% CI, 0.399–0.820; N2), and 0.740 (95% CI, 0.546–1.001; N3) in RSG, and 0.559 (95% CI, 0.313–1.000; N0), 0.562 (95% CI, 0.335–0.942; N1), 0.483 (95% CI, 0.237–0.981; N2), and 0.560 (95% CI, 0.369–0.849; N3) in RTG. The optimal NLN thresholds were 18 for RSG and 19 for RTG, both associated with improved overall survival in internal and external cohorts (all log-rank P < 0.05). These findings suggest that optimal lymph node targets vary by surgical approach and nodal stage, and stratified thresholds provide quantitative reference for surgical quality control and prognostic evaluation.