ArticleJournal of gastrointestinal cancer2026
Therapeutic Value of Dissecting Distal Lymph Nodes in Proximal Gastric Cancer: A TVI-Based Risk Stratification.
Article in Journal of gastrointestinal cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStations 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).
methodsWe 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.
resultsPathological 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.
conclusionTumor 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.
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