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The Prognostic Impact of Occult Lymph Node Metastasis in Node-negative Gastric Cancer: A Systematic Review and Meta-analysis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

This work was supported by National Science Foundation of China [No. 81000943]; Scientific Research Foundation for Doctors of Liaoning Province [No. 20101146]; and the Key Laboratory Programme of Education Department of Liaoning Province (LS2010165).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

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

    Jin-yu Huang MD, Ying-ying Xu MD, PhD, Zhe Sun MD, PhD, Zhi Zhu MD, PhD, Yong-xi Song MD, Zhi-feng Miao MD, Jian-hua Wu MD & Hui-mian Xu MD, PhD

  2. Department of Breast Surgery, First Affiliated Hospital of China Medical University, Shenyang, China

    Ying-ying Xu MD, PhD

  3. Department of Clinical Epidemiology, First Affiliated Hospital of China Medical University, Shenyang, China

    Min Li MD

Authors
  1. Jin-yu Huang MD
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  2. Ying-ying Xu MD, PhD
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  3. Min Li MD
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  4. Zhe Sun MD, PhD
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  5. Zhi Zhu MD, PhD
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  7. Zhi-feng Miao MD
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  9. Hui-mian Xu MD, PhD
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Corresponding author

Correspondence to Hui-mian Xu MD, PhD.

Additional information

J. Huang and Y. Xu contributed equally to this study.

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Huang, Jy., Xu, Yy., Li, M. et al. The Prognostic Impact of Occult Lymph Node Metastasis in Node-negative Gastric Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 20, 3927–3934 (2013). https://doi.org/10.1245/s10434-013-3021-7

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  • DOI: https://doi.org/10.1245/s10434-013-3021-7

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