Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.3967
Revised: January 3, 2014
Accepted: January 19, 2014
Published online: April 14, 2014
Gastric cancer, one of the most common malignancies in the world, frequently reveals lymph node, peritoneum, and liver metastases. Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection, which results in poor prognosis. Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer. Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials, it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year follow-up study. Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide, but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis. It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer. Besides, the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer.
Core tip: Many issues regarding lymph node metastasis in gastric cancer need to be addressed for improving prognostic evaluation. Theoretically, the appropriate classification of lymph node metastasis is able to improve the accurate prognosis of patients. However, it is still controversial over which classification of lymph node metastasis should be deemed as the most powerful predictor of prognosis. The optimal extent of lymph node dissection has been still debating for several decades in the world. The perfect lymphadenectomy can provide the abundant count of dissected lymph nodes for pathological examination, which is considered as the irreplaceable element for accurate evaluation of disease status. In addition, the negative node count should not be considered as a clinical variable without any significance in prognostic evaluation.