{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T22:11:26Z","timestamp":1772575886717,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2014,5,22]],"date-time":"2014-05-22T00:00:00Z","timestamp":1400716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2014,9,15]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>National guidelines recommend examination of \u2265\u200915 lymph nodes for adequate staging of resectable gastric adenocarcinoma (GA). The relevance of these guidelines, which were established before the increasing use of multimodality therapy, and the impact of inadequate lymph node staging (LNS) in a contemporary cohort have not been extensively explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Stage I\u2010III GA patients who underwent gastrectomy from 1998 to 2011 were identified using the National Cancer Data Base. Trends in LNS adequacy, predictors of inadequate LNS (&lt;\u200915 LN examined) and the relationship between LNS and overall survival (OS) were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In 22,409 patients, compliance with LNS guidelines was poor (inadequate LNS in 61.2% of cases, median LN harvested in 11.0%). Subtotal\/partial gastrectomy was the strongest predictor of inadequate LNS (OR\u2009=\u20092.01, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). Survival analyses included 9139 patients with minimum 5 years follow\u2010up; median, 1\u2010year, and 5\u2010year survival was 35.6 months, 75.5%, and 39.7%, respectively. LN positivity (HR\u2009=\u20091.90) and age &gt;\u200976 years (HR\u2009=\u20091.73) were the strongest predictors of worse OS (both <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). Inadequate LNS was independently associated with worse OS (HR\u2009=\u20091.33, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). Median OS after inadequate compared to adequate LNS was significantly worse (33.3 months versus 42.0 months, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001), regardless of AJCC clinical stage subgroup or tumor T classification (both <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Adequate LNS is achieved in a minority of patients. Inadequate LNS was independently associated with worse OS. Examination of \u2265\u200915 LN is a reproducible prognosticator of gastric cancer outcomes in the United States and should continue to serve as a benchmark for quality of care. <jats:bold><jats:italic>Cancer<\/jats:italic> 2014;120:2855\u20132865.<\/jats:bold> \u00a9 <jats:italic>2014 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.28780","type":"journal-article","created":{"date-parts":[[2014,5,22]],"date-time":"2014-05-22T10:48:51Z","timestamp":1400755731000},"page":"2855-2865","source":"Crossref","is-referenced-by-count":51,"title":["Implications of inadequate lymph node staging in resectable gastric cancer: A contemporary analysis using the <scp>N<\/scp>ational <scp>C<\/scp>ancer <scp>D<\/scp>ata <scp>B<\/scp>ase"],"prefix":"10.1002","volume":"120","author":[{"given":"Jashodeep","family":"Datta","sequence":"first","affiliation":[{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Russell S.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronac","family":"Mamtani","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Stripp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel R.","family":"Kelz","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey A.","family":"Drebin","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Fraker","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgos C.","family":"Karakousis","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert E.","family":"Roses","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,5,22]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"National Cancer Institute.SEER Cancer Statistics Factsheets: Stomach Cancer.National Cancer Institute:Bethesda MD.http:\/\/seer.cancer.gov\/statfacts\/html\/stomach.html. 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