{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:27:23Z","timestamp":1786944443905,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastric cancer is a biologically heterogeneous disease with variable patterns of lymph node (LN) metastasis influenced by tumour biology and anatomical location. Contemporary Western data on LN dissemination remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicentre study evaluated data from patients with resectable gastric adenocarcinoma who underwent curative-intent gastrectomy at five high-volume European centres. LN retrieval and metastatic involvement were analysed according to tumour location, Lauren histotype, pathological (p) stage, neoadjuvant chemotherapy, and microsatellite status (microsatellite instability (MSI) or microsatellite stable (MSS)). Lymph node stations were analysed individually and grouped into three anatomical tiers based on proximity to the stomach, according to the Japanese Gastric Cancer Association classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all, 950 patients were included in the study. The incidence of LN metastasis in diffuse and mixed histotypes was approximately twice that of intestinal-type tumours, along with higher metastatic rates across multiple perigastric first-tier and selected second-tier stations (P &amp;lt; 0.050 to P &amp;lt; 0.001). The anatomical pattern of lymphatic spread was site-specific, with consistent drainage pathways across tumour locations. In early gastric cancer, LN metastases were rare and largely confined to stations 3 and 4. Neoadjuvant chemotherapy reduced overall nodal burden without altering the anatomical distribution of metastatic stations. MSI tumours exhibited lower nodal involvement than MSS tumours, with higher rates of node-negative disease (49.3% versus 41.3%) and fewer patients with pN3 tumours (15.9% versus 27.7%; P = 0.044).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tumour location influenced the anatomical pattern of LN spread, whereas histological and molecular features were associated with differences in metastatic risk and extent. The integration of biological and anatomical factors may support more tailored surgical strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag076","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:37:38Z","timestamp":1779190658000},"source":"Crossref","is-referenced-by-count":0,"title":["Pattern of lymph node spread in gastric cancer: Western multicenter retrospective study"],"prefix":"10.1093","volume":"10","author":[{"given":"Francesca","family":"Blasa","sequence":"first","affiliation":[{"name":"General and Upper GI Surgery Division, Department of Surgery, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Verlato","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidde","family":"Overtoom","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Treatment and Quality of Life, Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina Hermez","family":"Chole","sequence":"additional","affiliation":[{"name":"Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital , Stockholm ,","place":["Sweden"]},{"name":"Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Tedone","sequence":"additional","affiliation":[{"name":"General and Upper GI 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,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7046-0112","authenticated-orcid":false,"given":"Dimitrios","family":"Schizas","sequence":"additional","affiliation":[{"name":"First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Theodorou","sequence":"additional","affiliation":[{"name":"First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6215-8132","authenticated-orcid":false,"given":"Magnus","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital , Stockholm ,","place":["Sweden"]},{"name":"Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne S","family":"Gisbertz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Treatment and Quality of Life, Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Bencivenga","sequence":"additional","affiliation":[{"name":"General and Upper GI Surgery Division, Department of Surgery, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0774-1904","authenticated-orcid":false,"given":"Ioannis","family":"Rouvelas","sequence":"additional","affiliation":[{"name":"Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital , Stockholm ,","place":["Sweden"]},{"name":"Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens 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