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作者

Qing Yang MS Jingyang He MS Qianyu Zhao MS Siwei Pan MD Ruolan Zhang MD Mengxuan Cao MS Jiaqing Zhang MS Weiwei Zhu MS Mengya Zhou MS Jintao He MS Ruixin Xu MS Can Hu MD Zaisheng Ye MD Chen Gao MD Jie Chai MD Zhiyuan Xu MD

作者单位

⁹Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China ⁷Department of Urological Surgery, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China ¹⁰Department of Gastrointestinal Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, 250000, China ³Department of Pain Medicine, Suizhou Hospital of Hubei University of Medicine, Suizhou, China ⁸Department of Gastrointestinal Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China ⁴Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Hangzhou, Zhejiang, China ²Department of Gastric Surgery, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China ⁶Department of Radiology, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China ⁵Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China ¹Postgraduate Training Base Alliance, Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China

刊名

Surgery

年份

2026

卷号

Vol.194

页码

110140

ISSN

0039-6060

摘要

Background Given the significant relationship between the number of metastatic lymph nodes and primary tumor location, which is overlooked in the current pathologic node staging system, this study seeks to optimize pathologic node staging by incorporating this critical factor. Methods This study analyzed patients with primary gastric cancer who underwent radical gastrectomy, comprising 4,926 from a local cohort, 623 from a domestic cohort, and 4,243 from a public database. Patients were stratifi...更多

Background Given the significant relationship between the number of metastatic lymph nodes and primary tumor location, which is overlooked in the current pathologic node staging system, this study seeks to optimize pathologic node staging by incorporating this critical factor. Methods This study analyzed patients with primary gastric cancer who underwent radical gastrectomy, comprising 4,926 from a local cohort, 623 from a domestic cohort, and 4,243 from a public database. Patients were stratified by tumor location: upper, middle, or lower gastric subgroups. Restricted cubic spline plots evaluated nonlinear relationships between the number of metastatic lymph nodes and mortality across locations. The Cox proportional hazards model was used to assess the effects of clinical factors on patient prognosis. Univariate analyses assessed metastatic lymph nodes and tumor location effects on overall survival. Results Survival disparities persist by tumor location within identical pathologic node stages. Patients with upper-third gastric cancer show significantly worse survival than middle- or lower-third groups across pathologic node stages . Mortality risk progressively increases with more metastatic lymph nodes regardless of location. Critically, patients in the upper gastric cancer group exhibit a markedly accelerated mortality risk escalation than middle and lower groups , a trend consistent across pathologic tumor stages. Conclusion This study demonstrated that patients in the upper gastric cancer group have significantly worse survival than those in the middle and lower groups with identical metastatic lymph nodes. Leveraging tumor location and metastatic lymph nodes, we established a novel pathologic node staging system that outperformed the conventional pathologic tumor-node-metastasis staging in prognostic discrimination.收起

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