Number of Lymph Nodes Assessed in Iranian Gastric Cancer patients

Background: We studied the number of lymph nodes (LN) assessed in gastric cancer, and evaluated the association between different factors and a lower number of LN assessed. Methods: We conducted a retrospective study in three hospitals in Tehran city, I.R. Of Iran. We used patient medical and pathological reports and obtained personal and clinical information. We studied the association of being on the N3 stage with the number of assessed lymph nodes (NALN), gender, tumor size, T stage, hospital, tumor site, histopathological diagnosis, tumor grade and age at diagnosis. In addition, we estimated the association between NALN and different clinical variables. A logistic regression model estimated the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). Results: The average number of NALN was 10.48 (±6.9). We found that the probability of being diagnosed as stage N3 was significantly lower in patients who had less than 15 LN assessed compared to those who had more than 15 LN assessed in their pathology reports (OR=0.2; 95% CI 0.1-0.4). The hospital, tumor sizes were significantly associated with NALN. Conclusion: Lower NALN led to stage migration and underestimation of the real tumor stage in GC patients. The LN assessments were lower than recommended by the American Joint Cancer Clinician Association in all the three hospitals included in this study. Developing national guidelines, training surgeons and pathologists, conducting regular monitoring and evaluation of the data is necessary to increase NALN and thus improve the staging of GC patients.