Survival impact of the number of lymph node retrieved on patients with node-negative gastric cancer: more is better?

Adequate and proper lymphadenectomy has been widely accepted as a standard treatment for localized gastric cancer (GC) (1-3). The number of lymph node involvement is one of the parts of TNM classification based on American Joint Committee on Cancer (4). Accordingly, accuracy of nodal metastasis is important to predict patient’s survival precisely. In the issue of Annals of Surgical Oncology, Deng et al. investigated whether increasing the number of examined lymph node (NELN) will affect prognosis of node-negative GC patients after radical resection (5). Their results indicated that increasing the NELN improves the accuracy of cancer staging, especially in advanced stage disease. Furthermore, the authors also concluded that based on the discrepancy findings between China and Japan, inexperienced pathologists in China may potentially result in the low NELN, which led to incorrect cancer staging (5). Besides, they also observed that Chinese patients had more advanced diseases and less mean NELN as compared with Japanese patients. These are the principal causes explaining worse overall survival (OS) in Chinese patients than Japanese patients with regard to NELN.