# Tumor Characteristics and D2 Lymph Node Involvement in Gastric Cancer: A Clinicopathological Analysis (2018–2023): -

## TL;DR

This study examines how tumor features relate to lymph node involvement in gastric cancer and finds that D2 lymph node metastasis is a strong indicator of poor survival.

## Contribution

The study identifies tumor stage and D2 lymph node status as key predictors of survival in gastric cancer patients.

## Key findings

- D2 lymph node metastasis was associated with significantly lower overall survival (25.43 months) compared to patients without metastasis (43.06 months).
- Tumor stage and size were strong predictors of survival, with Stage 3C tumors showing the poorest outcomes.
- Tumor grade, size, and location were not independently predictive of D2 lymph node involvement.

## Abstract

Gastric adenocarcinoma is a leading cause of cancer-related
mortality worldwide, with lymph node involvement, particularly at the level
2 lymph node dissection (D2),
serving as a critical determinant of prognosis and surgical strategy. This
study aimed to evaluate
the association between primary tumor characteristics and D2 lymph node
involvement and
examine these factors’ impact on overall survival (OS) and disease-free
survival (DFS) in patients undergoing curative gastrectomy.

A retrospective cohort study
was conducted on 233 patients with histologically confirmed gastric cancer
who underwent
curative-intent surgery at Namazi Hospital (Shiraz, Iran) between April 2018
and March 2023.
Clinicopathological variables, including tumor size, location, grade, and
histologic type, were
assessed with D2 lymph node involvement. Survival outcomes were analyzed
using Kaplan–
Meier estimates and compared using the log-rank test. Multivariate logistic
regression and Cox
proportional hazards models were employed to identify independent nodal
involvement and
survival predictors.

D2 lymphadenectomy in 38.1% of patients indicated no significant
associations between D2 involvement and tumor grade (P=0.443), size
(P=0.215), or location
(P=0.522). However, D2 lymph node metastasis was associated with a
significantly descending
mean of overall survival (25.43 ± 3.36 months) compared to patients without
D2 involvement
(43.06 ± 2.59 months; P0.001). Tumor stage and size were strong predictors
of survival, with
Stage 3C patients revealing a median overall survival of 13.45 months and
tumors 3 cm being
associated with superior outcomes (P=0.002).

D2 lymph node involvement reflects progressive disease biology
and is an assertive prognostic marker in gastric adenocarcinoma. While tumor
grade, size, and location were not independently predictive of D2
metastasis,
tumor stage and nodal status were strongly associated with survival. These
results reinforce
the use of extended lymphadenectomy in selected patients and underscore the
requirement for
individualized surgical planning based on total tumor profiling.