Preoperative lymph node size is helpful to predict the prognosis of patients with stage III gastric cancer after radical resection.

Objective: To investigate the association between preoperative lymph node size (Ns) and prognosis of radical gastrectomy for gastric cancer.
Methods: The clinical and pathological data of 970 patients undergoing radical gastrectomy for gastric cancer were retrospectively analyzed. The correlation between Ns and the identified variables for the prediction of overall survival (OS) and disease-free survival (DFS) was examined.
Results: Three hundred and thirty-one (34.1%) of 970 patients developed recurrence, which was most commonly in local lymph nodes. The average Ns was 1.52 cm in patients with recurrence, which was significantly higher than the 1.14 cm observed in patients without recurrence (p < 0.001). Patients were categorized into three groups as follows (Ns category):Ns0:≤1.10 cm, Ns1:1.10-1.70 cm, and Ns2:>1.70 cm, determined using the X-tile program. In univariate and multivariate analyses, Ns category, age, tumor size, lymphadenectomy, adjuvant chemotherapy and TNM stage were independent prognostic factors for DFS. Stratified analysis only in stage III was there a significant difference in the Ns category based on TNM stage. Furthermore, in the stage III subgroup, univariate and multivariate analyses revealed that Ns category, lymphadenectomy, and TNM stage was independent prognostic factors for DFS. A nomogram were developed to predict the 3-year DFS rate.
Conclusions: Preoperative Ns is an independent prognostic factor for DFS of patients after radical surgery for gastric cancer. The proposed nomogram combined with Ns could be a simple and effective approach to predict the 3-year DFS of stage III patients.
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