Abstract
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.