Clinicopathologic study of node-negative advanced gastric cancer and analysis of factors predicting its recurrence and prognosis

Chou, Hsu‐Huan; Kuo, Chia‐Jung; Chen, Tsung‐Hsing; Lin, Chun-Jun; Tseng, Jeng‐Hwei; Yeh, Ta‐Sen; Hwang, Tsann‐Long; Jan, Yi-Yin

doi:10.1016/j.amjsurg.2012.04.014

Cited by 44 publications

(43 citation statements)

References 26 publications

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“…5,[8][9][10][11][12][13][14][15] However, these studies generally represent single-center experiences, the majority of which come from Eastern centers. Only 4 available studies are from Western populations.…”

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confidence: 98%

Factors Associated With Recurrence and Survival in Lymph Node–negative Gastric Adenocarcinoma

et al. 2015

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confidence: 98%

Factors Associated With Recurrence and Survival in Lymph Node–negative Gastric Adenocarcinoma

et al. 2015

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“…Survival impact of the number of lymph node dissection on stage I-III node-negative gastric cancer subsequently led to higher recurrence rates and worse survival time compared to our previous research (6). Furthermore, a limited sample size in Jin's study might make the statistical difference insignificant between T2-T4 GC patients with less (< D2) and extensive (> D2) lymphadenectomy.…”

Section: Commentarymentioning

confidence: 38%

“…Our previous study has shown that there was no survival benefit of >15 nodes retrieved for patients with T1 node-negative GC; however, patients with T2-4 nodenegative GC with extensive lymphadenectomy (>25 nodal dissection) had longer survival time than those with nodes retrieved <25 (6). The GC-specific 5-year survival rates were 96.2%, 94.6%, and 97.9% in T1 tumor with the number of examined LN <15, 16-25 and >25, respectively (P=0.468).…”

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confidence: 99%

“…Curative resection including adequate lymphadenectomy provided the chance of a cure for stage I-III disease (1,4,5). Unfortunately, a subgroup of patients with node-negative GC who underwent radical surgery including extensive LN dissection still experiences tumor recurrence, distant metastasis and subsequently died from the disease (6,7). In the issue of Annals of Surgery, Jin et al indicated that in node-negative GC patients undergoing curative intent surgery, T3/T4 tumors, presence of lymphovascular invasion and signet ring histology independently affected overall survival suggesting that these patients may benefit from more aggressive adjuvant therapies (8).…”

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confidence: 99%

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Survival impact of the number of lymph node dissection on stage I–III node-negative gastric cancer

Yeh

Jan

2016

Transl. Gastroenterol. Hepatol.

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It is well known that lymph node (LN) status is the most important prognostic factor in localized gastric adenocarcinoma (GC) (1-4). Curative resection including adequate lymphadenectomy provided the chance of a cure for stage I-III disease (1,4,5). Unfortunately, a subgroup of patients with node-negative GC who underwent radical surgery including extensive LN dissection still experiences tumor recurrence, distant metastasis and subsequently died from the disease (6,7). In the issue of Annals of Surgery, Jin et al. indicated that in node-negative GC patients undergoing curative intent surgery, T3/T4 tumors, presence of lymphovascular invasion and signet ring histology independently affected overall survival suggesting that these patients may benefit from more aggressive adjuvant therapies (8). However, it should be noted that recurrence rates were 8.4% and 10.5% in T1 and stage I GC, respectively and 35.0% and 37.5% in T4 and stage III cancer, respectively in their study. The median number of nodes examined for patients with recurrence was 14 (range, 6-22), which might result in the possibility of underestimation of nodal involvement and understaging. In addition, tumor recurrence rates did not differ regardless of the extent of lymphadenectomy or the total nodes examined. The overall 5-year survival rate was 53% for the whole cohort.Our previous study has shown that there was no survival benefit of >15 nodes retrieved for patients with T1 node-negative GC; however, patients with T2-4 nodenegative GC with extensive lymphadenectomy (>25 nodal dissection) had longer survival time than those with nodes retrieved <25 (6). The GC-specific 5-year survival rates were 96.2%, 94.6%, and 97.9% in T1 tumor with the number of examined LN <15, 16-25 and >25, respectively (P=0.468). The overall 5-year survival rates were 74.0%, 81.9% and 84.4% for patients with T2, T3 and T4 nodenegative GC, respectively. In contrast to the results of Jin et al., our large-scale study (n=1,030) indicated that tumor size, tumor location, the number of nodal retrieval, T4 status, and presence of perineural invasion were prognostic factors for T1-T4 node-negative GC based on multivariate analysis (7). The extent of lymphadenectomy and the number of LNs retrieved might explain the great survival discrepancy between Jin's and our studies (7,8).As T1 node-negative GC patients undergoing R0 resection had an excellent 5-year survival period and extremely low recurrence rates (7), we enrolled 448 T2-4 node-negative GC patients, who underwent radical resection (>10 nodes retrieved) without receiving neoadjuvant chemotherapy or postoperative irradiation therapy to identify determinants of tumor recurrence and to analyze the prognostic factors (6). Our results show that there was no significant difference in mean number of LN retrieved between GC patients without recurrence and with recurrence (26 vs. 24). The median followup time was 78.7 months. Recurrence was found in 85 patients (18.9%) in the whole cohort. Patients with T2, T3 and T4 tumor had recur...

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“…The association between LN involvement and the presence of perineural invasion was of borderline significance. Both depth of tumor invasion [1,33,48], and perineural invasion [48,49] have been reported to be risk factors for LN metastases and a worse prognosis in gastric carcinoma. Recently there has been debate whether preoperative chemotherapy in gastric cancer has an influence on LN yield [50,51] and nodal status [52].…”

Section: Survival Analysismentioning

confidence: 99%

Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases

Jeuck

Wittekind

2014

Gastric Cancer

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Background Immunohistochemically detected micrometastases of the regional lymph nodes in previously pN0-classified gastric cancer have been incorporated in the TNM staging system. This study aims to determine the incidence of such micrometastases in gastric carcinoma and to investigate their impact on stage grouping and prognosis. Methods Ninety-five patients with gastric carcinoma classified as pN0 by conventional histological examination were enrolled. All patients underwent gastric resection with regional lymphadenectomy between 2006 and 2010. A total of 2018 lymph nodes was obtained (median, 20 Lymph nodes) and immunohistostained with anti-pan cytokeratin antibody (KL1). Results Micrometastases were detected in regional lymph nodes by immunohistostaining in 16 out of all 95 patients. Fourteen patients were upstaged by micrometastasis-positive regional lymph nodes. Three patients demonstrated lymph nodes with isolated tumor cells alone. A significantly higher incidence of micrometastases was observed in patients with diffuse histologic type (p = 0.007) and total gastrectomy (p = 0.007). When isolated tumor cells were also regarded as lymph node involvement, the recurrence rate was significantly higher for node-positive than for node-negative patients and for those younger than 70 years (33.3 and 6.7 %, respectively; p = 0.026; n = 39). Overall survival analysis revealed no significant difference between micrometastasis-positive and micrometastasis-negative patients. ConclusionImmunohistostaining of regional lymph nodes in node-negative gastric carcinoma patients leads to an increased detection of micrometastases with significant implications for the staging system. Although no impact on survival time was shown, the higher recurrence rate for node-positive patients younger than 70 years indicates a prognostic value of immunohistochemically detectable micrometastases.

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Clinicopathologic study of node-negative advanced gastric cancer and analysis of factors predicting its recurrence and prognosis

Cited by 44 publications

References 26 publications

Factors Associated With Recurrence and Survival in Lymph Node–negative Gastric Adenocarcinoma

Factors Associated With Recurrence and Survival in Lymph Node–negative Gastric Adenocarcinoma

Survival impact of the number of lymph node dissection on stage I–III node-negative gastric cancer

Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases

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