Gastric cancer lymph node resection—the more the merrier?

Nienhüser, Henrik; Schmidt, Thomas

doi:10.21037/tgh.2017.12.08

Cited by 10 publications

(4 citation statements)

References 14 publications

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“…But for the pN+ patients with insufficient LNRs, introducing an index of positive lymph node ratio (NR) could potentially overcome the bias of inaccurate N staging, which is in concordance with the previous reports (17,18). Nevertheless, the efforts by the surgeons and pathologists to retrieve more lymph nodes were important for avoiding false pN staging (19). To retrieve more lymph nodes, continuous cooperation between surgeons and pathologists is necessary.…”

Section: Discussionsupporting

confidence: 62%

Retrieval of 30 Lymph Nodes Is Mandatory for Selected Stage II Gastric Cancer Patients

et al. 2021

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BackgroundAccording to the 8th edition AJCC staging manual, a least of 16 lymph nodes retrieval (LNRs) is the minimal requirement for lymph nodes (LNs) dissection of gastric cancer surgery. Previous studies have shown that increasing the number of LNRs (≥30) prolongs survival for selected patients. However, the necessity of retrieving 30 or more LN for stage II gastric cancer patients is still under debate.AimThis study aims to explore the impact of retrieving 30 or more lymph nodes on the survival of stage II cancer patients.MethodsA total of 1,177 patients diagnosed with stage II gastric cancer were enrolled in this study. The clinicopathological parameters and the impact of different LNRs (<30 or ≥30) and positive lymph node ratio (NR) on overall survival (OS) were retrospectively analyzed.ResultsThe mean number of LNRs was 34 ± 15. A total of 44% (518/1,177) of patients had an LNRs <30, while 56% (659/1,177) of patients had an LNRs ≥30. The 5-year survival rate was 81% for all patients, 76% for the LNRs <30 group, and 86% for LNRs ≥30 group, respectively (P = 0.003). The survival benefit of retrieving 30 lymph nodes was significant in certain subgroups: age >60 years/male/underwent total gastrectomy/stage IIB. For N+ patients, higher NR was significantly correlated with poor survival.ConclusionThe survival benefit of retrieving 30 LNs varies in different subgroups. An LNRs of 30 is mandatory for selected stage II gastric cancer patients.

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Section: Discussionsupporting

confidence: 62%

Retrieval of 30 Lymph Nodes Is Mandatory for Selected Stage II Gastric Cancer Patients

et al. 2021

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“…Pathologic data concerning gastric primary and metastases were collected as suggested by the general rules of the JGCA and classified following the 8th AICC-TNM system [19,20]. Follow-up was structured as previously described [21] and stopped in December 2018.…”

Section: Methodsmentioning

confidence: 99%

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Ministrini

Bencivenga

Solaini

et al. 2020

Cancers

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Background/Aim: This work explored the prognostic role of curative versus non-curative surgery, the prognostic value of the various localizations of metastatic disease, and the possibility of identifying patients to be submitted to aggressive therapies. Patients and Methods: Retrospective chart review of stage IV patients operated on in our institutions. Results: Two hundred and eighty-two patients were considered; 73.4% had a single metastatic presentation. In 117 cases, a curative (R0) resection of primary and metastases was possible; 75 received a R1 resection and 90 a palliative R2 gastrectomy. Surgery was integrated with chemotherapy in multiple forms: conversion therapy, HIPEC, neo-adjuvant and adjuvant treatment. Median overall survival (OS) of the entire cohort was 10.9 months, with 14 months for the R0 subgroup. There was no correlation between metastasis site and survival. At multivariate analysis, several variables associated with the lymphatic sphere showed prognostic value, as well as tumor histology and the curativity of the surgical procedure, with a worse prognosis associated with a low number of resected nodes, D1 lymphectomy, pN3, non-intestinal histology, and R+ surgery. Considering the subgroup of R0 patients, the variables pT, pN and D displayed an independent prognostic role with a cumulative effect, showing that patients with no more than 1 risk factor can reach a median survival of 33 months. Conclusions: Our data show that the possibility of effective care also exists for Western patients with stage IV gastric cancer.

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“…According to Globocan 2020, gastric cancer (GC) ranks fourth in the number of cancerrelated deaths per year, with 768,793 casualties in 2020 (Global Cancer Observatory; https://gco.iarc.fr/; last accessed 1 July 2021). Additionally, differential diagnosis of GC supposes a substantial challenge due to the vague nature of its symptomatology (anemia, dysphagia, abdominal pain, anemia, and anorexia) on early and later phases, which can be easily attributed to other milder gastrointestinal diseases, supposing an important delay on cancer therapy and prognosis [33,34]. This situation of unspecific symptoms, high mortality, and difficult diagnosis hinders the success rate of chemotherapeutics but also leads the scientific effort towards the development of novel tools for early diagnosis, or therapeutic strategies with higher efficacy and selectivity against cancer cells than current antineoplastic approaches [35,36].…”

Section: Discussionmentioning

confidence: 99%

Purinergic P2Y2 and P2X4 Receptors Are Involved in the Epithelial-Mesenchymal Transition and Metastatic Potential of Gastric Cancer Derived Cell Lines

et al. 2021

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Gastric cancer (GC) is a major health concern worldwide, presenting a complex pathophysiology that has hindered many therapeutic efforts so far. In this context, purinergic signaling emerges as a promising pathway for intervention due to its known role in cancer cell proliferation and migration. In this work, we explored in more detail the role of purinergic signaling in GC with several experimental approaches. First, we measured extracellular ATP concentrations on GC-derived cell lines (AGS, MKN-45, and MKN-74), finding higher levels of extracellular ATP than those obtained for the non-tumoral gastric cell line GES-1. Next, we established the P2Y2 and P2X4 receptors (P2Y2R and P2X4R) expression profile on these cells and evaluated their role on cell proliferation and migration after applying overexpression and knockdown strategies. In general, a P2Y2R overexpression and P2X4R downregulation pattern were observed on GC cell lines, and when these patterns were modified, concomitant changes in cell viability were observed. These modifications on gene expression also modified transepithelial electrical resistance (TEER), showing that higher P2Y2R levels decreased TEER, and high P2X4R expression had the opposite effect, suggesting that P2Y2R and P2X4R activation could promote and suppress epithelial-mesenchymal transition (EMT), respectively. These effects were confirmed after treating AGS cells with UTP, a P2Y2R-agonist that modified the expression patterns towards mesenchymal markers. To further characterize the effects of P2Y2R activation on EMT, we used cDNA microarrays and observed that UTP induced important transcriptional changes on several cell processes like cell proliferation induction, apoptosis inhibition, cell differentiation induction, and cell adhesion reduction. These results suggest that purinergic signaling plays a complex role in GC pathophysiology, and changes in purinergic balance can trigger tumorigenesis in non-tumoral gastric cells.

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Gastric cancer lymph node resection—the more the merrier?

Abstract: et al. Increasing the number of examined lymph nodes is a prerequisite for improvement in the accurate evaluation of overall survival of node-negative gastric cancer patients.

Cited by 10 publications

References 14 publications

Retrieval of 30 Lymph Nodes Is Mandatory for Selected Stage II Gastric Cancer Patients

Retrieval of 30 Lymph Nodes Is Mandatory for Selected Stage II Gastric Cancer Patients

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Purinergic P2Y2 and P2X4 Receptors Are Involved in the Epithelial-Mesenchymal Transition and Metastatic Potential of Gastric Cancer Derived Cell Lines

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