How many nodes must be examined to accurately stage gastric carcinomas?

Bouvier, Anne–Marie; Haas, Olivier; Piard, F; Roignot, P.; Bonithon‐Kopp, Claire; Faivre, Jean

doi:10.1002/cncr.10550

Cited by 145 publications

(117 citation statements)

References 9 publications

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“…Thus it is more reasonable to classify gastric cancer patients with criteria of tumor-positive node numbers rather than tumorpositive nodes. Similar results have been revealed in a previous report by Wu et al They divided the gastric cancer patients into two groups according to the number of involved lymph nodes, and found that the number of positive nodes rather than lymph node involvement was suitable for the classification of nodal stages in gastric cancer [8,17,18] . Lymph node metastatic ratio, namely the number of metastatic lymph nodes to the total number of resected lymph nodes, has also been found to be an important prognostic factor [19][20][21][22] .…”

Section: Discussionsupporting

confidence: 85%

Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of gastric carcinoma in surgically-treated patients

Ding

Chen²,

Xia³

et al. 2004

WJG

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AIM:To evaluate the tumor-positive ratio and number of perigastric lymph nodes as prognostic factors of gastric carcinoma in surgically-treated patients. METHODS:The postoperative survival of 169 patients with gastric cancer who were performed D 2 curative gastrectomy was analyzed with regard to its lymph node metastasis ratio and number. Meanwhile correlation of tumor-positive ratio and number of perigastric lymph nodes with pathological parameters of these patients was studied. RESULTS:The overall 5-year survival rate of all the patients studied was 29.6%. The 5-year cumulative survival rate in patients with 1%-20% and more than 20% of tumor-positive lymph nodes was 70.6% and 12.0% respectively, and 46.6% and 17.4% in those with 1-5 and more than 5 of tumorpositive lymph nodes respectively, which were significantly decreased with the increment of involved lymph nodes assessed by either numbers or ratio (P<0.05). Multiple stepwise regression analysis showed that both the positive ratio and number of tumor-involved lymph nodes were sensitive prognostic factors in these surgically-treated patients, which were also significantly correlated with tumor size and depth of submucosal invasion (P<0.05). CONCLUSION:Tumor-positive ratio and number of perigastric lymph nodes are associated with cancer progression and five-year survival rate, and may serve as valuable prognostic factors of gastric cancer in surgically-treated patients.Ding YB, Chen GY, Xia JG, Zang XW, Yang HY, Yang L,Liu YX. Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of gastric carcinoma in surgicallytreated patients.

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Section: Discussionsupporting

confidence: 85%

Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of gastric carcinoma in surgically-treated patients

Ding

Chen²,

Xia³

et al. 2004

WJG

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“…If an inadequate number of LNs are assessed, a patient may be inappropriately considered ''node negative'' and therefore classified as a lower stage, with a worse survival than those patients who were classified as node negative through a thorough LN assessment. Studies have shown that the proportion of node positive tumors changes most significantly when fewer than 10 LNs are examined [43,46], but stage migration continues with even greater numbers of LNs examined [43,47]. For example, 45% of nodes were found to be positive when only 10 or fewer were examined compared to only 17% positive if 40þ were examined [47].…”

Section: Staging Systems In Gastric Cancermentioning

confidence: 99%

Lymph nodes and gastric cancer

Coburn

2009

Journal of Surgical Oncology

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Worldwide, gastric cancer is one of the top three leading causes of cancer mortality, but incidence and presentation vary geographically. Currently, surgery is the only possible cure. Nodal status is an important prognostic indicator for gastric cancer, and despite results of randomized controlled trials, debate continues over the importance of aggressive lymphadenectomy.J. Surg. Oncol. 2009;99:199-206. ß 2009 Wiley-Liss, Inc. KEY WORDS: gastric neoplasm; lymph nodes; surgery Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of cancer death worldwide [1]. In areas without screening for gastric cancer, it presents late, and has a high frequency of nodal involvement [1]. Surgery is the only effective intervention for cure or long-term survival. Nodal status is an important prognostic indicator for gastric cancer, and debate continues over the importance of aggressive lymphadenectomy for gastric cancer.Historically, gastric lymph node (LN) metastases were detected as distant disease due to advanced presentation, with resultant poor prognosis. Sister Mary Joseph, surgical assistant to Dr. William Mayo, first described the relationship between advanced intra-abdominal malignancy and an umbilical nodule, now known as the Sister Mary Joseph's nodule [2], while Virchow's node (supra-clavicular) [3] and an Irish node (axillary) are used to describe other distant metastatic LN disease for gastric cancer. The idea of an extended lymphadenectomy for gastric cancer was first advanced by Mikulicz in 1889, who stated that the distal pancreas should be removed if necessary [4,5]. ASSESSING LYMPH NODE INVOLVEMENT IN GASTRIC CANCERStudies estimate that LNs will be involved with tumors for 3-5% of cases of gastric adenocarcinoma limited to the mucosa; 11-25% of cases for those limited to the sub-mucosa; 50% for T2; and 83% for T3 tumors [6,7]. Nodal status is one of the most important independent predictors of patient survival [8,9]. For example, for 288 T4 gastric cancers, the 1 and 3-year survivals were 76% and 21.9% for node negative cases, versus 40% and 10% for node positive cases, respectively [10].Pre-operative examinations to study the extent of the cancer may include esophagogastro-duodenoscopy (EGD), radiological imaging, and laparoscopy. A computed tomography (CT) scan of the abdomen and pelvis is the most widely recommended method for pre-operative staging of gastric cancer [11,12]. The sensitivity and specificity of CT scan for determining nodal involvement ranges from 50 to 95% and 40 to 99%, respectively; typically, specificity is higher than sensitivity for nodal involvement, but this is not consistent between studies [13][14][15]. Importantly, the ability of the CT scan to detect nodal involvement is determined primarily by the size of the nodes. In a recent study of 23 patients with equivocal findings of para-aortic LN involvement on CT scan (0.7-1 cm or nodes >1 cm with a fatty marrow) treated with an aggressive LN dissection, including paraaortic LN diss...

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“…Significant variability in the extent of lymphadenectomy and number of lymph nodes examined pathologically leads to difficulty in comparing the outcomes of patients from different regions based on stage of disease as well as stage migration. It is difficult to be confident that a tumor is truly node negative when Ͻ10 lymph nodes are examined [32,33], and N1 tumors can be upstaged to N2 or even N3 tumors as more lymph nodes are harvested [33,34]. Furthermore, it is impossible to be categorized as N3 if Ͻ15 lymph nodes are harvested.…”

Section: Potential Benefits Of More Extensive Lymphadenectomiesmentioning

confidence: 99%

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

Yoon

Yang

2009

The Oncologist

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After completing this course, the reader will be able to:1. Calculate the lymph node drainage patterns of gastric adenocarcinoma based on the location of the tumor.2. Differentiate and explain the extent of lymphadenectomies performed in different countries.3. Analyze the risks and benefits of performing more extensive lymphadenectomies for gastric adenocarcinoma.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe extent of lymphadenectomy that should be performed for gastric adenocarcinoma has been a topic of persistent debate. In countries such as Japan and Korea, where the incidence of gastric adenocarcinoma is high, more extensive (e.g., D2) lymphadenectomies are routinely performed, usually by experienced surgeons with low morbidity and mortality. In western countries such as the U.S., where the incidence of gastric adenocarcinoma is tenfold lower, the performance of more extensive lymphadenectomies is generally limited to specialized centers, and quite possibly the majority of patients are treated at nonreferral centers with less than a D1 lymphadenectomy. There is little disagreement among gastric cancer experts that the minimum lymphadenectomy that should be performed for gastric adenocarcinoma should be at least a D1 lymphadenectomy. Two large, prospective randomized trials performed in the United Kingdom and the Netherlands failed to demonstrate a survival benefit of D2 over D1 lymphadenectomy, but these trials have been criticized for high surgical morbidity and mortality rates in the D2 group. More recent studies have demonstrated that western surgeons can be trained to perform D2 lymphadenectomies on western patients with low morbidity and mortality. Retrospective analyses and one prospective, randomized trial suggest that there may be some benefits to more extensive lymphadenectomies when performed safely, but this assertion requires further validation. This article provides an update on the current literature regarding the extent of lymphadenectomy for gastric adenocarcinoma.

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How many nodes must be examined to accurately stage gastric carcinomas?

Cited by 145 publications

References 9 publications

Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of gastric carcinoma in surgically-treated patients

Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of gastric carcinoma in surgically-treated patients

Lymph nodes and gastric cancer

Lymphadenectomy for Gastric Adenocarcinoma: Should West Meet East?

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