Lymph node metastasis as a significant prognostic factor in early gastric cancer: Analysis of 1,136 early gastric cancers

Kim, Jin Pok; Hur, Yoon Seok; Yang, Han–Kwang

doi:10.1007/bf02307062

Cited by 81 publications

(66 citation statements)

References 25 publications

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“…Many previous studies [10][11][12][13][14][15][16][17]29,30,[32][33][34][39][40][41], although not all [5,18,35,42], showed tumor histology to have no correlation with node involvement. However, in the present study, based on a nationwide investigation, in both m-and sm-cancers, the incidence of lymph node metastasis was significantly higher in undifferentiated than in differentiated tumors.…”

Section: Discussionmentioning

confidence: 99%

“…The different frequencies oßf nodal involvement in mucosal versus submucosal cancer are well known. The reported frequency of lymph node metastasis in submucosal cancer varies from 9.7% to 24.3% [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][28][29][30][31][32][33][34][35][36][37][39][40][41], whereas that in mucosal cancer is low (0%-6.4%) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][31][32][33][34][35][36][37]4...…”

Section: Introductionmentioning

confidence: 99%

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Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer

et al. 2001

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer

et al. 2001

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“…The 1997 TNM classification for gastric cancer has now adopted the number of involved nodes for classifying nodal involvement. Several investigators had already proposed these changes for many years (Kim et al, 1992(Kim et al, ,1995Ichikura et al, 1993;Wu et al, 1996). In 1993, Ichikura et al compared the JRSGC, the 4th TNM classification and the number of nodes and concluded that patients with 1-3 positive nodes had as good a prognosis as those without nodal involvement when analysed per T-stage (Ichikura et al, 1993).…”

Section: Discussionmentioning

confidence: 99%

“…A multivariate analysis in patients with 4 or more positive nodes showed that the number of positive nodes was the most important prognostic determinant and that N stage (1987) was not significantly prognostic. Authors from Korea also proposed the number of involved nodes (0, 1-3 and 4) (Kim et al, 1995). Others have proposed to use metastatic rate (Kodera et al, 1997;Yu et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

et al. 2001

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SummaryThe main change in the 5th edition (1997) of the TNM classification for gastric cancer compared to the 4th edition (1987) is the use of the number of involved nodes instead of the location of positive nodes. As a result stage grouping is also altered. A second change is the requirement for the examination of at least 15 nodes to justify the N0 status. Patients with fewer examined negative nodes are unclassifiable (Nx). Data were retrieved from a randomized trial database comparing D1 and D2 dissection and 633 curatively operated patients were included. According to the criteria of the 5th edition, 39% of the node-positive patients had another N stage compared to the 4th: 21% had a lower and 18% had a higher stage. 5-year survival rates according to the 4th edition N0, N1 and N2 groups were respectively 72%, 34% and 27%. According to the 5th edition these percentages were for the N0, N1, N2, N3 and Nx groups respectively 75%, 38%, 19%, 8% and 65%. The former 1987 N1 and N2 group were significantly split into three new N 1997 groups (P = 0.006, respectively P < 0.0005). The Cox's regression analysis showed the N 1997 classification to be the most important prognostic variable, with a higher prognostic value than N 1987. In addition, the new TNM stage was also a better prognosticator. The requirement for examining at least 15 nodes, however, could not be fulfilled in 38% of all nodenegative patients and we found that a minimum of 5 consecutive negative lymph nodes is a reliable number for staging purposes. We conclude that the 5th edition of the TNM classification provides a better estimation of prognosis, however, examination of at least 15 negative regional lymph nodes is too high a threshold and 5 gives similar prognostic value. 64-71 © 2001 Cancer Research Campaign doi: 10.1054/ bjoc.2000.1548, available online at http://www.idealibrary.com on http://www.bjcancer.com abdominal washing, 35 due to resection-line involvement and 3 patients due to positive cytology as well as positive margins. In 5 of the remaining 639 R0 patients, no primary tumour could be found and in one patient the T-stage could not be determined due to inadequate specimen handling. The present report will therefore be based on 633 patients, including 44 patients who died in the post-operative phase (in-hospital death or within 30 days after surgery), since the postoperative mortality was different between the D1 and D2 group (15 versus 29 patients). Survival time was calculated from the date of surgery until death or last follow-up alive. The range in follow-up time of patients still alive was 6.0 to 10.2 years, with a median follow-up of 7.9 years. ClassificationsIn (Table 2). As said before, we had to make additional to the official 1997 TNM definitions, a Nx category and consequently an 'unclassifiable' TNM category for the node-negative patients with <15 lymph nodes examined (TNMx). StatisticsThe χ 2 test was applied to assess differences in the distribution of patients among groups. The Mann-Whitney test was used for comparis...

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“…However, gastric cancer still remains a major cause of cancer death worldwide (1). Lymph node status is one of the most important prognostic factors for patients with radically resected gastric cancer (2)(3)(4). The appropriate extension of lymphadectomy on the basis of accurate lymph node status for surgical treatment is still controversial (5,6).…”

Section: Introductionmentioning

confidence: 99%

CD44v6, MMP-7 and nuclear Cdx2 are significant biomarkers for prediction of lymph node metastasis in primary gastric cancer

Okayama

Kumamoto²,

Saitou³

et al. 2009

Oncol Rep

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Abstract. The aim of this study was to examine the expression of CD44v6, CD54, Cdx2, CXCL5, Cyclin B1, MMP-7, nm23, RCAS1 and Survivin in primary gastric cancer and to investigate whether these molecules were useful in predicting the lymph node status. They were selected as candidates for indicators of lymph node metastasis from various kinds of cancer-associated genes reported previously. In 135 cases of radically resected primary gastric adenocarcinoma, we investigated the association between the expression of these molecules and clinocopathologic factors by immunohistochemistry. The results revealed that the expression of CD44v6 and MMP-7 were significantly associated with lymph node status. By contrast, nuclear Cdx2 expression was found to be inversely correlated with lymph node metastasis. Moreover, multivariate analysis demonstrated that CD44v6, MMP-7 and nuclear Cdx2 were independent predictors for lymph node status. In conclusion, our results suggest that positive expression of both CD44v6 and MMP-7, and negative expression of nuclear Cdx2 may serve as powerful predictors of lymph node metastasis in gastric cancer. Combined evaluation of these markers could be further useful to predict lymph node status clinically.

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Lymph node metastasis as a significant prognostic factor in early gastric cancer: Analysis of 1,136 early gastric cancers

Abstract: We propose that for early gastric cancer, lymph node dissection is necessary in addition to gastric resection, at least in patients with a high risk of lymph node metastasis.

Cited by 81 publications

References 25 publications

Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer

Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

CD44v6, MMP-7 and nuclear Cdx2 are significant biomarkers for prediction of lymph node metastasis in primary gastric cancer

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