Preoperative assessment of lymph node metastases in patients with gastric cancer: evaluation of the Maruyama computer program

Bollschweiler, Elfriede; Boettcher, K.; Hoelscher, Arnulf H.; Sasako, Mitsuru; Kinoshita, Taira; Maruyama, Keiichi; Siewert, J. R.

doi:10.1002/bjs.1800790221

Cited by 102 publications

(56 citation statements)

References 19 publications

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“…24 Subsequent studies showed that although the sensitivity for lymph-node detection was high (97-100%), the specificity was very low (20%). 25 Recently, the gene expression profile of primary gastric cancer was applied to identify mRNAs associated with lymph node metastasis. 26 Marchet et al evaluated 5,541 genes in frozen tumor samples obtained from 32 patients with primary gastric adenocarcinomas (21 with lymph node metastasis and 11 without lymph node metastasis).…”

Section: Discussionmentioning

confidence: 99%

Protein predictive signatures for lymph node metastasis of gastric cancer

Wang

et al. 2012

Intl Journal of Cancer

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Lymph node status remains one of most crucial indicators of gastric cancer prognosis and treatment planning. Current imaging methods have limited accuracy in predicting lymph node metastasis. We sought to identify protein markers in primary gastric cancer and to define a risk model to predict lymph node metastasis. The Protein Pathway Array (PPA) (initial selection) and Western blot (confirmation) were used to assess the protein expression in a total of 190 freshly frozen gastric cancer samples. The protein expression levels were compared between samples with lymph node metastasis (n 5 73) and those without lymph node metastasis (n 5 57) using PPA. There were 27 proteins differentially expressed between lymph node positive samples and lymph node negative samples. Five proteins (Factor XIII B, TFIIH p89, ADAM8, COX-2 and CUL-1) were identified as independent predictors of lymph node metastasis. Together with vascular/lymphatic invasion status, a risk score model was established to determine the risk of lymph node metastasis for each individual gastric cancer patient. The ability of this model to predict lymph node metastasis was further confirmed in a second cohort of gastric cancer patients (33 with and 27 without lymph node metastasis) using Western blot. This study indicated that some proteins differentially expressed in gastric cancer can be selected as clinically useful biomarkers. The risk score model is useful for determining patients' risk of lymph node metastasis and prognosis.Gastric cancer is the fourth most common malignancy and the second leading cause of cancer-related death, after lung cancer, in the world. More than 80% of patients are diagnosed at an advanced stage or experienced tumor recurrence after surgical resection.1 Despite of some decline in the incidence and prolonged overall survival of gastric cancer patients in the past decade thanks to the advancement of treatments (e.g., surgery, chemotherapy and radiotherapy), gastric cancer continues to be a major health problem with a high mortality rate. 2Most gastric cancer patients are diagnosed at Stages III or IV, with 50-75% of patients presenting with lymph node metastasis.3 The preoperative determination of lymph node status is critical in tumor staging and in planning optimal management of gastric cancer patients. For early gastric cancer without lymph node involvement, less invasive treatment (e.g., endoscopic mucosal resection) can be performed. For localized gastric cancer without lymph node involvement, surgical resection with limited lymph node dissection is recommended to reduce postoperative morbidity and mortality. For advanced gastric cancer with lymph node involvement, surgical resection with extensive lymphadenectomy is necessary to achieve better outcome. 4 Currently, preoperative assessment of lymph node status is mainly based on imaging studies such as computerized tomography, magnetic resonance imaging and positron emission tomography/computed tomography. However, many studies show that lymph node size determined by imagin...

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Section: Discussionmentioning

confidence: 99%

Protein predictive signatures for lymph node metastasis of gastric cancer

Wang

et al. 2012

Intl Journal of Cancer

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“…Furthermore, Maruyama computer program can also be used to predict lymph node metastasis for patients with gastric carcinoma. Analysis of eight prognostic parameters such as gender, age, macroscopic type, location, position, diameter, histological classification, and depth of invasion using this computer program can gain the information on the expected frequency of metastasis in the 16 lymph node stations of each patient with gastric carcinoma [61,62] . However, to date, the prospective study for evaluating the accuracy of this computer program has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Expression of vascular endothelial growth factor C and chemokine receptor CCR7 in gastric carcinoma and their values in predicting lymph node metastasis

Yan

Zhu²,

Yu³

et al. 2004

WJG

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AIM:To study the expression of vascular endothelial growth factor C (VEGF-C) and chemokine receptor CCR7 in gastric carcinoma and to investigate their associations with lymph node metastasis of gastric carcinoma and their values in predicting lymph node metastasis. METHODS:The expression of VEGF-C and CCR7 in gastric carcinoma tissues obtained from 118 patients who underwent curative gastrectomy was examined by immunohistochemistry. Among these patients, 39 patients underwent multi-slice spiral CT (MSCT) examination. RESULTS:VEGF-C and CCR7 were positively expressed in 52.5 and 53.4% of patients. VEGF-C expression was more frequently found in tumors with lymph node metastasis than those without it (P<0.001). VEGF-C expression was also closely related to lymphatic invasion (P<0.001), vascular invasion (P<0.01), and TNM stage (P<0.001). However, there was no significant correlation between VEGF-C expression and age at surgery, gender, tumor size, tumor location, Lauren classification, and depth of invasion. CCR7 expression was significantly higher in patients with lymph node metastasis compared with those without lymph node metastasis (P<0.001) and was also associated with tumor size (P<0.01), depth of invasion (P<0.001), lymphatic invasion (P<0.001), and TNM stage (P<0.001). However, the presence of CCR7 had no correlation to age at surgery, gender, tumor location, Lauren classification, and vascular invasion. Among the 39 patients who underwent MSCT examination, only CCR7 expression was related to lymph node metastasis determined by MSCT (P<0.05). In the current retrospective study, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of VEGF-C and CCR7 expression in the diagnosis of lymph node metastasis for patients with gastric carcinoma were 73.8%, 70.2%, 72.6%, 71.4% and 72.0%, and 82.0%, 77.2%, 79.4%, 80.0% and 79.7%, respectively. After subdivision according to the combination of VEGF-C and CCR7 expression, receiver operating characteristic (ROC) analysis showed that the accuracy of the combined examination of VEGF-C and CCR7 expression in predicting lymph node metastasis was relatively high (area under ROC curve [Az]=0.83). CONCLUSION:The expression of VEGF-C and CCR7 is related to lymph node metastasis of gastric carcinoma and both of them may become new targets for the treatment of gastric carcinoma. Furthermore, the combined examination of VEGF-C and CCR7 expression in endoscopic biopsy specimens may be useful in predicting lymph node metastasis of gastric carcinoma and deciding the extent of surgical lymph node resection.

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“…Based on recorded experience with actual patients, the likelihood of disease in 16 defi ned nodal stations around the stomach could be thus estimated. Performance of the so-called Maruyama program has been evaluated in German [2] and Italian populations [3] and found to be fairly accurate. For more than 15 years, the program has been used throughout the world as a tool to augment Japanese D-level guidelines with respect to lymph node dissection.…”

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confidence: 99%