Preoperative staging of nodal status in gastric cancer

Berlth, Felix; Chevallay, Mickaël; Jung, Minoa; Mönig, Stefan P.

doi:10.21037/tgh.2017.01.08

Cited by 11 publications

(12 citation statements)

References 40 publications

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“…The cT and cN status was defined by clinical assessment with computerized tomography by an experienced radiologist. Lymph nodes more than 10 mm in the smallest axis were considered metastatic 15,16 . The T assessment was defined in accordance with the 8th edition of the UICC Staging System 17,18…”

Section: Methodsmentioning

confidence: 99%

“…Lymph nodes more than 10 mm in the smallest axis were considered metastatic. 15,16 The T assessment was defined in accordance with the 8th edition of the UICC Staging System. 17,18 The type of gastrectomy and lymphadenectomy were defined based on the Japanese Gastric Cancer Association criteria, 19 Complications were categorized based on the Clavien-Dindo classification system and major complications were defined as Clavien >II.…”

Section: Methodsmentioning

confidence: 99%

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Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

Charruf

Ramos

Pereira

et al. 2020

Journal of Surgical Oncology

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Background and Objective Neoadjuvant chemotherapy (NACT) followed by radical surgery represents a treatment option for patients with advanced gastric cancer (GC). This case‐control study aimed to evaluate the clinicopathological characteristics and surgical outcomes of GC patients who received NACT, and its impact on survival. Methods We retrospectively reviewed all patients with GC who underwent gastrectomy. A total of 45 cases with NACT were matched with consecutive 45 patients who underwent upfront gastrectomy for the following characteristics: gender, age, gastrectomy type, lymphadenectomy extent, American Society of Anesthesiologists class, histological type, cT and cN. Results NACT group had smaller tumors (4.9 vs 6.8 cm P = .006), lower lymphatic invasion rate (40% vs 73.3%, P = .001), lower venous invasion rate (18% vs 46.7%, P = .003) and lower perineural invasion rate (35% vs 77.8%, P < .0001). The ypTNM stage was lower in patients treated with NACT (P < .001). The major postoperative complication (POC) rate was lower in NACT patients (6.7% vs 24.4%, P = .02), as was hospital length of stay (10.8 vs 17 days, P = .005). Conclusions NACT allowed nodal and tumor downstaging. In addition, patients who underwent NACT had fewer POC and shorter length of hospital stay.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

Charruf

Ramos

Pereira

et al. 2020

Journal of Surgical Oncology

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“…Computed tomography (CT) is widely recognized as the primary method for staging and detecting distant metastases, determining surgical treatment [21]. Accuracy of preoperative cN staging is strongly dependent on cT stage and histological type of GC [22].…”

Section: Computed Tomographymentioning

confidence: 99%

“…A German study showed that even 55% of cancerous-infiltrated LN remain smaller than 5 mm [26], which implies high possibility of false-negative and false-positive results. Limitations are related to poor visualisation of nodal engagement [21,27], nodal location dependency and sensitivity rate of 44.4% [22]. Moreover, in up to 30% of negative CT scans, endoscopic ultrasound (EUS) reveals nodal involvement [27,28].…”

Section: Computed Tomographymentioning

confidence: 99%

“…According to Gertsen et al, restaging CT prevents only 1% of unnecessary laparotomies, although preoperative assessment was performed before completing NAC [29]. High volume centres present contrasting numbers with negative prognostic value (NPV) of LN involvement at a level of 90.1% among patients with early GC [21,30]. However, in advanced GC Kagedan et al estimated NPV of LN metastases at 43.3%, emphasizing the issue of cN understaging [31].…”

Section: Computed Tomographymentioning

confidence: 99%

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Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Pelc

Skórzewska

Rawicz‐Pruszyński

et al. 2021

Cancers

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Gastric cancer (GC) continues to be one of the major oncological challenges on a global scale. The role of neoadjuvant chemotherapy (NAC) in GC is to downstage primary tumour, eliminate potential micrometastases, and increase the chance for radical resection. Although systemic treatment prolongs the survival in advanced GC, persistent lymph node (LN) metastases indicate poor prognosis. Further identification of prognostic factors after NAC is urgent and could positively influence clinical outcomes. This article aimed to review the actual trends and future perspectives in multimodal therapy of advanced GC, with a particular interest in the post-neoadjuvant pathological nodal stage. A favourable prognostic impact for ypN0 patients is observed, either due to truly negative LN before the start of therapy or because preoperative therapy achieved a pathologically complete nodal response. Ongoing trials investigating the extent of lymphadenectomy after neoadjuvant therapy will standardise the LN dissection from the multimodal therapy perspective. Since downstaged and primarily node-negative patients show a similar prognosis, the main target for NAC in advanced GC should be nodal clearance. Adequate staging and personalised perioperative therapy seem to be of great importance in the multimodal treatment of GC.

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Identification and external validation of a novel miRNA signature for lymph node metastasis prediction in submucosal‐invasive gastric cancer patients

Moody

Liu

et al. 2019

Cancer Medicine

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Endoscopic resection (ER) has been increasingly performed in the treatment of early gastric cancer (GC). However, lymph node metastasis (LNM) can cause treatment failure with ER, especially in T1b patients. Here, we attempted to develop a miRNA‐based classifier to detect LNM in T1b patients. Based on high‐throughput data from The Cancer Genome Atlas, we identified 20 miRNAs whose expression significantly changed in T1‐2 GC with LNM vs T1‐2 GC without LNM. We then developed a miRNA signature to predict LNM of T1b GC using the LASSO model and backward step wise elimination approach in a training cohort. Furthermore, the predictive accuracy of this classifier was validated in both an internal testing group of 63 patients and an external independent group of 114 patients. This systematic and comprehensive in silico study identified a 7‐miRNA signature with an area under the receiver operating characteristic curve (AUROC) value of 0.843 in T1‐2 GC and 0.911 in T1 EGC. The backward elimination was further used to develop a 4‐miRNA (miR‐153‐3p, miR‐708, miR‐940 and miR‐375) risk‐stratification model in the training cohort with an AUROC value of 0.898 in cohort 2. When pathologic results were used as a reference, the risk model yielded AUROC values of 0.829 and 0.792 in two cohorts of endoscopic biopsy specimens. This novel miRNA‐LNM classifier works better than the currently used pathologic criteria of ER in T1b EGC. This classifier could individualize the management of T1b patients and facilitate treatment decisions.

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Preoperative staging of nodal status in gastric cancer

Cited by 11 publications

References 40 publications

Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Identification and external validation of a novel miRNA signature for lymph node metastasis prediction in submucosal‐invasive gastric cancer patients

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