Recurrence of a pT2N0cM0 Lower Third Gastric Cancer with No. 6 Lymph Node Micrometastasis after R0 Extended Surgery. Should Adjuvant Therapy be Performed in Conventionally Node-Negative but Micrometastasis-Positive pT2 Gastric Cancer?

Blouhos, Konstantinos; Boulas, Konstantinos A.; Tsalis, Konstantinos; Barettas, Nikolaos; Aftzoglou, Michail; Hatzigeorgiadis, Anestis

doi:10.1007/s12029-016-9811-y

Cited by 3 publications

(2 citation statements)

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“…Although the majority of studies have demonstrated that patients with lymph node micrometastasis have a worse prognosis, whether lymph node micrometastasis results in postoperative recurrence or metastasis and consequently affects patients' prognosis remains controversial (30)(31)(32). Micrometastases can be promoted or inhibited by various factors, such as the host's immune status, postoperative radiotherapy or chemotherapy, and tumor microenvironment.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Metastasis or Micrometastasis to the Lymph Node Along the Superior Mesenteric Vein in Gastric Carcinoma: A Retrospective Analysis

Zheng

Zhang

et al. 2021

Front. Oncol.

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BackgroundThe validity of lymphadenectomy of the lymph node along the superior mesenteric vein (LN14v) in gastric cancer remains controversial. The study investigated the characteristics and prognosis of gastric cancer with metastasis or micrometastasis to LN14v.MethodsA retrospective study of 626 patients undergoing radical gastrectomy in our center from January 2003 to December 2015 was analyzed. In total, 303 patients had lymphadenectomy of LN14v, and lymph node micrometastasis was evaluated by immunohistochemical staining for cytokeratin nodes CK8/18. A logistic regression model was applied to confirm the predictive factors of micrometastasis. Survival analysis was performed to evaluate the effect of micrometastasis or metastasis on prognosis.ResultsThe metastatic rate of the LN14v lymph node was 15.8%, and the micrometastatic rate was 3.3%. Multivariate analysis showed site, Borrmann classification, postoperative lymph node metastasis (pN), and metastasis in LN6 and LN9 were predictive factors for LN14v micrometastasis or metastasis (P < 0.05). The 5-year survival rate in the positive group (LN14v micrometastasis or metastasis) was 12.4%. The prognosis of patients without LN14v lymph node micrometastasis was better than that of the positive group, whereas the difference between group of LN14v micrometastasis and LN14v metastasis was not obvious. In matched analysis, patients with stage III gastric cancer L/M area, pN2-3, and LN6(+) who underwent lymphadenectomy of LN14v had better survival than those without lymphadenectomy of LN14v.ConclusionLymph node micrometastasis may provide accurate prognostic information for patients with gastric cancer. Moreover, lymphadenectomy of LN14v might improve the survival of patients with stage III gastric cancer of L/M area, pN2-3, and LN6(+).

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Section: Discussionmentioning

confidence: 99%

Clinical Significance of Metastasis or Micrometastasis to the Lymph Node Along the Superior Mesenteric Vein in Gastric Carcinoma: A Retrospective Analysis

Zheng

Zhang

et al. 2021

Front. Oncol.

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“…So far, adjuvant chemotherapy is not indicated for patients whose LN micrometastases were detected. According to guidelines from the National Comprehensive Cancer Network (NCCN), as well as from the JGCA, adjuvant chemotherapy has only been proved to be beneficial in patients with advanced GC, and in patients with LN metastases, increasing both disease-free survival and overall survival [32][33][34] .…”

Section: Discussionmentioning

confidence: 99%

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma – Case series

Santos

Drummond-Lage

Wainstein

et al. 2020

Sci Rep

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Gastric carcinoma (GC) locoregional recurrence may occur even in cases where the tumor has been completely resected, possibly due to lymph node (LN) micrometastases. It is estimated that in 10% to 30% of cases, LN micrometastases are not detected by a conventional method for histological assessment of LN metastases with hematoxylin-eosin (HE). A cross-sectional study assessed 51 patients with GC by histological evaluation of the LN micrometastases through LN multi sectioning associated with immunohistochemistry analysis with monoclonal antibodies AE1 and AE3. Total gastrectomy was performed in 51% of patients. The total number of resected LN nodes was 1698, with a mean number of resected LN of 33.3 ± 13.2 per surgical specimen, of which 187 had metastasis. After the application of LN multisection and immunohistochemistry, LN micrometastases were found in 45.1% of the cases. LN staging changed in 29.4%, and tumor staging changed in 23.5% of the cases. In patients initially staged as pN0, LN staging and tumor staging changed, both in 19.2% of the cases. In patients initially staged as pN1 or more, LN staging changed in 40.0% of them, and tumor staging changed in 28.0% of the cases. The accuracy of HE for the histological staging of LN tumoral involvement was 76%, which was considered insufficient for CG patients staging. Investigation of LN micrometastasis through LN multisection and immunohistochemistry should be performed, particularly in cases where the presence of blood and lymphatic vessel invasion has been identified after conventional histological analysis, as well as in patients with advanced Gc. Gastric carcinoma (GC), despite the recent decrease observed in its incidence, remains the second most common cause of cancer death in the world, with more than 600,000 deaths per year. The main chance of cure of this neoplasm is on surgical resection. The standard procedure for the treatment of this condition is radical gastrectomy, which includes gastric resection with surgical margins free of neoplasia, associated with extended locoregional lymphadenectomy 1-3. Accurate tumor staging is one of the leading factors in the definition of the therapeutic strategy. From the exact knowledge of the extent of tumor dissemination, it is possible to define, with greater security, the best therapeutic approach for each patient, and, consequently, avoid incomplete or excessive treatments 4,5. Recent literature has discussed the role of lymph node (LN) micrometastasis in GC. Conceptually, micrometastases are metastases of sizes between 0.2 mm and 2.0 mm (5). Its incidence varies between 10% to 30% 6,7. Currently, many authors admit that its presence is associated with a worse prognosis and that the clinical behavior of these patients is like those with lymph node involvement by metastasis 8. In the submucosal GC (T1b), with the absence of LN metastases and micrometastases, the five-year survival rate is close to 100%, being significantly higher than in micrometastases positive cases (82%) 6. The presence of micrometastasis ma...

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Influence of lymph node micrometastasis on the staging system for gastric cancer*

Gao

Ren

et al. 2020

Oncology and Translational Medicine

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ObjectiveThe aim of this study was to investigate the effect of lymph node micrometastasis on the prognosis of patients with gastric cancer and the necessity of integrating it into the gastric cancer staging system.MethodsIn total, 241 patients with gastric cancer were included. Hematoxylin and eosin staining of lymph nodes was performed, and negative lymph nodes were evaluated by immunohistochemistry to detect micrometastases. Differences in survival rates between stages were evaluated.Results(1) A total of 78 patients (32.4%) had lymph node micrometastases. Compared with the group without micrometastases, the overall recurrence rate, lymph infiltration, vascular invasion, and nerve invasion rate in the micrometastasis group were significantly higher (P < 0.05). (2) According to the standard N staging system, the rates of disease-free survival (DFS) for the N0, N1, N2, N3a, and N3b groups were 96.0%, 84.0%, 67.6%, 59.0%, and 21.7%, respectively. There was no significant difference in survival between N2 and N3a. The cumulative survival curves for N2 and N3a intersected. (3) The N stage of 38 patients (15.8%) differed between the traditional system and the new N staging system reflecting micrometastasis. The DFS for N0, N1, N2, N3a, and N3b were 97.0%, 86.3%, 74.2%, 65.4%, and 29.2%, respectively. There was no significant difference in survival between N2 and N3a, but the cumulative survival curves for N2 and N3a did not intersect. (4) Based on a Cox multivariate analysis, various independent risk factors for recurrence were identified (P < 0.05).ConclusionLymph node micrometastasis is an important risk factor for gastric cancer recurrence. Lymph node micrometastasis should be considered in TNM staging to determine prognosis and optimal treatment strategies.

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Recurrence of a pT2N0cM0 Lower Third Gastric Cancer with No. 6 Lymph Node Micrometastasis after R0 Extended Surgery. Should Adjuvant Therapy be Performed in Conventionally Node-Negative but Micrometastasis-Positive pT2 Gastric Cancer?

Cited by 3 publications

References 18 publications

Clinical Significance of Metastasis or Micrometastasis to the Lymph Node Along the Superior Mesenteric Vein in Gastric Carcinoma: A Retrospective Analysis

Clinical Significance of Metastasis or Micrometastasis to the Lymph Node Along the Superior Mesenteric Vein in Gastric Carcinoma: A Retrospective Analysis

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma – Case series

Influence of lymph node micrometastasis on the staging system for gastric cancer*

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