Should Lymph Node Micrometastasis be Considered in Node Staging For Gastric Cancer?

Lee, Chang Min; Cho, Jun Min; Jang, Youjin; Park, Seong-Heum; Kim, Seungjoo; Mok, Young Jae; Kim, Chong Suk; Kim, Jong Han

doi:10.1245/s10434-014-4073-z

Cited by 31 publications

(25 citation statements)

References 33 publications

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ Nevertheless, when considering two different groups, one with initial and other with advanced GC, it was noted that the incidence of micrometastatic LN was significantly higher in the second group. These observations were also reported by other authors 14,22,26,27 . In the overall analysis of the results obtained in the present study, it should be noted that, with the addition of LN MS and IHC, the final LN and tumor staging changed significantly.…”

Section: Discussionsupporting

confidence: 91%

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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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Section: Discussionsupporting

confidence: 91%

“…With this change, the survival curve was within the normal range and maintained throughout the years. The authors urged the need for the inclusion of micrometastases in the LN node staging system 31 .…”

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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“…In addition, immunohistochemistry using antibody CAM 5.2 was performed for lymph nodes that were found to be tumor-negative by HE staining. 36 Antibody CAM 5.2 identifies the lower-molecular-weight cytokeratin protein expressed by tumor cells, representing micrometastasis, that were not detected by HE staining. 37 In this study, ''micrometastasis'' was defined as tumor cell clusters measuring from 0.2 to 2.0 mm at the greatest dimension.…”

Section: Postoperative Processing Of Lymph Nodesmentioning

confidence: 99%

Sentinel Node Mapping Using a Fluorescent Dye and Visible Light During Laparoscopic Gastrectomy for Early Gastric Cancer

et al. 2017

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“…An additional poor prognosticator is micro metastases in LNs. Micro metastases could be identified as risk factors for recurrent gastric cancer and poorer survival (34)(35)(36). The percentage of micro metastases ranges from 1.8% in pT1a gastric cancer (37) up to 32% (34,36).…”

Section: Prognostic Role In Primarily Resected Gastric Cancermentioning

confidence: 99%

“…Micro metastases could be identified as risk factors for recurrent gastric cancer and poorer survival (34)(35)(36). The percentage of micro metastases ranges from 1.8% in pT1a gastric cancer (37) up to 32% (34,36). Micro metastases were observed beyond the perigastric nodes along the left gastric or common hepatic artery, which underlies the importance of a D2 LAD for gastric cancer (34).…”

Section: Prognostic Role In Primarily Resected Gastric Cancermentioning

confidence: 99%

Prognostic impact of nodal status and therapeutic implications

Ott¹,

Blank²,

Ruspi³

et al. 2017

Transl. Gastroenterol. Hepatol.

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The prognostic impact of lymph node (LN) metastases in gastric cancer is generally accepted. In primarily resected patients the pN-category and LN ratio are independent prognostic factors. Number of involved LNs, number of resected LNs, lymphangiosis and micrometastases also influence the prognosis significantly. To guarantee a proper D2 lymphadenectomy (LAD) at least 25 LNs according to the German S3 guidelines for the treatment of gastric cancer should be removed. Also in neoadjuvantly treated patients the ypN-category and LN ratio play an important prognostic role, despite the fact that UICC staging system was development based only on primarily resected patients. The role of response of LNs in neoadjuvantly treated patients is still unclear and needs further investigation. It seems to be less important than the response of the primary tumor. Limited data exists, suggesting that preoperative treatment might reduce the number of LNs involved and improve ypN-category. Due to further development in gastric cancer like laparoscopic resection and effective perioperative treatment in locally advanced tumor the role and the prognostic impact of LAD is again in the focus of discussion.

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Should Lymph Node Micrometastasis be Considered in Node Staging For Gastric Cancer?

Abstract: Lymph node micrometastasis was clinically significant as a risk factor for recurrent gastric cancer. Lymph node micrometastasis should be considered when estimating TNM stage for determining prognosis and the best treatment strategy.

Cited by 31 publications

References 33 publications

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

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

Sentinel Node Mapping Using a Fluorescent Dye and Visible Light During Laparoscopic Gastrectomy for Early Gastric Cancer

Prognostic impact of nodal status and therapeutic implications

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