Venous Invasion Is a Risk Factor for Recurrence of pT1 Gastric Cancer with Lymph Node Metastasis

Takeuchi, Akihiro; Ojima, Toshiyasu; Katsuda, Masahiro; Hayata, Keiji; Goda, Taro; Kitadani, Junya; Tominaga, Shinta; Fukuda, N.; Nakai, Tomoki; Yamaue, Hiroki

doi:10.1007/s11605-021-05238-0

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…Our site-specific recurrence analyses revealed that VI grade was an independent predictor of hematogenous and peritoneal recurrences but not of nodal recurrence. VI has been reported to be associated with hematogenous metastasis as with the present study [ 17 , 18 , 23 ]. Furthermore, Nakanishi et al reported that VI was not associated with nodal recurrence consistent with our results [ 17 ].…”

Section: Discussionsupporting

confidence: 82%

“…Nakanishi et al investigated postoperative courses of 132 patients who had undergone curative gastrectomy for advanced GC (pT2−4) and found that the VI grade was an independent prognostic factor for hematogenous recurrence but not for peritoneal and nodal metastases [ 17 ]. Takeuchi et al analyzed pT1N + GC patients (n = 97) who underwent radical gastrectomy and found that VI was an independent risk factor for recurrence [ 18 ]. Nine of 12 recurrences in their study were hematogenous.…”

Section: Discussionmentioning

confidence: 99%

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Risk stratification for predicting postoperative recurrence of gastric cancer by grade of venous invasion

2023

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Background Venous invasion (VI) in pathological examination of surgically resected gastric cancer (GC) may predict postoperative recurrence, but there are no objective criteria for VI grading. Methods 157 GC patients (pathological stages I 82, II 34, and III 41) who underwent surgery with curative intent were analyzed. VI was graded in pathological examination by elastica van Gieson staining based on the number of VIs per glass slide as follows: v0, 0; v1, 1−3; v2, 4−6; and v3, ≥ 7. Filling-type invasion in veins with a minor axis of ≥ 1 mm increased the grade by 1. The association of VI grade with prognosis was statistically analyzed. Results Recurrence increased with VI grade (v0 1.5%, v1 29.6%, v2 41.7%, v3 78.6%). VI grade as well as pathological (p) tumor, node, metastasis (TNM) stage was a significant recurrence predictor by the multivariate Cox analysis. VI grade was implicated in hematogenous and peritoneal recurrences independent of pTNM stage but not in nodal recurrence. GC was then divided into two tiers, without indication of adjuvant chemotherapy (AC) (pStage I, pT1 and pT3N0) and with AC indication (pStages remaining II/III), based on the ACTS-GC trial, which is common in Japan and East Asia. VI grade was a significant recurrence predictor in both tiers. v2/v3 revealed a significantly worse recurrence-free survival (RFS) than v0/v1 in GC without AC indication. v0/v1 exhibited RFS rate exceeding 95% even after 5 years but that of v2/v3 fell around 70% within one year postoperatively, suggesting that AC may be considered for this tier with v2/v3. GC with AC indication exhibited dismal RFS according to the VI grade. RFS rate fell below 80% within one year postoperatively when VI was positive, while recurrence was not observed in v0, which was, however, rare in this tier (10.9%). Differentiation grade did not significantly affect postoperative prognosis in both tiers. Conclusions VI grade was a significant predictor of postoperative GC recurrence irrespective of the AC indication based on the ACTS-GC study and this VI grading system could be applied in future studies of adjuvant therapy in GC presently deemed without AC indication in Japan.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Risk stratification for predicting postoperative recurrence of gastric cancer by grade of venous invasion

2023

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“…Zou et al (2021) [ 25 ], Chen et al (2021) [ 26 ], Nakagawa et al (2018) [ 27 ], and Jin et al (2020) [ 28 ] proposed that tumor stage, tumor size, patients' age, and postoperative treatment affected the recurrence of gastric cancer, which supported the results of this experiment. Moreover, inflammatory factors and venous infiltration can also affect the surgical prognosis and recurrence of patients with gastric cancer [ 29 , 30 ], which was not involved in this experiment. Hence, it will be further explored in the future.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Texture Features and Risk Factor Analysis of Postoperative Recurrence of Patients with Advanced Gastric Cancer after Radical Treatment under Artificial Intelligence Algorithm

Zhou

Zhang

Liao

et al. 2022

Computational Intelligence and Neuroscience

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Computer tomography texture analysis (CTTA) based on the V-Net convolutional neural network (CNN) algorithm was used to analyze the recurrence of advanced gastric cancer after radical treatment. Meanwhile, the clinical characteristics of patients were analyzed to explore the recurrence factors. 86 patients who underwent the advanced radical gastrectomy for gastric cancer were retrospectively selected as the research objects. Patients were divided into the no-recurrence group (30 cases) and the recurrence group (56 cases) according to whether there was recurrence after radical treatment. CTTA was performed before and after surgery in both groups to analyze the risk factors for recurrence. The results showed that the dice coefficient (0.9209) and the intersection over union (IOU) value (0.8392) of the V–CNN segmentation effect were signally higher than those of CNN, V-Net, and context encoder network (CE-Net) ( P < 0.05). The mean value of arterial phase and portal phase (65.29 ± 9.23)/(79.89 ± 10.83), kurtosis (3.22)/(3.13), entropy (9.99 ± 0.53)/(9.97 ± 0.83), and correlation (4.12 × 10−5/4.21 × 10−5) of the recurrence group was higher than the no-recurrence group, while the skewness (0.01)/(−0.06) of the recurrence group was lower than that of the no-recurrence group ( P < 0.05). Patients aged 60 years old and above, with a tumor diameter of 6 cm and above, and in the stage III/IV in the recurrence group were higher than those in the no-recurrence group, and patients with chemotherapy were lower ( P < 0.05). To sum up, age, tumor diameter, whether chemotherapy should be performed, and tumor staging were all the risk factors of postoperative recurrence among patients with gastric cancer. Besides, CT texture parameter could be used to predict and analyze the postoperative recurrence of gastric cancer with good clinical application values.

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“…Although early GC has a better prognosis, patient prognosis of patients still differs significantly. When accompanied by lymphatic and vascular invasion, the prognosis of early GC is still poor, and the risk of LN metastasis is high[ 26 , 27 ]. Osumi et al [ 26 ] found that the frequency of LNs also increased with increasing macroscopic tumor diameter.…”

Section: Discussionmentioning

confidence: 99%

Metastatic lymph nodes and prognosis assessed by the number of retrieved lymph nodes in gastric cancer

Wang¹,

Yin²,

Lou³

et al. 2022

World J Gastrointest Surg

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BACKGROUND The prognostic value of quantitative assessments of the number of retrieved lymph nodes (RLNs) in gastric cancer (GC) patients needs further study. AIM To discuss how to obtain a more accurate count of metastatic lymph nodes (MLNs) based on RLNs in different pT stages and then to evaluate patient prognosis. METHODS This study retrospectively analyzed patients who underwent GC radical surgery and D2/D2+ LN dissection at the Cancer Hospital of Harbin Medical University from January 2011 to May 2017. Locally weighted smoothing was used to analyze the relationship between RLNs and the number of MLNs. Restricted cubic splines were used to analyze the relationship between RLNs and hazard ratios (HRs), and X-tile was used to determine the optimal cutoff value for RLNs. Patient survival was analyzed with the Kaplan-Meier method and log-rank test. Finally, HRs and 95% confidence intervals were calculated using Cox proportional hazards models to analyze independent risk factors associated with patient outcomes. RESULTS A total of 4968 patients were included in the training cohort, and 11154 patients were included in the validation cohort. The smooth curve showed that the number of MLNs increased with an increasing number of RLNs, and a nonlinear relationship between RLNs and HRs was observed. X-tile analysis showed that the optimal number of RLNs for pT1-pT4 stage GC patients was 26, 31, 39, and 45, respectively. A greater number of RLNs can reduce the risk of death in patients with pT1, pT2, and pT4 stage cancers but may not reduce the risk of death in patients with pT3 stage cancer. Multivariate analysis showed that RLNs were an independent risk factor associated with the prognosis of patients with pT1-pT4 stage cancer ( P = 0.044, P = 0.037, P = 0.003, P < 0.001). CONCLUSION A greater number of RLNs may not benefit the survival of patients with pT3 stage disease but can benefit the survival of patients with pT1, pT2, and pT4 stage disease. For the pT1, pT2, and pT4 stages, it is recommended to retrieve 26, 31 and 45 LNs, respectively.

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Venous Invasion Is a Risk Factor for Recurrence of pT1 Gastric Cancer with Lymph Node Metastasis

Cited by 10 publications

References 12 publications

Risk stratification for predicting postoperative recurrence of gastric cancer by grade of venous invasion

Risk stratification for predicting postoperative recurrence of gastric cancer by grade of venous invasion

Computed Tomography Texture Features and Risk Factor Analysis of Postoperative Recurrence of Patients with Advanced Gastric Cancer after Radical Treatment under Artificial Intelligence Algorithm

Metastatic lymph nodes and prognosis assessed by the number of retrieved lymph nodes in gastric cancer

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