Extracapsular Lymph Node Spread: A New Prognostic Factor in Gastric Cancer

Peritoneal metastasis in gastric cancer with particular reference to lymphatic advancement : Extranodal invasion is a significant risk factor for peritoneal metastasis

Background In addition to the stepwise manner of lymph-node metastasis from the primary tumour, the skip lymph-node metastasis (SLNM) was identified as a low-incidence metastasis of gastric cancer (GC). So far, both the mechanism and outcome of SLNM have not been elucidated completely. The purpose of this study was to analyse the clinical significance and the potential mechanism of SLNM in GC patients who had lymph-node metastasis. Methods Clinicopathological data and follow-up information of 505 GC patients who had lymph-node metastasis were analysed to demonstrate the significance of SLNM in evaluating the prognostic outcome. According to the pathological results, all GC patients who had lymph-node metastasis were categorized into three groups: patients with the perigastric lymph-node metastasis, patients with the perigastric and extragastric lymph-node metastasis and patients with SLNM.Results: Among the 505 GC patients who had lymph-node metastasis, 24 (4.8%) had pathologically identified SLNM. The location of lymph-node metastasis was not significantly associated with 5-year survival rate and overall survival (OS) (P = 0.194). The stratified survival analysis results showed that the status of SLNM was significantly associated with the OS in patients with pN1 GC (P = 0.001). The median OS was significantly shorter in 19 pN1 GC patients with SLNM than in 100 patients with perigastric lymph-node metastasis (P < 0.001). The case-control matched logistic regression analysis results showed that tumour size (P = 0.002) was the only clinicopathological factor that may predict SLNM in pN1 GC patients undergoing curative surgery. Among the 19 pN1 GC patients with SLNM, 17 (89.5%) had metastatic lymph nodes along the common hepatic artery, around the celiac artery or in the hepatoduodenal ligament. Conclusions SLNM may be considered a potentially practicable indicator for prognosis among various subgroups of pN1 GC patients.

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Clinical significance of skip lymph-node metastasis in pN1 gastric-cancer patients after curative surgery

Objectives The TNM classification is the main tool for lymph node (LN) staging in gastric cancer (GC). However, alternative LN staging systems have been proposed, and the role of features other than the number of metastatic LNs is being investigated. Our aim is to discuss the main challenges of LN assessment in GC. Methods Comprehensive review of the literature on alternative LN staging systems, examined LNs, sentinel LN (SLN) biopsy, LN micrometastases (LNMIs), extracapsular extension (ECE), and tumor deposits (TDs) in GC. Results Many controversies exist regarding LN assessment in GC. The TNM classification shows excellent prognostic performance, but alternative prognostic methods such as the LN ratio or log odds of positive LNs have demonstrated to be better than the TNM system in terms of prognostic accuracy. The value of SLN biopsy and LNMIs in GC is still unclear, and several challenges concerning their clinical impact and pathologic analysis must be overcome before their introduction in clinical practice. Most authors have identified ECE and TDs as independent prognostic factors for survival in GC. Conclusions Further studies should be performed to evaluate the impact of these features on the TNM classification and patient outcomes, as well as to standardize alternative LN staging systems.

Pathologic Lymph Node Staging of Gastric Cancer.

Little is known about the features of gastric cancer located in the lesser and greater curve. This study aims to investigate the clinicopathological features and prognosis of gastric cancer located in the lesser and greater curve. From September 2008 to March 2015, 780 gastric cancer patients were enrolled in the present study. The associations between locations and features of patients were analyzed. There were 571 male (73.2 %) and 209 female (26.8 %) patients. The median age was 56 years (ranged 21–86). There were 684 tumors located in the lesser curve (87.7 %) and 96 located in the greater curve (12.3 %). The incidence of melena was significantly lower in patients with tumors located in the lesser curve than that in the greater curve (8.5 vs 15.6 %, P = 0.024). The median size of tumors in the lesser curve was significantly larger than that in the greater curve (5.0 (0.3–15) vs 4.0 cm (0.5–15), P = 0.001). The remaining clinicopathological features were comparable between the two groups (all P > 0.05). Tumor location was not a risk factor for the prognosis of gastric cancer by univariate and multivariate analysis (both P > 0.05). The postoperative complications (all P > 0.05) and prognoses (P = 0.279) were comparable between tumors located in the lesser and greater curve. The ratio of gastric cancer located in the lesser to greater curve was 7.1:1. Compared with tumors located in the greater curve, the incidence of melena was significantly lower and the tumor size was significantly larger in tumors located in the lesser curve. The prognoses were comparable between tumors located in the lesser and greater curve.

Comparison of clinicopathological features and prognosis of gastric cancer located in the lesser and greater curve.

BACKGROUND This study aimed to elucidate the intensive effect of the number of positive niduses in extranodal soft tissues (PNESTs) on the overall survival of gastric cancer (GC) patients after curative gastrectomy. METHODS The clinicopathological data of 961 GC patients were studied to determine whether increased number of PNESTs was a high-risk factor for the dismal prognosis of GC patients. RESULTS Survival analyses revealed that the number of PNESTs was negatively associated with the overall survival (OS) (P<0.001) and was an independent prognostic predictor (HR=1.360, P<0.001) for the 961 GC patients. The number of PNESTs, with the smallest BIC value (421.947, P=0.018), was identified as the most intensive independent predictor of prognosis for the 961 GC patients. Correlation analyses showed that the pT stage, pN stage, pTNM classification, tumor size, and type of gastrectomy were significantly related to the number of PNESTs, and that tumor size was the most closely relevant factor in all included GC patients. These findings revealed that increased number of PNESTs was suitable to evaluate the dismal prognosis of GC patients. CONCLUSIONS The number of PNESTs is an important high-risk clinicopathological characteristic for improving the accuracy of prognostic evaluation of GC patients.

Effect of the number of positive niduses in extranodal soft tissues on the overall survival of gastric cancer patients

Many issues of middle-third gastric cancer need to be address for obtaining preferably clinical treatment. The objective of this retrospective study was to analyze clinicopathologic characteristics and results of surgery for 113 middle-third gastric cancer patients admitted to our hospital. Retrospective cohort analyses of clinicopathologic data and postoperative prognosis of 113 middle-third gastric cancer patients who underwent curative resection between January 1997 and December 2003 were reviewed. Compared with lower-third gastric cancer patients, middle-third gastric cancer patients had significantly lower 5-year survival rate (P < 0.001) and higher recurrence rate (P < 0.001). With the Cox proportional hazards model analysis, the types of gastrectomy (hazard ratio (HR) = 0.495, P = 0.012) and ratio between metastatic and dissected lymph nodes (RML) (HR = 1.681, P < 0.001) were identified as the independent predictors of overall survival (OS) of middle-third gastric cancer patients. Besides, only RML (HR = 3.026, P < 0.001) was an independent predictor of recurrence for middle-third gastric cancer patients after surgery identified using the logistic regression analysis. The prognosis of middle-third gastric cancer was significantly worse than lower-third gastric cancer. RML was a key indicator for OS and recurrence of middle-third gastric cancer.

Clinicopathologic characteristics and outcomes of surgery of middle-third gastric cancer.

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Effect of the number of positive niduses in extranodal soft tissues on the overall survival of gastric cancer patients

Clinicopathologic characteristics and outcomes of surgery of middle-third gastric cancer.