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Tsao MW, Kahl MS, Deneve JL, Yakoub D, Glazer ES, Shibata D, Jain R, Clark I, Dickson PV. The Association of Race With Adequate Lymph Node Evaluation for Gastric Cancer. Am Surg 2022; 88:2280-2288. [PMID: 35570820 DOI: 10.1177/00031348221101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND National studies have reported racial and socioeconomic disparities in gastric cancer (GC) care. The current study evaluated adequate lymph node (LN) assessment (≥16 LNs) during resection for GC within a healthcare system servicing a socioeconomically disparate, mostly non-White population in the Southeast United States. METHODS A retrospective cohort study of patients undergoing resection for GC between 2003-2019 was performed. Factors associated with adequate LN assessment including patient and tumor characteristics were analyzed. RESULTS Among 202 patients, adequate LN assessment was performed in 97 (48%) patients. On univariable analysis, younger age, non-White race, lower Charlson Comorbidity Index (CCI), Medicaid or no insurance, D1+/D2 lymphadenectomy, clinical evidence of regional LN metastases, total gastrectomy, and receipt of neoadjuvant therapy were associated with adequate LN assessment. On multivariable analysis, non-White race (OR 2.79, 95% CI 1.38-5.65), CCI <4 (OR 2.14, 95% CI 1.15-3.96), and D1+/D2 lymphadenectomy (OR 3.63, 95% CI 1.96-6.74) were the only factors independently associated with adequate LN evaluation. CONCLUSIONS In the current study, non-White race, independent of socioeconomics, was significantly associated with adequate LN assessment. Future work is necessary to improve standardization and achieve higher rates of adequate LN assessment for all patients during resection for GC.
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Affiliation(s)
- Miriam W Tsao
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Madison S Kahl
- College of Medicine, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Evan S Glazer
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Richa Jain
- Department of Pathology, 5416Methodist LeBonheur Healthcare, Memphis, TN, USA
| | - Ian Clark
- Department of Pathology, 5416Methodist LeBonheur Healthcare, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
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2
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Sun JW, Liu DL, Chen JX, Lin LZ, Zhuang LP, Hou XH. Early and late recurrences in lymph node-negative gastric cancer: a retrospective cohort study. Ann Saudi Med 2021; 41:336-349. [PMID: 34873937 PMCID: PMC8650598 DOI: 10.5144/0256-4947.2021.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Predictors of recurrence in patients with lymph node-negative gastric cancer (GC) who have undergone curative resection have been widely investigated, but not the effects of predictors on timing of recurrence. OBJECTIVE Determine the factors associated with early and late recurrence in patients with node-negative GC. DESIGN Retrospective cohort. SETTING Academic tertiary care center. PATIENTS AND METHODS The study included patients with node-negative GC after curative resection between 2008 and 2018 at two institutions. Early and late recurrences were determined using a minimum P value approach to evaluate the optimal cutoff for recurrence-free survival (RFS). A competing risk model and landmark analysis were used to analyze factors associated with early and late recurrences. MAIN OUTCOME MEASURES Recurrence-free survival and factors associated with survival. SAMPLE SIZE 606. RESULTS After a median follow-up of 70 months, 50 (8.3%) patients experienced recurrent disease. The optimal length of RFS for distinguishing between early (n=26) and late recurrence (n=24) was 24 months (P=.0013). The median RFS in the early and late recurrence groups was 11 and 32 months, respectively. Diffuse tumors (hazard ratio 3.358, P=.014), advanced T stage (HR 8.804, P=.003), perineural invasion (HR 10.955, P<.001), and anemia (HR 2.351, P=.018) were independent predictors of early recurrence. Mixed tumor location (HR 5.586, P=.002), advanced T stage (HR 5.066, P<.001), lymphovascular invasion (HR 5.902, P<.001), and elevated CA19-9 levels (HR 5.227, P<.001) were independent predictors of late recurrence. Similar results were obtained in the landmark analysis. CONCLUSIONS Individualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence. LIMITATIONS Retrospective design, small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
- Jian-Wei Sun
- From the Department of Surgery, Qingyang's People's Hospital, Qingyan, China
| | - Dao-Li Liu
- From the Department of Gastrointestinal Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Jia-Xian Chen
- From the Department of Surgery, Qingyang's People's Hospital, Qingyan, China
| | - Li-Zhen Lin
- From the Graduate School, Fujian Medical University, Fuzhou, China
| | - Lv-Ping Zhuang
- From the Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xian-Hai Hou
- From the Department of Surgery, Qingyang's People's Hospital, Qingyan, China
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3
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Huang JB, Lu J, Wu D, Xu BB, Xue Z, Lin GS, Zheng HL, Shen LL, Lin J, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Zheng CH, Huang CM, Li P. Is Adjuvant Chemotherapy Beneficial to All Patients With pT3N0M0 Stage Gastric Cancer? Front Oncol 2021; 11:712432. [PMID: 34513692 PMCID: PMC8428976 DOI: 10.3389/fonc.2021.712432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background The efficacy and benefits of adjuvant chemotherapy (AC) for patients with gastric cancer pT3N0M0 remain controversial. Methods We prospectively collected and retrospectively analyzed 235 patients with pT3N0M0 gastric cancer who underwent radical resection between February 2010 and January 2016. Patients were divided into two groups: the surgery-alone (SA) group (n = 82) and the AC group (n = 153). We analyzed the effects of AC on the overall survival (OS) and recurrence-free survival (RFS), and the relationship between the number of chemotherapy cycles (CC) and recurrence rate (RR). Results The 5-year OS and RFS of the participants were 80.9% and 87.7%, respectively, and those in the AC group were significantly higher than those in the SA group (86.9% vs. 69.5%, p = 0.003). The RFS of the AC and SA groups were 88.9% and 85.4%, respectively; the difference was not statistically significant (p = 0.35). The independent risk factors affecting the OS were perineural invasion-positive (PNI+) (HR = 2.64, 95%CI: 1.45-4.82, p = 0.003) and age ≥ 65 years (HR = 2.58, 95%CI: 1.39-4.8, p = 0.003). The independent risk factor affecting the RFS was also PNI+ (HR3.11; 95%CI: 1.48-6.54, p = 0.003). Stratified analysis revealed that postoperative AC can significantly improve the OS of PNI+ patients (AC group versus SA group: 84.1% vs. 45.5%, p = 0.001) and RFS (86.4% vs. 63.6%, p = 0.017). However, perineural invasion negative (PNI-) patients did not show the same results (p = 0.13 and p = 0.48, respectively). According to the number of CC, divided into CC < 3 groups and CC ≥ 3 groups, the cumulative RR in the CC ≥ 3 group of patients with PNI+ was significantly lower than that of the CC < 3 group (7.4% vs. 28.2%, p = 0.037). Conclusion For pT3N0M0 gastric cancer patients with PNI+, at least three cycles of postoperative AC can significantly reduce the overall RR. This finding should be verified by using large external sample data.
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Affiliation(s)
- Jiao-Bao Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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4
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Lin GT, Chen QY, Zhong Q, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Huang CM. Intraoperative Surrogate Indicators of Gastric Cancer Patients' Long-Term Prognosis: The Number of Lymph Nodes Examined Relates to the Lymph Node Noncompliance Rate. Ann Surg Oncol 2020; 27:3281-3293. [PMID: 32212034 DOI: 10.1245/s10434-020-08387-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The number of examined lymph nodes (ExLNs) and the rate of lymph node (LN) noncompliance are two independent indicators for evaluating the oncological efficacy for radical gastric cancer (GC) surgery. There are no studies to prove the relationship between these two indicators and their influence on the long-term prognosis of GC patients. METHODS The clinicopathological data of 1872 patients with radical GC resection with pathological stage pT2-4N0-3M0 from June 2007 to June 2013 were retrospectively analyzed. Noncompliance was defined as patients with more than one or more LN stations absence as described in the protocol for lymphadenectomy in the Japanese Gastric Cancer Association. RESULTS Among 1872 patients, 941 (50.3%) had complete LN compliance, 469 (25.1%) had minor LN noncompliance, and 462 (24.6%) had major LN noncompliance. Logistic regression analysis showed that cT staging and ExLNs were independent risk factors for LN noncompliance. In the whole group, Kaplan-Meier survival curve elucidated that overall survival (OS) differences of ExLNs ≤ 25 and ExLNs > 25 were statistically significant (p < 0.001). Stratified analysis of LN noncompliance elucidated no statistically significant difference in OS of these two group. Multivariate COX regression analysis suggested that LN noncompliance was an independent prognostic factor for OS, whereas ExLNs was no longer an independent prognostic factor for OS. CONCLUSIONS The increase number of ExLNs can improve the OS of GC patients, which depends on the decrease of LN noncompliance rate. As surrogate indicators for long-term prognosis of GC patients, LN noncompliance rate was better than ExLNs number.
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Affiliation(s)
- Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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5
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Khanjani N, Mirzaei S, Nasrolahi H, Hamedi SH, Mosalaei A, Omidvari S, Ahmadloo N, Ansari M, Sobhani F, Mohammadianpanah M. Insufficient lymph node assessment in gastric adenocarcinoma. J Egypt Natl Canc Inst 2019; 31:2. [PMID: 32372269 DOI: 10.1186/s43046-019-0004-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study aimed to investigate the sufficient (≥ 16) lymph node assessment in 449 patients with gastric adenocarcinoma and literature review. METHODS Four hundred and forty-nine patients with pathologically confirmed locoregional invasive gastric adenocarcinoma from 2004 to 2013 were included. A standard surgical resection was performed for all the patients with (n = 16) or without (n = 433) neoadjuvant treatment. RESULTS In this study, 301 men and 148 women with a median age of 58 (range 21-88) years were included. The median total numbers of examined lymph nodes were 9 (range 0-55). Ninety-five patients (21.2%) had adequate (≥ 16) lymph node examination, and 70 patients (15.6%) had no examined lymph nodes. In univariate analysis, total or near total gastrectomy (P < 0.001), advanced node stage (P < 0.001), primary tumor size > 6 cm (P < 0.001), and the presence of perineural invasion (P = 0.039) were associated with more average number of examined lymph nodes. On multivariate analysis, node stage (P < 0.001) and type of surgery (P = 0.008) were independent predictive factors. CONCLUSION In this study, approximately one in five patients with gastric adenocarcinoma had sufficient lymph node assessment. More studies are suggested for identifying a true inadequate lymph node dissection from insufficient lymph node assessment.
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Affiliation(s)
- Nezhat Khanjani
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepideh Mirzaei
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nasrolahi
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hasan Hamedi
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Mosalaei
- Shiraz Institute for Cancer Research, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shapour Omidvari
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Ahmadloo
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansour Ansari
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sobhani
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Wang ZK, Lin JX, Li P, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Huang CM, Zheng CH. Higher Risk of Lymph Node Metastasis in Young Patients with Early Gastric Cancer. J Cancer 2019; 10:4389-4396. [PMID: 31413759 PMCID: PMC6691700 DOI: 10.7150/jca.30260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 05/14/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: Whether age affects lymph node metastasis (LNM) in patients with gastric cancer (GC) is currently inconclusive. This study investigates the effect of age on LNM in patients with GC. Methods: From January 1988 to December 2013, 22,808 GC patients underwent gastrectomy at the Surveillance, Epidemiology, and End Results database were included. The relationship between age and LNM was analyzed. Results: The median number of examined lymph nodes (ELNs) was 12 (interquartile range [IQR], 7-20) among the 22,808 patients with GC, and the median numbers of ELNs were 10 (IQR, 5-18), 12 (IQR, 6-19), 13 (IQR, 7-21) and 13 (IQR, 7-21) in patients with T1 to T4 disease, respectively. A total of 13,780 (60.4%) patients presented with LNM. The LNM rates were 69.6%, 66.1%, 64.7%, 61.8%, 57.8% and 55.6% for patients in the 20-39, 40-49, 50-59, 60-69, 70-79 and ≥ 80 age groups, respectively (P < 0.001). The LNM rates and the number of positive lymph nodes were correlated with age among patients whose diseases were of the same T stage (all P < 0.01). Multivariate analysis showed that age was an independent predictor for LNM in patients with early gastric cancer (EGC) (P < 0.05), and linear regression analysis showed that the LNM rate was higher in young patients with EGC (P < 0.05). Conclusions: Age is an independent predictor for LNM in EGC. Moreover, LNM is more common in young patients with EGC than in other age groups, which indicates that limited lymph node dissection may not be appropriate for young patients with EGC.
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Affiliation(s)
- Zu-Kai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
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7
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Lu J, Dai Y, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Zheng CH, Li P, Huang CM. Combination of lymphovascular invasion and the AJCC TNM staging system improves prediction of prognosis in N0 stage gastric cancer: results from a high-volume institution. BMC Cancer 2019; 19:216. [PMID: 30857518 PMCID: PMC6413460 DOI: 10.1186/s12885-019-5416-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 02/27/2019] [Indexed: 12/14/2022] Open
Abstract
Background This study sought to explore whether lymphovascular invasion can affect the prognosis of patients with stage N0 gastric cancer and to evaluate the survival benefit of adjuvant chemotherapy for such patients. Method From January 2006 to December 2011, a total of 2102 gastric cancer patients undergoing radical gastric resection were enrolled in this study. Homogeneity, discriminatory ability, and monotonicity of gradients in the combination of lymphovascular invasion and the 8th edition of the AJCC staging system and the 8th edition of the AJCC staging system alone were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations. The Kaplan-Meier method and the log-rank test were used to analyze between-group differences in survival rate. Result The median follow-up time of the whole group was 58 months, and the average age of the whole group was 63.9 years (range 21–89 years). The 3-year and 5-year overall survival rates in N0 patients with lymphovascular invasion were lower than those in N0 patients without lymphovascular invasion (3-year OS: 78.3% vs 92.5%, 5-year OS: 70.0% vs 88.3%, p < 0.001). A multivariate analysis showed that age (p < 0.001), lymphovascular invasion (p < 0.001), and pT (p < 0.001) were independent risk factors for the prognosis of N0 patients. Compared with the 8th edition of the AJCC staging system alone, the 8th AJCC staging system combined with lymphovascular invasion demonstrated a better linear trend χ2, likelihood ratio χ2 statistics, and AIC value (68.99 vs 58.58, 70.18 vs 58.36, 1473.38 vs 1485.04). In pT3N0M0 patients with lymphovascular invasion, the 3-year and 5-year overall survival rates of the adjuvant chemotherapy group were higher than those of the surgery alone group (3-year OS: 83.3% vs 68.2%, 5-year OS: 72.3% vs 50.0%, p = 0.048). Conclusion Lymphovascular invasion is an independent prognostic factor in N0 patients. The 8th AJCC staging system combined with lymphovascular invasion can improve the accuracy of the AJCC staging system for N0 patients. Moreover, adjuvant chemotherapy improves the survival of pT3N0M0 patients with lymphovascular invasion. Electronic supplementary material The online version of this article (10.1186/s12885-019-5416-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yun Dai
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China. .,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China. .,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China. .,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China.
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8
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Zheng WF, Ji TT, Lin Y, Li RZ. The prognostic value of lymph nodes count on survival of patients with node-negative gastric cancer. Oncotarget 2018; 7:43680-43688. [PMID: 27270656 PMCID: PMC5190052 DOI: 10.18632/oncotarget.9845] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/20/2016] [Indexed: 12/12/2022] Open
Abstract
The retrieved lymph node (LN) count has been validated as a prognostic factor in various cancers. However, the interaction between LN counts and patients' prognosis in gastric cancer with negative-LN metastasis is not fully studied. Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer patients were used for analysis in this study. Patients operated on for gastric cancer at N0 stage between 2004 and 2012 were identified from the SEER database. The association between the LN counts and survival was assessed using the Cox proportional hazards model. Patients were stratified into 1–4, 5−13, and > 13 subgroups according to LN count cut-off values determined by X-tile program, with the 5-year cause specific survival (CSS) rate of 64.8%, 72.5%, and 79.4%, respectively. LN count was also validated as an independently prognostic factor in multivariate Cox analysis (P < 0.001). In addition, nomograms including LN counts on CSS were established according to all significant factors, and the c-index was 0.703 (95% CI: 0.672−0.734). Further study indicated that patients with no LN metastasis had a decreased risk of death for each patient with LN examined up to approximately 14 LNs. Collectively, our study firmly demonstrated that the number of the retrieved LNs count was an independent prognostic factor for gastric cancer with no LN metastasis. The higher the LN count, the better the survival would be; the best CSS was observed on the LN count more than 14.
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Affiliation(s)
- Wei-Feng Zheng
- Department of Gastroenterology, Rui'an People's Hospital, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Ting-Ting Ji
- Department of Gastroenterology, Rui'an People's Hospital, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Yong Lin
- Department of Gastroenterology, Rui'an People's Hospital, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Rong-Zhou Li
- Department of Gastroenterology, Rui'an People's Hospital, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
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9
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Zhou Y, Cui JG, Huang F, Zhang A, Li C, Zhao ZC, Li WD, Fu WH. Prognostic Factors for Survival in Node-Negative Gastric Cancer Patients Who Underwent Curative Resection. Scand J Surg 2017; 106:235-240. [PMID: 28376652 DOI: 10.1177/1457496916677878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM Lymph node involvement is the strongest prognostic factor for patients with gastric cancer; patients with node-negative gastric cancer present with better survival. However, some patients develop recurrent gastric cancer. The aim of this study was to review the clinicopathological characteristics and factors for prognosis in patients with node-negative gastric cancer who underwent curative resection. METHODS Between January 2004 and December 2015, the clinicopathological characteristics of 302 patients with node-negative gastric cancer who underwent curative gastrectomy in our hospital were retrospectively analyzed. RESULTS The 1-, 3-, and 5-year overall survival rates for patients with node-negative gastric cancer were 80.0%, 69.0%, and 63.0%, respectively. Univariate analysis showed that tumor size, histologic type, and depth of invasion had significant effects on survival (p < 0.05). Multivariate analysis showed that tumor size (hazard ratio: 1.83%, 95.0% confidence interval: 1.13-2.96, p = 0.014), histologic type (hazard ratio: 1.57%, 95.0% confidence interval: 1.01-2.44, p = 0.042), and depth of invasion (hazard ratio: 1.38%, 95.0% confidence interval: 1.14-1.67, p = 0.001) were independent prognostic factors. CONCLUSION Tumor size, histologic type, and depth of invasion are important prognostic factors in patients with node-negative gastric cancer. These parameters should be considered to stratify patients for therapy and follow-up strategies.
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Affiliation(s)
- Y Zhou
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - J-G Cui
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - F Huang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - A Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - C Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Z-C Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - W-D Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - W-H Fu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
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10
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Factors Associated With Recurrence and Survival in Lymph Node-negative Gastric Adenocarcinoma: A 7-Institution Study of the US Gastric Cancer Collaborative. Ann Surg 2016; 262:999-1005. [PMID: 25607760 DOI: 10.1097/sla.0000000000001084] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma. STUDY DESIGN Multi-institutional retrospective analysis. BACKGROUND Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established. METHODS Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively. RESULTS Of 805 patients who met inclusion criteria, 317 (39%) had node-negative disease, of which 54 (17%) recurred. By 2 and 5 years, 66% and 88% of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR = 2.7; 95% confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR) = 1.8; 95% CI, 1.2-2.8], lymphovascular invasion (HR = 2.2; 95% CI, 1.4-3.4), and signet ring histology (HR = 2.1; 95% CI, 1.2-3.6) to be associated with decreased overall survival. CONCLUSIONS Despite absence of lymph node involvement, patients with T-stage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.
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11
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He H, Shen Z, Wang X, Qin J, Sun Y, Qin X. Survival benefit of greater number of lymph nodes dissection for advanced node-negative gastric cancer patients following radical gastrectomy. Jpn J Clin Oncol 2015; 46:63-70. [DOI: 10.1093/jjco/hyv159] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/29/2015] [Indexed: 12/20/2022] Open
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12
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Zhou Y, Yu F, Wu L, Ye F, Zhang L, Li Y. Survival after Gastrectomy in Node-Negative Gastric Cancer: A Review and Meta-Analysis of Prognostic Factors. Med Sci Monit 2015; 21:1911-9. [PMID: 26134762 PMCID: PMC4500595 DOI: 10.12659/msm.893856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Lymph node metastasis is one of the most important prognostic factors for survival of patients with gastric cancer (GC) after surgical resection. Nevertheless, a considerable number of patients have node-negative disease. We performed the present systematic review to evaluate survival and identify prognostic factors in node-negative GC patients undergoing curative intent resection. Material/Methods Relevant studies published between January 2000 and January 2015 were identified by searching the PubMed database and reviewed systematically. Summary relative risks (RR) and 95% confidence intervals (95% CI) were estimated using random-effects models. Results Thirty observational studies involving 12 504 patients were included in the review. Median 5-year overall survival was 84.3% (range, 53–96.3%). Pooled analysis showed that old age (RR, 1.26; 95%CI, 1.13–1.42), <D2 lymph node dissection (1.28; 1.05–1.55), larger tumor (1.18; 1.10–1.26), serosal invasion (2.03; 1.68–2.44), lymphatic invasion (1.25; 1.00–1.57), vascular invasion (1.67; 1.19–2.34), and lymphovascular invasion (1.93; 1.20–3.10) were significant association with decreased survival. Conclusions Surgical resection offers good overall survival for patients with node-negative GC. Tumor-related factors seem to have most prognostic significance.
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Affiliation(s)
- Yanming Zhou
- Department of Hepato-Biliary-Pancreato-Vascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China (mainland)
| | - Feng Yu
- Department of Hepatobiliary Surgery, The 101th Hospital of Chinese PLA, Wuxi, Jiangsu, China (mainland)
| | - Lupeng Wu
- Department of Hepato-Biliary-Pancreato-Vascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China (mainland)
| | - Feng Ye
- Department of Hepato-Biliary-Pancreato-Vascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China (mainland)
| | - Leilei Zhang
- Department of Anaesthesiology, Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yumin Li
- Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou, Gansu, China (mainland)
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13
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Predictive factors for survival and recurrence rate in patients with node-negative gastric cancer—a European single-centre experience. Langenbecks Arch Surg 2014; 400:27-35. [DOI: 10.1007/s00423-014-1226-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/09/2014] [Indexed: 11/26/2022]
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14
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Does tumor size improve the accuracy of prognostic predictions in node-negative gastric cancer (pT1-4aN0M0 stage)? PLoS One 2014; 9:e101061. [PMID: 25003849 PMCID: PMC4086925 DOI: 10.1371/journal.pone.0101061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 06/03/2014] [Indexed: 01/17/2023] Open
Abstract
Background The prognostic importance of tumor size in gastric cancer is unclear. This study investigated whether the inclusion of tumor size could improve prognostic accuracy in node-negative gastric cancer. Methods Clinical and pathological data of 492 patients with node-negative gastric cancer who underwent radical surgery in our department from January 1995 to December 2008 were analyzed. The prognostic accuracy of T stage was compared with that of T stage plus tumor size. The ability of tumor size to improve the 95% confidence interval (CI) of postoperative 5-year survival rate in gastric cancer patients was assessed. Different T stages plus tumor size were further analyzed to assess improvements in prognosis. Results Mean tumor size was 3.79±1.98 cm with a normal distribution. Multivariate analysis showed that tumor size and T stage were independent prognostic factors. Postoperative 5-year survival rate tended to decrease as tumor size increased in 1 cm increments. The addition of tumor size to T stage improved accuracy in predicting 5-year survival by 4.2% (P<0.05), as well as improving the 95% CI of postoperative 5-year survival rate by 3.2–5.1%. The addition of tumor size improved the predictive accuracy of postoperative 5-year survival rate by 3.9% (95% CI 70.4%–91.1%, P = 0.033) in patients with stage T3N0M0 tumors and by 6.5% (95% CI 68.7%–88.4%, P = 0.014) in patients with stage T4aN0M0 tumors. Conclusions Tumor size is an independent prognostic factor for survival in patients with node-negative gastric cancer, as well as improving prognostic accuracy in stage T3/4aN0M0 tumors.
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15
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Clinicopathologic study of node-negative advanced gastric cancer and analysis of factors predicting its recurrence and prognosis. Am J Surg 2013; 205:623-30. [DOI: 10.1016/j.amjsurg.2012.04.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/01/2012] [Accepted: 04/01/2012] [Indexed: 01/16/2023]
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16
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Jeong JY, Kim MG, Ha TK, Kwon SJ. Prognostic factors on overall survival in lymph node negative gastric cancer patients who underwent curative resection. J Gastric Cancer 2012; 12:210-6. [PMID: 23346492 PMCID: PMC3543970 DOI: 10.5230/jgc.2012.12.4.210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/06/2012] [Accepted: 09/09/2012] [Indexed: 12/21/2022] Open
Abstract
Purpose To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. Materials and Methods Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. Results There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph node-positive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (≥59, hazard ratio, 2.882), and carcinoembryonic antigen level (≥5 ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. Conclusions Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.
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Affiliation(s)
- Ji Yun Jeong
- Department of Surgery, College of Medicine, Hanyang University, Seoul, Korea
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17
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Prognostic factors and recurrence pattern in node-negative advanced gastric cancer. Eur J Surg Oncol 2012; 39:136-40. [PMID: 23148932 DOI: 10.1016/j.ejso.2012.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 12/20/2022] Open
Abstract
AIMS Despite better overall survival in node-negative advanced gastric cancer (AGC), a significant proportion of patients develop recurrence and they may benefit from adjuvant therapy. The aim of this study was to evaluate the prognostic factors and recurrence pattern of node-negative AGC. METHODS A total of 424 patients who underwent curative gastrectomy with extended lymphadenectomy for node-negative AGC between 2003 and 2005 were retrospectively reviewed. Patients with tumor involvement of adjacent organs (T4b), gastric cancer recurrence, tumor in the remnant stomach, less than 15 harvested lymph nodes, and those who received neoadjuvant chemotherapy were excluded. RESULTS Invasion to deeper layers, undifferentiated histology, signet ring cell type compared with tubular adenocarcinoma, and tumor size larger than 6.3 cm correlated with poorer prognosis in univariate analysis. In multivariate one, however, only differentiation and depth of invasion, especially the presence of serosa involvement were significant. The 5-year survival rates of the four groups classified by differentiation and depth of invasion [T2/3 (differentiated type), T2/3 (undifferentiated type), T4a (differentiated type), and T4a (undifferentiated type)] were 98%, 92%, 80%, and 72%, respectively (P < 0.01). In terms of recurrence pattern, Lauren's type and depth of invasion were significant. Recurrence with peritoneal seeding was associated with the diffuse type and invasion into the subserosa or serosa, while hematogenous metastasis was related to the intestinal type and invasion to the proper muscle or subserosa layer. CONCLUSIONS Differentiation and serosa involvement should be considered to stratify patients with node-negative AGC for adjuvant treatment.
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18
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How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. Gastric Cancer 2012; 15 Suppl 1:S70-88. [PMID: 22895615 DOI: 10.1007/s10120-012-0169-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 06/01/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nodal status is one of the most important prognostic factors in gastric adenocarcinoma (GC). As such, it is important to assess an appropriate number of lymph nodes (LNs) in order to accurately stage patients. However, the number of LNs assessed in each GC case varies, and in many cases the number examined per gastric specimen is less than current recommendations. PURPOSE We aimed to identify and synthesize findings from all articles evaluating the association of clinicopathological features and long-term outcomes with the number of LNs assessed among GC patients. METHODS Systematic electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1998 to 2009. RESULTS Twenty-five articles were included in this review. Extensive resection, increased tumor size, and greater TNM staging were all associated with a greater number of LNs assessed. The disease-free survival was longer and recurrence rate was lower in patients with more LNs assessed. Overall survival, as well as survival by TNM and clinical stage, was improved among patients with an increased number of LNs assessed, but much of this appears to be due to stage migration, with the effect more pronounced in more advanced disease. CONCLUSION More LNs assessed resulted in less stage migration and possibly better long-term outcomes. Although current guidelines suggest 16 LNs to be assessed, especially in advanced GC, a higher number of LNs should be assessed.
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Liu X, Cai H, Shi Y, Wang Y. Prognostic factors in patients with node-negative gastric cancer: a single center experience from China. J Gastrointest Surg 2012; 16:1123-7. [PMID: 22488657 DOI: 10.1007/s11605-012-1881-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 03/22/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Lymph node metastasis was the most important prognostic factor in gastric cancer. Patients with node-negative gastric cancer presented better survival. However, some of them would die of the disease. The aim of this study was to evaluate the prognostic factors of patients with node-negative gastric cancer. METHODS From 1996 to 2007, 4,426 patients had undergone curative D2 gastrectomy for gastric cancer at the Fudan University Shanghai Cancer Center. Patients with node-negative gastric cancer who underwent curative D2 gastrectomy with more than 15 lymph nodes dissected were selected into this study. The prognostic value of pathological features was investigated. RESULTS This study included 234 patients with node-negative gastric cancer. The 5-year overall survival in these patients was 85 %. The factors correlating significantly with overall survival on univariate analysis included age (P = 0.016), depth of invasion (P = 0.000), tumor size (P = 0.013), tumor site (P = 0.000), histological grade (P = 0.009), lymphatic tumor emboli (P = 0.014), vascular tumor emboli (P = 0.005), and nervous invasion (P = 0.033). Multivariate analysis showed that lymphatic tumor emboli (hazard ratio (HR) = 7.270), vascular tumor emboli (HR = 3.010), and depth of invasion (HR = 2.735) were defined as independent prognostic factors. CONCLUSION Among patients with node-negative gastric cancer and higher risk for recurrence, the use of adjuvant therapies should be considered.
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Affiliation(s)
- Xiaowen Liu
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, People's Republic of China
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20
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Lu X, Liu J, Li H, Li W, Wang X, Ma J, Tong Q, Wu K, Wang G. Conversion of intratumoral regulatory T cells by human gastric cancer cells is dependent on transforming growth factor-β1. J Surg Oncol 2011; 104:571-7. [PMID: 21695703 DOI: 10.1002/jso.22005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 05/31/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Regulatory T cells (Treg) inhibits immune responses mediated by T cells. This study aimed to investigate whether Treg are accumulated in human gastric cancer tissue and the mechanism of Treg induction by gastric cancer cells. METHODS Tissue infiltrated leukocytes from gastric adenocarcinomas were subjected to flow cytometry and immunohistochemistry. Percentage, phenotype, function, and clinical relevance of Treg were analyzed. TGF-β1 production by cancer cells was determined by Western blot and in vitro co-culture experiments were performed to mimic gastric cancer microenvironment. RESULTS The percentages of CD4(+) Foxp3(+) T cells in gastric cancer tissues were significantly higher than those from adjacent non-tumor gastric tissues (P < 0.05). The results of classical Treg phenotype and proliferation assay supported that the elevated CD4(+) Foxp3(+) T cells represents a suppressive Treg population. High proportion of Treg is correlated to advance TNM stage and reduced survival. Primary gastric cancer cells produced abundance of TGF-β1 which was responsible for conversion of Treg. CONCLUSION The proportion of functional Treg is elevated in human gastric cancer and related to poor prognosis. Gastric cancer cells directly convert CD4(+) naive T cells to Treg by TGF-β1, suggesting a possible mechanism through which tumor cells evade the immune system.
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Affiliation(s)
- Xiaoming Lu
- Department of Gastroenterology Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Seshadri RA, Jayanand SB, Ranganathan R. Prognostic factors in patients with node-negative gastric cancer: an Indian experience. World J Surg Oncol 2011; 9:48. [PMID: 21554745 PMCID: PMC3112415 DOI: 10.1186/1477-7819-9-48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/10/2011] [Indexed: 12/13/2022] Open
Abstract
Background The status of the regional nodes is the most important prognostic factor in gastric cancer. There are subgroups of patients with different prognosis even in node-negative patients of gastric cancer. The aim of this study is to analyze the factors influencing the prognosis in Indian patients with node-negative gastric cancer. Methods This was a retrospective analysis of patients who underwent radical gastrectomy in a tertiary cancer centre in India between1991 and 2007. The study group included only patients with histologically node-negative disease. Various clinical, pathological and treatment related factors in this group of patients were analyzed to determine their prognostic ability by univariate and multivariate analyses. Results Among the 417 patients who underwent gastrectomy during this period, 122 patients had node-negative disease. A major proportion of the patients had advanced gastric cancer. The 5-year overall survival and disease-free survival in all node-negative gastric cancer patients was 68.2% and 67.5% respectively. The overall recurrence rate in this group was 27.3%. On univariate analysis, the factors found to significantly influence the disease-free survival were the size, location and presence or absence of serosal invasion of the primary tumor. However, on multivariate analysis, only tumor size more than 3 cm and serosal invasion were found to be independently associated with an inferior survival. Conclusion Serosal invasion and primary tumor size more than 3 cm independently predict a poor outcome in patients with node-negative gastric cancer.
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Qiu MZ, Wang ZQ, Luo HY, Zhang DS, Zhou ZW, Li YH, Jiang WQ, Xu RH. Prognostic analysis in node-negative gastric cancer patients in China. Tumour Biol 2010; 32:489-92. [PMID: 21181465 DOI: 10.1007/s13277-010-0142-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022] Open
Abstract
Gastric cancer patients with negative nodes were considered to have better outcomes, however, some of them still suffered from disease recurrences or distant metastases after radical resection. A total of 1,020 gastric carcinoma patients receiving treatment in our center between 2003 and 2008 were selected for the analysis. All patients received gastrectomy and D2 lymphadenectomy. Survival analysis was performed with Cox regression model. The final study includes 222 patients. The overall 5-year disease-specific survival rate was 73.0%. Factors bearing significant association with lower survival on univariate analysis included the age of 58 years old or more (P = 0.021), tumor size longer than 4 cm (P < 0.001), presence of angiolymphatic invasion (P = 0.006), proximal site (P = 0.030), serosal invasion (T3+T4, P = 0.003), and higher TNM stage (P < 0.001). Only three factors including serosal invasion, tumor size at least 4.0 cm, and presence of angiolymphatic invasion remained independent negative predictors of survival in multivariable analysis. These parameters can be employed to select node-negative gastric cancer patients for an adjuvant setting and close follow-up scheduling.
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Affiliation(s)
- Miao-zhen Qiu
- State Key Laboratory of Oncology in South China, Guangzhou 510060, China
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A multicentric Western analysis of prognostic factors in advanced, node-negative gastric cancer patients. Ann Surg 2010; 252:70-3. [PMID: 20562605 DOI: 10.1097/sla.0b013e3181e4585e] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The presence of lymph node metastasis is one of the most important prognostic factors in patients with gastric carcinoma. Node-negative patients have a better outcome, nevertheless a subgroup of them experience disease recurrence. AIM To analyze the clinicopathological characteristics of lymph node-negative advanced gastric carcinoma patients submitted to gastrectomy and D2 lymphadenectomy with a retrieved number of nodes greater than 15, after an actual follow-up of almost 5 years, and to evaluate outcome indicators. STUDY DESIGN The records of 301 patients who underwent curative gastrectomy for gastric carcinoma and were adequately staged as N0 between 1992 and 2002 were retrospectively analyzed from the prospectively collected database of 7 centers participating to the Italian Research Group for Gastric Cancer. RESULTS Disease-specific and disease-free survival after 3, 5, and 10 years were 90.4%, 86.1%, 75.9%, and 72.1%, 57.3%, 57.3%, respectively. Mortality was 1.7%. The factors associated with a better disease-free survival at univariate analysis were age <60, T2 tumors, distal location, intestinal histotype, and number of retrieved nodes >25; depth of infiltration and histotype were the only 2 independent predictors of 5-year recurrence-free survival at multivariate analysis. CONCLUSION These parameters must be considered to stratify node-negative gastric cancer patients for an adjuvant treatment and follow-up scheduling. Survival was similar to that previously reported by Eastern Centers. Lymphadenectomy is suggested to be effective, and retrieval of more than 25 nodes may be warranted.
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Saito H, Kuroda H, Matsunaga T, Fukuda K, Tatebe S, Tsujitani S, Ikeguchi M. Prognostic indicators in node-negative advanced gastric cancer patients. J Surg Oncol 2010; 101:622-5. [PMID: 20461771 DOI: 10.1002/jso.21562] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite carrying better overall prognoses, some node-negative gastric cancer patients die from recurrent malignancies. Identifying factors associated with disease-specific survival in adequately staged node-negative gastric cancer is important, as these patients are presumably free of microscopic regional metastases and may derive significant benefit from existing or future adjuvant strategies. METHODS To investigate significant prognostic indicators in node-negative advanced gastric cancer patients, we reviewed 777 advanced gastric cancer patients who had undergone curative gastrectomies. RESULTS The 5-year survival rate of node-negative advanced gastric cancer patients is 84.9%, which is significantly better than that of patients with lymph node metastasis. Multivariate analysis indicated that tumor size, histology, and depth of invasion are independent prognostic factors. The 5-year survival rate of patients with larger tumors (>or=7 cm), poorly differentiated adenocarcinoma, and serosal invasion was 49.1%, which was significantly worse that of patients with fewer or none of these factors. CONCLUSIONS Tumor size, histology, and the presence of serosal invasion are strong indicators of poor prognosis in node-negative advanced gastric cancer patients.
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Affiliation(s)
- Hiroaki Saito
- Division of Surgical Oncology, Department of Surgery, Tottori University School of Medicine, Yonago, Japan.
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Huang KH, Chen JH, Wu CW, Lo SS, Hsieh MC, Li AFY, Lui WY. Factors affecting recurrence in node-negative advanced gastric cancer. J Gastroenterol Hepatol 2009; 24:1522-6. [PMID: 19467143 DOI: 10.1111/j.1440-1746.2009.05844.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Prognostic factors of lymph node-negative gastric adenocarcinoma after curative resection have been discussed. Recurrent pattern of advanced lymph node-negative gastric cancer after curative resection has rarely been described. METHODS Recurrent sites and correlated clinicopathological factors of 372 patients with lymph node-negative advanced gastric adenocarcinoma that underwent R0 resection from 1988 to 2005 were analyzed. RESULTS Recurrence was noted in 51 (13.7%) patients. Recurrent rates according to site of recurrence were 26 peritoneal seeding (51.0%), 26 locoregional (51.0%), 17 hematogenous (33.3%), and 4 lymph node metastasis (7.8%). Clinicopathological factors to predict peritoneal seeding were serosal exposure, lymphovascular invasion, Lauren's diffuse type differentiation and scirrhous stromal reaction. Serosal exposure, tumor size, microscopic infiltrating growth type predicts locoregional recurrence. Tumor had only lymphovascular invasion predict hematogenous spreading. CONCLUSION Node-negative advanced gastric cancer has more peritoneal seeding and locoregional recurrence. Aggressive cell behavior predicted the route of tumor cell spreading.
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Affiliation(s)
- Kuo-Hung Huang
- Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
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Huang CM, Lin JX, Zheng CH, Li P, Xie JW, Lin BJ, Lu HS. Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer. World J Gastroenterol 2009; 15:3926-30. [PMID: 19701974 PMCID: PMC2731256 DOI: 10.3748/wjg.15.3926] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer.
METHODS: Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate.
RESULTS: The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival (P < 0.05). A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts ≥ 15 for pT1-2, ≥ 20 for pT3-4, and ≥ 15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate (P < 0.01). The post-operative complication rate was 10.9% and was not significantly correlated with the number of dissected LNs (P > 0.05).
CONCLUSION: For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the post-operative complication rate.
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Prognosis of gastric cancer patients with node-negative metastasis following curative resection: outcomes of the survival and recurrence. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 22:835-9. [PMID: 18925308 DOI: 10.1155/2008/761821] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The purpose of the present study was to provide valuable prognostic information on lymph node-negative gastric cancer patients following curative resection. METHODS Data from 112 lymph node-negative gastric cancer patients who underwent curative resection were reviewed to identify the independent factors of overall survival and recurrence. RESULTS The five-year survival rate of lymph node-negative gastric cancer patients was 85.7%, and recurrence was identified in 25 patients after curative surgery. The five-year survival rate of lymph node-negative gastric cancer patients was higher than that of lymph node-positive gastric cancer patients (P<0.001). Recurrence in lymph node-negative gastric cancer patients was less than that of lymph node-positive gastric cancer patients (P=0.001). The median survival after recurrence of lymph node-negative gastric cancer patients was longer than that of lymph node-positive gastric cancer patients (P=0.021). Using multivariate analyses, the following results were determined for lymph node-negative gastric cancer patients: sex, operative type and the presence of serosal involvement were independent factors of overall survival; and lymphadenectomy, number of dissected nodes and the presence of serosal involvement were independent factors of recurrence. CONCLUSIONS The prognosis of lymph node-negative gastric cancer patients was better than that of lymph node-positive gastric cancer patients. Male sex, subtotal gastrectomy and nonserosal involvement should be considered to be the favourable predictors of postoperative long-term survival of lymph node-negative gastric cancer patients. Conversely, limited lymphadenectomy, few dissected nodes and serosal involvement should be considered to be risk factors of postoperative recurrence of lymph node-negative gastric cancer patients.
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Lee CC, Wu CW, Lo SS, Chen JH, Li AFY, Hsieh MC, Shen KH, Lui WY. Survival predictors in patients with node-negative gastric carcinoma. J Gastroenterol Hepatol 2007; 22:1014-8. [PMID: 17608847 DOI: 10.1111/j.1440-1746.2006.04488.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Presence or absence of nodal metastasis influences outcome of gastric cancer patients. This study gives insight into survival predictors and clinicopathological features of node-negative gastric adenocarcinoma. METHODS Between 1988 and 1999, 689 gastric cancer patients without other cancer or gastrectomy for benign disease who underwent curative resection were enrolled in this study. Clinicopathological data in patients with node metastasis were compared with those without. RESULTS The survival rate at 5 and 10 years for node-negative cases was 91.7% and 89.7%, respectively. On univariate analysis, node-negative patients were characterized by frequent location in the lower two-thirds of the stomach (84.9%), tumor size less than 4 cm (63.5%), grossly superficial type (71.6%), more medullary stromal reaction (50.5%) and intestinal type (67.7%), tumor invasion confined to serosa (78.4%), less poorly differentiated cell type (43.2%), and less lymphovascular invasion (33.4%). Multivariate analysis demonstrated that lymphovascular invasion (relative risk: 5.036) and depth of cancer invasion (relative risk: 4.404) were independent poor prognostic factors. However, lymphovascular invasion and serosal invasion were also correlated (P < 0.001). CONCLUSION Patients with node-negative gastric adenocarcinoma had less disease progression and a favorable survival. Lymphovascular invasion and depth of cancer invasion were two independent but correlated survival predictors.
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Affiliation(s)
- Chin-Chun Lee
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Chen JH, Wu CW, Lo SS, Li AFY, Hsieh MC, Shen KH, Lui WY. Outcome of distal gastric cancer with pyloric stenosis after curative resection. Eur J Surg Oncol 2007; 33:556-60. [PMID: 17329063 DOI: 10.1016/j.ejso.2007.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Accepted: 01/15/2007] [Indexed: 11/29/2022] Open
Abstract
AIMS Pyloric stenosis usually presents with symptoms, and this may lead patients to consult their physician. We evaluate whether distal gastric cancer patients with pyloric stenosis had a better outcome than those without. METHODS A total of 551 distal gastric cancer patients who received curative subtotal gastrectomy between January 1988 and December 2003 at Taipei Veterans General Hospital were analyzed. Among them, 174 patients were sorted into the pyloric stenosis group according to obstructive symptoms. Their clinicopathological features, survival and prognostic factors were evaluated. RESULTS The 5-year overall and disease-free survival rate of distal third gastric adenocarcinoma for the pyloric stenosis group was significantly lower than those without pyloric stenosis. Multivariate analysis revealed the pyloric stenosis group had deeper cancer invasion (relative to pT1, RR of pT2 3.1, p=0.009; pT3 6.1, p<0.001; pT4 16.5, p<0.001), and more lymph node metastasis (RR 3.6; p=0.001). The pyloric stenosis group had a tendency to lymph node metastasis toward the hepatoduodenal ligament, but this did not reach statistical difference. However, the pyloric stenosis group had significantly higher lymph node metastasis in the retropancreatic region (5.17% vs. 0.53%; p=0.001). CONCLUSIONS Distal gastric cancers with pyloric stenosis have worse biological behavior than those without, and consequently have a poor outcome.
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Affiliation(s)
- J-H Chen
- Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Section 2, Shih-Pai Rd., 201, Taipei 11217, Taiwan
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Coburn NG, Swallow CJ, Kiss A, Law C. Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer 2006; 107:2143-51. [PMID: 17001662 DOI: 10.1002/cncr.22229] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lymph node (LN) status is a major determinant of prognosis and treatment of gastric adenocarcinoma. The 1997 American Joint Commission on Cancer/Union Internationale Contre le Cancer guidelines were revised, requiring examination of > or =15 LN for staging. METHODS We investigated compliance with these guidelines and the correlation with overall survival (OS) by analyzing 10,807 resected gastric cancers in the Surveillance, Epidemiology and End Results (SEER) database, 1988-2002. Kaplan-Meier survival curves were constructed; survival was compared by using Cox proportional hazards. RESULTS Overall, 29% of cases had > or =15 LN examined. After 1997, the median number of LN assessed increased from 9 to 10 (P < .0001). Factors predictive of adequate LN assessment (ALNA) were higher stage, worse grade, age <74 years, later year of diagnosis, nonwhite race, more extensive surgery, female sex, and SEER region. Differences in the rate of ALNA between regions were noted, ranging from 19.7-53% (P < .0001). Of T1N0 patients, 19% had ALNA. Improved OS was predicted by earlier stage, lower grade, marital status, Asian race, younger age, T-stage, female sex, SEER region, and ALNA. Median OS was highest in the region with the best ALNA rate and worst in the region with the lowest (33 mos vs. 17 mos, P < .0001). Inadequate LN assessment led to poorer survival at every stage (P < .001). CONCLUSION The overwhelming majority of patients have an inadequate LN assessment. ALNA was associated with improved OS, with significant variation across regions. Understaging due to inadequate LN assessment may affect eligibility for adjuvant therapy. Education is required to improve LN retrieval.
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Affiliation(s)
- Natalie G Coburn
- Division of Surgical Oncology, Toronto Sunnybrook Regional Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Kim DY, Seo KW, Joo JK, Park YK, Ryu SY, Kim HR, Kim YJ, Kim SK. Prognostic factors in patients with node-negative gastric carcinoma: A comparison with node-positive gastric carcinoma. World J Gastroenterol 2006; 12:1182-6. [PMID: 16534868 PMCID: PMC4124426 DOI: 10.3748/wjg.v12.i8.1182] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the clinicopathological characteristics of lymph node-negative gastric carcinoma, and also to evaluate outcome indicators in the lymph node-negative patients.
METHODS: Of 2848 gastric carcinoma patients, 1524 (53.5%) were lymph node-negative. A statistical analysis was performed using the Cox model to estimate outcome indicators.
RESULTS: There was a significant difference in the recurrence rate between lymph node-negative and lymph node-positive patients (14.4% vs 41.0%, P < 0.001). The 5-year survival rate was significantly lower in lymph node-positive than in lymph node-negative patients (31.1% vs 77.4%, P < 0.001). Univariate analysis revealed that the following factors influenced the 5-year survival rate: patient age, tumor size, depth of invasion, tumor location, operative type, and tumor stage at initial diagnosis. The Cox proportional hazard regression model revealed that tumor size, serosal invasion, and curability were independent, statistically significant, prognostic indicators of lymph node-negative gastric carcinoma.
CONCLUSION: Lymph node-negative patients have a favorable outcome attributable to high curability, but the patients with relatively large tumors and serosal invasion have a poor prognosis. Curability is one of the most reliable predictors of long-term survival for lymph node-negative gastric carcinoma patients.
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Affiliation(s)
- Dong Yi Kim
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
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Kooby DA, Suriawinata A, Klimstra DS, Brennan MF, Karpeh MS. Biologic predictors of survival in node-negative gastric cancer. Ann Surg 2003; 237:828-35; discussion 835-7. [PMID: 12796579 PMCID: PMC1514693 DOI: 10.1097/01.sla.0000072260.77776.39] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate factors predictive of survival following curative resection for node-negative gastric adenocarcinoma. SUMMARY BACKGROUND DATA Presence or absence of lymph node metastases is the most powerful predictor of survival following curative resection for gastric adenocarcinoma. Factors predictive of survival in node-negative gastric cancer have not been clarified. METHODS Histopathology and clinical outcome for all patients undergoing R0 resections for gastric adenocarcinoma at a tertiary center between 1985 and 2001 were reviewed. RESULTS Of 1,256 R0 resections performed, 507 (40%) were node-negative, 465 were T1-T3, and 317 of these were adequately staged, as defined by histologic evaluation of at least 15 lymph nodes. Median age was 67 years, and 62% were male. Forty percent had T1 tumors, 34% were T2, and 26% were T3. Median tumor size was 3 cm. Vascular invasion (VI) was present in 17% of tumors and neural invasion (NI) in 31%. Extended (D2) lymphadenectomy was performed in 75% of cases. Five- and 10-year disease-specific survival rates were 79% and 67% respectively. Factors associated with poorer disease-specific survival on univariate analysis were male gender, serosal invasion, presence of VI, presence of NI, and resection other than distal subtotal gastrectomy. On multivariate analysis, NI was not an independent predictor of survival, but correlated directly with advancing T stage and tumor size. CONCLUSIONS Serosal invasion and presence of VI are strong predictors of poor survival in this disease. NI correlates with T stage and tumor size and may serve as a marker of advanced disease.
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Affiliation(s)
- David A Kooby
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Spanknebel KA, Brennan MF. Is D2 lymphadenectomy for gastric cancer a staging tool or a therapeutic intervention? Surg Oncol Clin N Am 2002; 11:415-30, xii. [PMID: 12424860 DOI: 10.1016/s1055-3207(02)00008-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The extent of lymphadenectomy for gastric cancer is a controversial topic widely debated by those treating the disease. Regional differences in outcome have been noted between patients treated in Japan centers and those treated in Western centers. Technical differences have been investigated within the context of two large, prospective randomized trials, which found no benefit to more extensive lymphadenectomy procedures with increased morbidity. Subsets of patients being treated for cure may benefit from extended resections. The impact of tumor features, such as depth of invasion and number of metastatic lymph nodes, has been described and incorporated into current staging systems. The role of enhanced pathologic evaluation of surgical specimens and impact on staging and treatment strategies is evolving.
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Affiliation(s)
- Kathryn A Spanknebel
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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