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Li K, Li C, Lu S, He W, Wang C, Han Y, Leng X, Peng L. Effect of cervical paraesophageal lymph node metastasis versus supraclavicular lymph node metastasis on the overall survival of patients with thoracic esophageal squamous cell carcinoma: an observational study. Ann Med Surg (Lond) 2024; 86:2518-2523. [PMID: 38694352 PMCID: PMC11060193 DOI: 10.1097/ms9.0000000000001955] [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: 12/16/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Background Esophageal cancer (EC) is a major global health burden, with a particularly high incidence in East Asia. The authors aimed to investigate the effect of metastasis in cervical paraesophageal lymph nodes (station 101) and supraclavicular lymph nodes (station 104) on the survival of patients who underwent esophagectomy for esophageal squamous cell carcinoma (ESCC). Materials and Methods Data were obtained from the database of the authors' hospital. The authors retrospectively analyzed the patients with EC who underwent esophagectomy from January 2010 to December 2017. These patients were allocated into two groups based on the presence of lymph node metastasis (LNM) in the cervical paraesophageal or supraclavicular regions. Clinical outcomes and survival data were compared using the TNM staging system of the 8th edition of the American Joint Committee on Cancer (AJCC). Results After a median follow-up of 62.1 months, 122 patients with LNM in the supraclavicular region were included in the study. Among these patients, 53 showed cervical paraesophageal LNM and an overall survival (OS) of 19.9 months [95% confidence interval (CI): 16.3-23.5]. In contrast, 69 patients showed supraclavicular LNM with an OS of 34.9 months (95% CI 25.7-44.1). The OS rates at 1, 3, and 5 years were 77%, 29%, and 21%, respectively, for patients with cervical paraesophageal LNM. Moreover, patients with supraclavicular LNM demonstrated OS rates of 88%, 48%, and 34%, respectively [Hazard ratio (HR): 0.634, 95% CI: 0.402-1.000, P=0.042]. Conclusions Patients with ESCC with cervical paraesophageal LNM had significantly worse OS than those with supraclavicular LNM. This study underscores the importance of accurately identifying and managing ESCC with cervical paraesophageal LNM, as it may require more tailored and aggressive treatment strategies to prolong patient survival.
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Affiliation(s)
| | | | | | | | | | | | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (Sichuan Cancer Hospital), Chengdu, People’s Republic of China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (Sichuan Cancer Hospital), Chengdu, People’s Republic of China
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Ji H, Hu C, Yang X, Liu Y, Ji G, Ge S, Wang X, Wang M. Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Signal Transduct Target Ther 2023; 8:367. [PMID: 37752146 PMCID: PMC10522642 DOI: 10.1038/s41392-023-01576-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Lymph nodes (LNs) are important hubs for metastatic cell arrest and growth, immune modulation, and secondary dissemination to distant sites through a series of mechanisms, and it has been proved that lymph node metastasis (LNM) is an essential prognostic indicator in many different types of cancer. Therefore, it is important for oncologists to understand the mechanisms of tumor cells to metastasize to LNs, as well as how LNM affects the prognosis and therapy of patients with cancer in order to provide patients with accurate disease assessment and effective treatment strategies. In recent years, with the updates in both basic and clinical studies on LNM and the application of advanced medical technologies, much progress has been made in the understanding of the mechanisms of LNM and the strategies for diagnosis and treatment of LNM. In this review, current knowledge of the anatomical and physiological characteristics of LNs, as well as the molecular mechanisms of LNM, are described. The clinical significance of LNM in different anatomical sites is summarized, including the roles of LNM playing in staging, prognostic prediction, and treatment selection for patients with various types of cancers. And the novel exploration and academic disputes of strategies for recognition, diagnosis, and therapeutic interventions of metastatic LNs are also discussed.
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Affiliation(s)
- Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xuhui Yang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuanhao Liu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Zhao L, Zhang F, Jiao F, Zhou X, Niu P, Han X, Wang W, Luan X, He M, Guan Q, Li Y, Zhao D, Gao J, Chen Y. The minimum number of examined lymph nodes was 24 for optimal survival of pathological T2-4 gastric cancer: a multi-center, hospital-based study covering 20 years of data. BMC Cancer 2023; 23:892. [PMID: 37735628 PMCID: PMC10512540 DOI: 10.1186/s12885-023-11138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION The current National Comprehensive Cancer Network (NCCN) guidelines recommend that at least 16 lymph nodes should be examined for gastric cancer patients to reduce staging migration. However, there is still debate regarding the optimal management of examined lymph nodes (ELNs) for gastric cancer patients. In this study, we aimed to develop and test the minimum number of ELNs that should be retrieved during gastrectomy for optimal survival in patients with gastric cancer. METHODS We used the restricted cubic spline (RCS) to identify the optimal threshold of ELNs that should be retrieved during gastrectomy based on the China National Cancer Center Gastric Cancer (NCCGC) database. Northwest cohort, which sourced from the highest gastric cancer incidence areas in China, was used to verify the optimal cutoff value. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models. RESULTS In this study, 12,670 gastrectomy patients were included in the NCCGC cohort and 4941 patients in the Northwest cohort. During 1999-2019, the average number of ELNs increased from 17.88 to 34.45 nodes in the NCCGC cohort, while the number of positive lymph nodes remained stable (5-6 nodes). The RCS model showed a U-curved association between ELNs and the risk of all-cause mortality, and the optimal threshold of ELNs was 24 [Hazard ratio (HR) = 1.00]. The ELN ≥ 24 group had a better overall survival (OS) than the ELN < 24 group clearly (P = 0.003), however, with respect to the threshold of 16 ELNs, there was no significantly difference between the two groups (P = 0.101). In the multivariate analysis, ELN ≥ 24 group was associated with improved survival outcomes in total gastrectomy patients [HR = 0.787, 95% confidence interval (CI): 0.711-0.870, P < 0.001], as well as the subgroup analysis of T2 patients (HR = 0.621, 95%CI: 0.399-0.966, P = 0.035), T3 patients (HR = 0.787, 95%CI: 0.659-0.940, P = 0.008) and T4 patients (HR = 0.775, 95%CI: 0.675-0.888, P < 0.001). CONCLUSION In conclusion, the minimum number of ELNs for optimal survival of gastric cancer with pathological T2-4 was 24.
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Affiliation(s)
- Lulu Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Zhang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Fuzhi Jiao
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiadong Zhou
- Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Penghui Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Han
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyi Luan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingyan He
- Gansu Provincial Cancer Hospital, Lanzhou, China.
| | - Quanlin Guan
- The First Hospital of Lanzhou University, Lanzhou, China.
| | - Yumin Li
- Lanzhou University Second Hospital, Lanzhou, China.
| | - Dongbing Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jidong Gao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union College, Shenzhen, China.
| | - Yingtai Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Ning X, Liu R, Wang N, Xiao X, Wu S, Wang Y, Yi C, He Y, Li D, Chen H. Development of a deep learning-based model to diagnose mixed-type gastric cancer accurately. Int J Biochem Cell Biol 2023; 162:106452. [PMID: 37482265 DOI: 10.1016/j.biocel.2023.106452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE The accurate diagnosis of mixed-type gastric cancer from pathology images presents a formidable challenge for pathologists, given its intricate features and resemblance to other subtypes of gastric cancer. Artificial Intelligence has the potential to overcome this hurdle. This study aimed to leverage deep machine learning techniques to establish a precise and efficient diagnostic approach for this cancer type which can also predict the metastatic risk using two software, U-Net and QuPath, which have not been trialled in gastric cancers. METHODS A U-Net neural network was trained to recognise, and segment differentiated components from 186 pathology images of mixed-type gastric cancer. Undifferentiated components in the same images were annotated using the open-source pathology imaging software QuPath. The outcomes from U-Net and QuPath were used to calculate the ratios of differentiation/undifferentiated components which were correlated to lymph node metastasis. RESULTS The models established by U-Net recognised ∼91% of the regions of interest, with precision, recall, and F1 values of 90.2%, 90.9% and 94.6%, respectively, indicating a high level of accuracy and reliability. Furthermore, the receiver operating characteristic curve analysis showed an area under the cure of 91%, indicating good performance. A bell-curve correlation between the differentiated/undifferentiated ratio and lymphatic metastasis was found (highest risk between 0.683 and 1.03), which is paradigm-shifting. CONCLUSION U-Net and QuPath exhibit promising accuracy in the identification of differentiated and undifferentiated components in mixed-type gastric cancer, as well as paradigm-shifting prediction of metastasis. These findings bring us one step closer to their potential clinical application.
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Affiliation(s)
- Xinjie Ning
- Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Ruide Liu
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Nan Wang
- Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Xuewen Xiao
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Siqi Wu
- Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Yu Wang
- Department of Respiratory Diseases, Central Medical Branch of PLA General Hospital, Beijing 100081, China
| | - Chenju Yi
- Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China; Shenzhen Key Laboratory of Chinese Medicine Active substance screening and Translational Research, Shenzhen 518107, China; Guangdong Provincial Key Laboratory of Brain Function and Disease, Guangzhou 510080, China.
| | - Yulong He
- Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China.
| | - Dan Li
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China.
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Wu J, Wang H, Yin X, Wang X, Wang Y, Lu Z, Zhang J, Zhang Y, Xue Y. Efficacy of Lymph Node Location-Number Hybrid Staging System on the Prognosis of Gastric Cancer Patients. Cancers (Basel) 2023; 15:cancers15092659. [PMID: 37174124 PMCID: PMC10177424 DOI: 10.3390/cancers15092659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Lymph node metastasis location and number significantly affects the prognosis of patients with gastric cancer (GC). This study was designed to examine a new lymph node hybrid staging (hN) system to increase the predictive ability for patients with GC. METHODS This study analyzed the gastrointestinal treatment of GC at the Harbin Medical University Cancer Hospital from January 2011 to December 2016, and selected 2598 patients from 2011 to 2015 as the training cohort (hN) and 756 patients from 2016 as the validation cohort (2016-hN). The study utilized the receiver operating characteristic curve (ROC), c-index, and decision curve analysis (DCA) to compare the prognostic performance of the hN with the 8th edition of AJCC pathological lymph node (pN) staging for GC patients. RESULTS The ROC verification of the training cohort and validation cohort based on each hN staging and pN staging showed that for each N staging, the hN staging had a training cohort with an AUC of 0.752 (0.733, 0.772) and a validation cohort with an AUC of 0.812 (0.780, 0.845). In the pN staging, the training cohort had an AUC of 0.728 (0.708, 0.749), and the validation cohort had an AUC of 0.784 (0.754, 0.824). c-Index and DCA also showed that hN staging had a higher prognostic ability than pN staging, which was confirmed in the training cohort and the verification cohort, respectively. CONCLUSION Lymph node location-number hybrid staging can significantly improve the prognosis of patients with GC.
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Affiliation(s)
- Junpeng Wu
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Hao Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Xin Yin
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Xibo Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Yufei Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Zhanfei Lu
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Jiaqi Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Yao Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Yingwei Xue
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
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Maruri I, Pardellas MH, Cano-Valderrama O, Jove P, López-Otero M, Otero I, Campo V, Fernández R, Fernández-Fernández N, Sánchez-Santos R. Retrospective cohort study of laparoscopic ICG-Guided Lymphadenectomy in gastric cancer from a Western country center. Surg Endosc 2022; 36:8164-8169. [PMID: 35486191 DOI: 10.1007/s00464-022-09258-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Indocyanine green (ICG) guided lymphadenectomy has been proposed has a technique to improve the lymphadenectomy of patients with gastric cancer. Nevertheless, experience with this procedure is scarce in Western countries. METHODS A retrospective analytic study in a tertiary hospital in Spain was performed, comparing patients who underwent laparoscopic gastrectomy with (ICG cohort) and without (historic cohort) ICG guided lymphadenectomy. RESULTS Thirty four patients were included (17 in each group). Although the number of positive nodes was similar in both groups (0.0 in the ICG cohort vs. 2 in the historic cohort, p = 0.119), the number of lymph nodes removed was higher in the ICG cohort (42.0 vs 28.0, p = 0.040). In the ICG cohort, more lymph nodes were positive for adenocarcinoma in the group of nodes that were positive for IGC (10.6% of the IGC + nodes vs. 1.9% in the ICG - nodes, p < 0.001). CONCLUSIONS ICG lymphadenectomy is a promising procedure that could improve the lymphadenectomy of patients with gastric cancer. ICG lymphadenectomy could be used to increase the number of lymph nodes removed in patients with a high-risk of nodal invasion or it could be used to reduce the surgical aggressiveness in fragile patients with a low-risk of nodal invasion.
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Affiliation(s)
- Ignacio Maruri
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/Clara Campoamor 341, Vigo, Pontevedra, Spain
- Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - María Hermelinda Pardellas
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/Clara Campoamor 341, Vigo, Pontevedra, Spain
- Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Oscar Cano-Valderrama
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/Clara Campoamor 341, Vigo, Pontevedra, Spain.
- Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain.
| | - Patricia Jove
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/Clara Campoamor 341, Vigo, Pontevedra, Spain
- Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Marta López-Otero
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/Clara Campoamor 341, Vigo, Pontevedra, Spain
- Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Isabel Otero
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/Clara Campoamor 341, Vigo, Pontevedra, Spain
- Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | - Victor Campo
- Department of Public Health, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Rebeca Fernández
- Department of Pathology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Raquel Sánchez-Santos
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/Clara Campoamor 341, Vigo, Pontevedra, Spain
- Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
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Comparison of Outcomes Between Laparoscopic and Open Spleen-Preserving Gastrectomy in D2 Radical Gastrectomy of Upper and/or the Middle of the Stomach: a Systematic Review and Meta-analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Xu X, Zheng G, Zhang T, Zhao Y, Zheng Z. Clinical Significance of Metastasis or Micrometastasis to the Lymph Node Along the Superior Mesenteric Vein in Gastric Carcinoma: A Retrospective Analysis. Front Oncol 2021; 11:707249. [PMID: 34395282 PMCID: PMC8358673 DOI: 10.3389/fonc.2021.707249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background The validity of lymphadenectomy of the lymph node along the superior mesenteric vein (LN14v) in gastric cancer remains controversial. The study investigated the characteristics and prognosis of gastric cancer with metastasis or micrometastasis to LN14v. Methods A retrospective study of 626 patients undergoing radical gastrectomy in our center from January 2003 to December 2015 was analyzed. In total, 303 patients had lymphadenectomy of LN14v, and lymph node micrometastasis was evaluated by immunohistochemical staining for cytokeratin nodes CK8/18. A logistic regression model was applied to confirm the predictive factors of micrometastasis. Survival analysis was performed to evaluate the effect of micrometastasis or metastasis on prognosis. Results The metastatic rate of the LN14v lymph node was 15.8%, and the micrometastatic rate was 3.3%. Multivariate analysis showed site, Borrmann classification, postoperative lymph node metastasis (pN), and metastasis in LN6 and LN9 were predictive factors for LN14v micrometastasis or metastasis (P < 0.05). The 5-year survival rate in the positive group (LN14v micrometastasis or metastasis) was 12.4%. The prognosis of patients without LN14v lymph node micrometastasis was better than that of the positive group, whereas the difference between group of LN14v micrometastasis and LN14v metastasis was not obvious. In matched analysis, patients with stage III gastric cancer L/M area, pN2-3, and LN6(+) who underwent lymphadenectomy of LN14v had better survival than those without lymphadenectomy of LN14v. Conclusion Lymph node micrometastasis may provide accurate prognostic information for patients with gastric cancer. Moreover, lymphadenectomy of LN14v might improve the survival of patients with stage III gastric cancer of L/M area, pN2-3, and LN6(+).
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Affiliation(s)
- Xing Xu
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Guoliang Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Tao Zhang
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yan Zhao
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zhichao Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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Mocan L. Surgical Management of Gastric Cancer: A Systematic Review. J Clin Med 2021; 10:jcm10122557. [PMID: 34207898 PMCID: PMC8227314 DOI: 10.3390/jcm10122557] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the fifth most common cancer worldwide, and it is responsible for 7.7% of all cancer deaths. Despite advances in the field of oncology, where radiotherapy, neo and adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgery as part of a multimodal therapy. Two concepts may be adopted in appropriate cases, neoadjuvant treatment before gastrectomy (G) or primary surgical resection followed by chemotherapy. Such an approach, combined with early detection and better screening, has led to a decrease in the overall incidence of gastric cancer. Unfortunately, malignant tumors of the stomach are often diagnosed in locally advanced or metastatic stages when the median overall survival remains poor. Surgical care in these cases must be provided by a multidisciplinary team in a high-volume center. Important surgical aspects such as optimum resection margins, surgical technique, and number of harvested lymph nodes are important factors for patient outcomes. The standardization of surgical treatment of gastric cancer in accordance with the patient’s profile is of decisive importance for a better outcome. This review aims to summarize the current standards in the surgical treatment of gastric cancer.
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Affiliation(s)
- Lucian Mocan
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, RO-400012 Cluj-Napoca, Romania; or ; Tel.: +40-745-362-345
- Regional Institute of Gastroenterology and Hepatology, 19-21 Croitorilor Street, RO-400162 Cluj-Napoca, Romania
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