Prognostic significance and the role in TNM stage of extranodal metastasis within regional lymph nodes station in gastric carcinoma

Clinical significance of tumor deposits in gastric cancer after radical gastrectomy: a propensity score matching study

OBJECTIVE

The value of tumor deposits (TDs) in the prognosis and staging of gastric cancer (GC) is still under debate. This study aims to evaluate the prognostic value of TDs and the best ways to incorporate TDs in the TNM classification of GC.

METHODS

Patients (n = 3460) undergoing curative gastrectomy for GC in the West China Hospital from 2005 to 2017 were retrospectively reviewed and divided into two groups according to the TD status (positive vs. negative). Later, clinicopathological features and overall survival (OS) between the two groups were compared. Thereafter, the associations between the presence of TD and other clinicopathological factors were evaluated through logistic regression. In addition, univariate and multivariate Cox regression were conducted for determining prognostic factors. The possibility of selection bias was reduced through conducting the 1:1 propensity score matching (PSM) analysis. The modified classification systems proposed previously that incorporated TDs into the TNM staging system were assessed.

RESULTS

There were 10.5% of patients (362/3460) diagnosed with TDs. TDs were significantly related to unfavorable factors such as advanced T stage and N stage and independently associated with poor prognosis. The 5-year OS of patients with TDs was significantly lower than that of patients without TDs (31.0% vs. 60.9%, P < 0.001), whereas higher than that of patients with peritoneal metastasis (31.0% vs. 5.0%, P < 0.001). In patients receiving chemotherapy, the 5-year OS of patients with TDs was also significantly lower than that of patients without TDs (42.0% vs. 50.9%, P = 0.026). Moreover, the system incorporating TDs in the TNM classification as metastatic lymph nodes outperformed others.

CONCLUSIONS

TDs are related to the aggressive characteristics and are an independent prognostic factor for GC. Incorporating TDs in the TNM classification as the metastatic lymph nodes increases the accuracy in predicting prognosis.

Prognostic value of preoperative body mass index for diabetic patients with non-metastasis gastric cancer: a single center experience

Aim

This study was designed to investigate the prognostic effect of preoperative body mass index (BMI) for Type 2 diabetes mellitus (T2DM) patients with non-metastasis gastric cancer (GC) who underwent D₂ gastrectomy.

Methods

T2DM patients with pT_1–4bN_0–3bM₀ GC were retrospectively collected in Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital from January, 2000 to December, 2010. These patients underwent D₂ radical resection of the stomach combined with regional lymphadenectomy. Chi-square test was used to analyze unordered categorical variables and ranked data, followed by Kaplan–Meier analysis as well as Cox regression models to detect risk factors for survival outcomes. In addition, the cut-off point was determined by the X-tile program. All analyses were carried out using survival package of R and SPSS Software.

Results

A total of 302 T2DM patients with pT_1–4bN_0–3bM₀ GC were collected and analyzed. The cut-off points of BMI, identified by the X-tile program, was 19 kg/m². Patients with low BMI (< 19 kg/m²) had a higher percentage of advanced T stage (T_4a and T_4b), more advanced TNM stage (stage IIIA, IIIB and IIIC), and more elevated level of serum carcinoembryonic antigen (CEA), compared to those with high BMI (> 19 kg/m²) (all P < 0.05). In the low BMI subgroup, the 5-year overall survival rate was 39.02%, which was as high as 58.11% in the high BMI subgroup (P < 0.05). In the multivariate Cox regression model revealed that III_C stage (OR = 3.101), N_3b stage (OR = 3.113) were the most important prognostic indicators, followed by pretreatment BMI (OR = 2.136).

Conclusion

Low preoperative BMI (< 19 kg/m²) was a poor prognostic marker for T2DM patients with pT_1–4bN_0–3bM₀ GC.

The prognostic value of tumor deposits and the impact on the TNM classification system in esophageal cancer patients

OBJECTIVE

To explore the prognostic significance of tumor deposits (TDs), isolated tumor foci lacking residual lymph nodes, in esophageal cancer (EC).

METHODS

A retrospective review of patients with EC undergoing esophagectomy between 2005 and 2017 was conducted. The prognostic value of TD was evaluated using a Cox regression model. Patients from different sources and periods were split into discovery and validation sets. A propensity score matching model was used in the validation set to reduce the confounding bias. The impact of TD on the TNM classification system was evaluated.

RESULTS

The discovery and validation sets included 179 and 2875 patients, respectively. Propensity-matched patients with and without TDs were constructed in the validation set with 132 patients in each group. Overall survival (p < .001 and p = .004, respectively) and disease-free survival (p < .001 and p = .019, respectively) were both decreased in TD positive patients in the discovery set and propensity-matched groups of validation set. Classifying patients with TDs into pN3 stage improved the discriminative power of the current TNM staging system.

CONCLUSIONS

TD is an independent prognostic factor for EC. The inclusion of TD in the TNM staging system may upstage appropriate patients to help guide therapy, and future studies are warranted.

Tumor deposit serves as a prognostic marker in gastric cancer: A propensity score-matched analysis comparing survival outcomes

BACKGROUND

Gastric cancer (GC) treatment is determined by accurate tumor staging. The value of tumor deposit (TD) in prognostic prediction staging system is not yet determined.

METHODS

We retrospectively analyzed clinical information on GC patients who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital from July 2014 to June 2016. Propensity score matching (PSM) was performed to reduce the possibility of selection bias according to the presence of TD.

RESULTS

Of the 1034 GC patients, 240 (23.21%) presented with TD, which was associated with younger age and larger tumor size (all P < .05). TD-positive patients had a worse survival than TD-negative patients before (P < .001) and after (P = .017) matching. Multivariable analysis showed that mortality risk of patients with TD increased by 58%, 62%, 37%, and 40% in the crude (HR = 1.58, 95% CI 1.32-1.89, P < .001), adjusted I (HR = 1.62, 95% CI 1.35-1.94, P < .001), adjusted II (HR = 1.37, 95% CI 1.13-1.66, P = .001), and adjusted III (HR = 1.40, 95% CI 1.16-1.68, P < .001) models before matching. Similarly, in the PSM cohort patients with TD had worse prognosis in the crude (HR = 1.32, 95% CI 1.07-1.63, P = .011), adjusted I (HR = 1.35, 95% CI 1.09-1.67, P = .005), adjusted II (HR = 1.26, 95% CI 1.00-1.58, P = .049), and adjusted III (HR = 1.33, 95% CI 1.07-1.65, P = .010) models. TD had a similar value range between N1 and N2 stages among different models.

CONCLUSIONS

Among GC patients, TD is associated with survival and may have a role in the staging of patients.

Extra-perigastric Extranodal Metastasis is a Significant Prognostic Factor in Node-Positive Gastric Cancer

BACKGROUND

Extranodal metastasis is an isolated tumor nodule without a residual lymph node structure and has been reported as a poor prognostic factor in gastric cancer. The aim of this study is to assess the prognostic value of extranodal metastasis, especially from the viewpoint of its anatomical distribution.

METHODS

A total of 139 consecutive gastric cancer patients who underwent curative surgery with lymph node metastasis between 2008 and 2009 were included. Clinicopathological features and patient survival outcomes were retrospectively assessed. Patients with extranodal metastasis were subdivided into two groups: perigastric extranodal metastasis, located near the perigastric area (#1-#7 according to the Japanese classification of gastric carcinoma 15th edition), and extra-perigastric extranodal metastasis, located alongside the major vessels (#8-#12).

RESULTS

Extranodal metastasis was found in 51 patients (37%), and it was more frequent in those with bulky, ≥pT3, and pStage III tumors. All patients with extra-perigastric extranodal metastasis had recurrence, resulting in a 0% 5-year overall survival rate, which was significantly worse than that of patients with perigastric extranodal metastasis (59%), or those without extranodal metastasis (84%; P < 0.001). Multivariable analysis identified the presence of extra-perigastric extranodal metastasis as an independent poor prognostic factor.

CONCLUSIONS

Extranodal metastasis, especially extra-perigastric extranodal metastasis, was a pivotal poor prognostic factor in node-positive gastric cancer. Recognizing extra-perigastric extranodal metastasis would help provide optimal therapeutic options to these high-risk patients.

Calcium Carbonate Nanoparticles Can Activate the Epithelial⁻Mesenchymal Transition in an Experimental Gastric Cancer Model

Previously, we have shown the possibility of intramucosal gastric carcinoma induction by the intragastric administration of a mixture of formaldehyde and hydrogen peroxide in rats. In this study, we report a sizable increase in carcinogenic properties of the mixture when a suspension containing calcium carbonate nanoparticles was added to it. This technique allowed us to reduce both the number of the carcinogen administrations from twelve to two and the time to the cancer induction from six to four months. Although the induced tumors were represented by the intramucosal carcinomas, they were characterized by the extensive invasion of individual tumor cells and their clusters into the muscle layer and serosa as well as into the omentum and blood vessels. Considering that the invasive tumor cells were positive for vimentin, Snail and TGF-β2, we concluded that their invasion was the result of the activation of epithelial–mesenchymal transition (EMT) mechanisms. Thus, taking into account the data obtained, it can be assumed that under the conditions of inflammation or carcinogenesis, the calcium carbonate nanoparticles may affect the activation of EMT mechanisms.

Comparison of the 7th and the 8th AJCC Staging System for Non-metastatic D2-Resected Lymph Node-Positive Gastric Cancer Treated with Different Adjuvant Protocols

PURPOSE

The purpose of this study was to compare prognostic differentiation performances of the 7th and the 8th edition of American Joint Commission on Cancer (AJCC) staging system for gastric cancer (GC) patients.

Materials and Methods

A total of 1,633 GC patients who underwent curative D2 resection followed by adjuvant chemotherapy alone (CA) or concurrent chemo-radiotherapy (CCRT) from 2004 to 2013 were included. Concordance index (c-index) was applied to compare the discriminatory ability.

RESULTS

In the 8th edition, migration of stage was detected in 248 patients (15.2%). Among them, 121 patients were up-staged while 127 patients were down-staged. Overall, there was no statistically significant difference in the discriminatory ability between the 7th and 8th editions. The new edition of staging system, however, showed a trend of better prognostic performance not only in recurrence-free survival (c-index=0.734; 95% confidence interval [CI], 0.706 to 0.762 in the 7th edition vs. c-index=0.740; 95% CI, 0.712 to 0.768 in the 8th edition; p=0.14), but also in overall survival (c-index=0.717; 95% CI, 0.688 to 0.745 in the 7th edition vs. c-index=0.722; 95% CI, 0.694 to 0.751 in the 8th edition; p=0.19), especially in stage III. This finding was repeated in the subgroup analysis regardless of adjuvant CA or CCRT.

CONCLUSION

Generally, the 8th edition of AJCC staging system had failed to show a superior discriminatory ability for curatively D2 resected GC patients than the 7th edition, although there was a trend of better prognostic performance of the new edition, regardless of adjuvant treatment method.

Prognostic significance and role in TNM stage of tumor deposits in esophageal cancer

BACKGROUND

Tumor deposits (TDs) are now observed in esophageal cancer (EC), but the role of TDs is seldom elucidated. This study aimed to research the prognostic significance and the role of TDs in EC. The patients with primary EC, who had undergone curative esophagectomy in West China Hospital from May 2005 to May 2011 were retrospectively enrolled.

METHODS

The prognosis and clinicopathological traits were compared between tumor deposits positive (TDP) and tumor deposits negative (TDN) groups in all patients and TNM 0-IV stages respectively.

RESULTS

In our study, 1,044 patients were enrolled, with 948 (90.8%) in TDN group and 96 (9.2%) in TDP group. TDP group had significantly more advanced EC and worse prognosis (all P<0.001) than TDN group in all patients, TNM II stage and TNM III stage. The prognosis of TDP group in TNM II stage was significantly worse than TDN patients in TNM III stage (P<0.001), and the worst prognosis was always found in patients with at least one TD regardless of the number of metastatic lymph node is.

CONCLUSIONS

Patients in TDP subgroup had more advanced EC and worse prognosis than those in TDN subgroup. It might be more reasonable to be regarded as an indicator of stage migration in EC.

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

BACKGROUND

This study aimed to elucidate the intensive effect of the number of positive niduses in extranodal soft tissues (PNESTs) on the overall survival of gastric cancer (GC) patients after curative gastrectomy.

METHODS

The clinicopathological data of 961 GC patients were studied to determine whether increased number of PNESTs was a high-risk factor for the dismal prognosis of GC patients.

RESULTS

Survival analyses revealed that the number of PNESTs was negatively associated with the overall survival (OS) (P<0.001) and was an independent prognostic predictor (HR=1.360, P<0.001) for the 961 GC patients. The number of PNESTs, with the smallest BIC value (421.947, P=0.018), was identified as the most intensive independent predictor of prognosis for the 961 GC patients. Correlation analyses showed that the pT stage, pN stage, pTNM classification, tumor size, and type of gastrectomy were significantly related to the number of PNESTs, and that tumor size was the most closely relevant factor in all included GC patients. These findings revealed that increased number of PNESTs was suitable to evaluate the dismal prognosis of GC patients.

CONCLUSIONS

The number of PNESTs is an important high-risk clinicopathological characteristic for improving the accuracy of prognostic evaluation of GC patients.