scholarly journals P-OGC71 Five positive lymph nodes are a significant negative indicator of survival in Oesophago-Gastric Cancer surgery: an 8-year study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Tamsin Parker ◽  
Amjid Riaz ◽  
Alan Askari ◽  
Ahmad Ebrahim ◽  
Cheuk-Bong Tang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Survival ◽  
Systemic Disease ◽  
Treatment Strategies ◽  
Prognostic Indicator ◽  
Post Surgery ◽  
Kaplan Meier ◽  
Positive Lymph Nodes

Abstract Background Number of positive lymph nodes involved is an important prognostic indicator in Oesophago-Gastric cancer survival post surgery. We present an 8 year study examining the number of lymph nodes involved and its impacts on long term cancer survival and in particular to determine whether there is a threshold after which survival is significantly worsened. Methods A prospectively maintained single-institution database containing data from all patients from Jan 2012 to Dec 2020 was analysed. Survival analyses were undertaken to determine the association between lymph node positivity and survival.  Results A total of 430 patients underwent surgery for gastro-oesophageal cancer (oesophagectomy: n = 311, 72.3%; gastrectomy n = 119, 27.7%) of which 80.2% were male and the median age was 68 years old (IQR: 61-74). A median of 23 nodes were examined (IQR 18-33) and a median of one lymph node was positive for cancer (IQR 0-3 lymph nodes). The majority of patients (59.3%) had a T3 tumour, 24.0% had T2, and 12.1% had a T1 tumour. Over a median follow up of 30 months (IQR 13-61), 61.2% of the study population were alive. Kaplan Meier analyses demonstrated that patients who had five or more positive nodes had a survival of 36.3 months (IQR: 24.4-48.3 months) compared to those with four or fewer nodes (45.8 months, IQR: 27.6-64.1 months, p > 0.001). Survival did not worsen further with a higher number of positive nodes. Conclusions This study shows that having five or more positive lymph nodes significantly worsens Oesophago-gastric cancer survival. These results may suggest that from the threshold of 5 positive nodes, OG cancer behaves as a systemic disease and thus impact on adjuvant treatment strategies.

scholarly journals D2 lymphadenectomy with para-aortic sampling improves lymph node staging for gastric cancer

2007 ◽  
Vol 20 (3) ◽  
pp. 161-166
Author(s):  
Bruno José Queiroz Sarmento ◽  
Alexandre Menezes Brito ◽  
Daniela Medeiros Milhomem Cardoso ◽  
Paulo Moacir de Oliveira Campoli ◽  
Osterno Queiroz da Silva ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Histological Grade ◽  
Lymphatic Invasion ◽  
Peritoneal Cytology ◽  
Tnm System ◽  
Group 2 ◽  
Positive Lymph Nodes ◽  
Group 1

BACKGROUND: An important aspect dealing with gastric cancer is the role of lymphadenectomy in gastric cancer staging. AIM: To verify if lymphadenectomy with stations separation increases the number of dissected lymph nodes and establish comparison between TNM 2002 and JGCA 1998 evaluating lymph nodal status (N). METHODS: This is a retrospective analysis of the patients that underwent curative gastrectomy and D2 dissections for adenocarcinoma between 2004 and 2006. Between January of 2004 and June of 2005 (group 1), lymphadenectomy was performed en-bloc with gastrectomy and only TNM system was used. After June of 2005 (group 2), the surgeon himself dissected lymph nodal stations, allowing use of TNM and JGCA systems. Studied aspects were age, Borrmann classification, histological grade, venous or lymphatic invasion, depth of invasion, peritoneal cytology and type of gastrectomy. End points were number of dissected lymph nodes, number of positive lymph nodes and agreement between staging systems. Chi-square test and T-test were used for statistical analysis. RESULTS: One hundred forty-five gastrectomies were performed, 76 in group 1 and 69 in group 2. In group 1, mean age was of 61 years and 59 years in group 2 (P=0,12). Eighty per cent of tumors were advanced in both groups. Venous or lymphatic invasion and positive peritoneal cytology were more frequent in group 1, 65.6% vs 35,3% (P= 0,001) e 13.9% vs 3.1% (P=0,03), respectively. Borrmann classification, histological grade, Lauren classification and type of gastrectomy were not different between the groups. In group 1, mean number of lymph nodes was 32,7 and 37,35 in group 2 (P= 0,09). Rates of positive lymph nodes in groups 1 and 2 were 72.2% and 53%, respectively (P= 0,02). Migration analysis of lymph node status (N) realized only in group 2 (69 patients) showed agreement between TNM and JGCA in 50 patients (72,5%). Using JGCA system, modification in 19 patients occurred (27,5%), with upstaging in 13 (18,8%) and downstaging in six (8,7%). CONCLUSION: In this study, a tendency of increase in number of lymph nodes was verified when the surgeon himself dissected lymph nodal stations. JGCA system modified the lymph nodal staging in comparison to TNM system in 30% of all cases.

BIOPSY OF THE SIGNALING LYMPH NODES IN GASTRIC CANCER - CURRENT STATUS OF THE PROBLEM AND PROSPECTS

2018 ◽  
Vol 64 (3) ◽  
pp. 335-344
Author(s):  
Aleksey Karachun ◽  
Yuriy Pelipas ◽  
Oleg Tkachenko ◽  
D. Asadchaya
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Stomach Cancer ◽  
Current Status ◽  
Regional Lymph Nodes ◽  
Systematic Analysis ◽  
Tumor Spread ◽  
Special Value

The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.

scholarly journals Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Honghu Wang ◽  
Hao Qi ◽  
Xiaofang Liu ◽  
Ziming Gao ◽  
Iko Hidasa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Prognostic Index ◽  
Staging System ◽  
R0 Resection ◽  
Remnant Gastric Cancer ◽  
Curative Intent ◽  
Node Ratio

AbstractThe staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.

scholarly journals Predicting gastric cancer outcome from resected lymph node histopathology images using deep learning

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Xiaodong Wang ◽  
Ying Chen ◽  
Yunshu Gao ◽  
Huiqing Zhang ◽  
Zehui Guan ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Deep Learning ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Main Method ◽  
Learning Framework ◽  
Prognostic Assessment ◽  
N Stage ◽  
Cancer Outcome ◽  
Whole Slide Images

AbstractN-staging is a determining factor for prognostic assessment and decision-making for stage-based cancer therapeutic strategies. Visual inspection of whole-slides of intact lymph nodes is currently the main method used by pathologists to calculate the number of metastatic lymph nodes (MLNs). Moreover, even at the same N stage, the outcome of patients varies dramatically. Here, we propose a deep-learning framework for analyzing lymph node whole-slide images (WSIs) to identify lymph nodes and tumor regions, and then to uncover tumor-area-to-MLN-area ratio (T/MLN). After training, our model’s tumor detection performance was comparable to that of experienced pathologists and achieved similar performance on two independent gastric cancer validation cohorts. Further, we demonstrate that T/MLN is an interpretable independent prognostic factor. These findings indicate that deep-learning models could assist not only pathologists in detecting lymph nodes with metastases but also oncologists in exploring new prognostic factors, especially those that are difficult to calculate manually.

scholarly journals miR-21 Is a Promising Novel Biomarker for Lymph Node Metastasis in Patients with Gastric Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Yuejuan Xu ◽  
Jue Sun ◽  
Jianhua Xu ◽  
Qi Li ◽  
Yuewu Guo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Malignant Disease ◽  
Close Association ◽  
Survival Rates ◽  
Expression Level ◽  
Human Gastric Cancer ◽  
Node Metastasis ◽  
Kaplan Meier

Background. Gastric cancer (GC) is an important malignant disease around the world. Abnormalities of microRNAs (miRNAs) have been implicated in carcinogenesis of various cancers. In the present study, we examined miR-21 expression in human gastric cancer with lymph node metastasis and attempted to uncover its relationship with clinicopathologic data, especially with lymph node metastasis.Materials and Methods. The expression levels of miR-21 in the tumor specimens of GC patients were quantified by RT-PCR. The correlation between miR-21 level and multiple clinicopathological factors was then examined by Mann-Whitney test, Kaplan-Meier survival analysis, and operating characteristic (ROC) analysis.Results. The expression level of miR-21 was higher in GC patients with lymph node metastasis than in those without lymph node metastasis (P<0.05). Expression level of miR-21 was significantly correlated with histologic type, T stage, lymph node metastasis and pTNM stage. The overall survival rates in GC patients with low upregulated miR-21 expression were significantly higher than those with high upregulated miR-21 (P<0.05).Conclusion. A close association is implicated between the elevated miR-21and lymph node metastasis, which could potentially be exploited as a practical biomarker for lymph node metastasis in patients with GC.

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