513 WHAT FACTORS INFLUENCE THE ACCURACY OF CLINICAL STAGING OF ESOPHAGEAL- AND GASTRIC CANCER IN SWEDEN? A NATIONAL REGISTER STUDY

Abstract Cancer treatment is increasingly tailored to the individual patient. Treatment decisions are based on the evaluation of clinical stage which in turn is based on the result of the diagnostic pre-treatment work-up. The aim of this study was to investigate the accuracy of clinical staging of esophageal and gastric cancer in Sweden and what factors influence the quality of the staging procedure. Methods All patients operated for esophageal or gastric cancer, without neoadjuvant treatment, in Sweden from 2006 to 2018 was extracted from the Swedish national registry for esophageal and gastric cancer. Clinical TNM (cTNM) and pathological TNM (pTNM) was compared. The most common preoperative modalities for staging were endoscopy and CT-scan. Data on sex, age, smoking habits, multidisciplinary cancer conferences (yes/no), time of surgery (categorized in 5-year periods), number of resected lymph nodes and region of surgery were extracted from the registry. Uni- and multivariate logistic regression analyses were made comparing patients with correct cTNM to patients with incorrect cTNM. Results A total of 2500 patients met the inclusion criteria. 1173 patients were excluded because of missing data leaving 1327 patients for analyses. cTNM stage and pTNM stage was identical in 38% of patients. In 35% of patients there was a +/−1 stage difference comparing cTNM to pTNM. For esophageal cancer T-stage was on target in 32% and N-stage in 50% of cases. For gastric cancer the corresponding figures were 35% and 48% respectively. Multivariate regression analyzes showed that operation in the later time periods, a higher number of resected lymph nodes and discussion at multidisciplinary cancer conference improved staging accuracy. Conclusion In this study we found that 73% of patients were staged on target or +/− one stage-level. Operation in the later time periods, a higher number of resected lymph nodes and discussion at multidisciplinary cancer conference improved staging accuracy. This data indicate that treatment decisions should be made in a multidisciplinary setting. We believe that the gradual centralization of surgery and treatment decisions in Sweden during this time-period partly explains the improved accuracy over time.

Download Full-text

RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra09.01 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 39-40

Author(s):

Tomas Hansen ◽

Magnus Nilsson ◽

Daniel Lindholm ◽

Johan Sundström ◽

Jakob Hedberg

Keyword(s):

Computed Tomography ◽

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Conflicts Of Interest ◽

Clinical Stage ◽

Diagnostic Assessment ◽

Clinical Staging ◽

Short Axis ◽

Nodal Stage

Abstract Background Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. Methods In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. Results In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. Conclusion In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Normal radiological lymph node appearance in the thorax

Diseases of the Esophagus ◽

10.1093/dote/doy120 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

T Hansen ◽

M Nilsson ◽

D Lindholm ◽

J Sundström ◽

J Hedberg

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Healthy Subjects ◽

Clinical Stage ◽

Diagnostic Assessment ◽

Clinical Staging ◽

Short Axis ◽

Swedish Population ◽

Nodal Stage

SUMMARY Modern treatment of esophageal cancer is multimodal and highly dependent on a detailed diagnostic assessment of clinical stage, which includes nodal stage. Clinical appraisal of nodal stage is highly dependent on knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. In a sample of the Swedish Cardiopulmonary bioimage study, which investigates a sample of the Swedish population aged 50–64 years, the CT scans of 426 subjects were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and the distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. In the 214 men (aged: 57.3 ± 4.1 years) and 212 women (aged: 57.8 ± 4.4 years) included in this study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in at least one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) of the subjects. Men had higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10 mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. We conclude that, in a randomly selected cohort of patients between 50 and 64 years, almost 10% of the men and 4% of the women had lymph nodes above 10 millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above 5 millimeters on CT and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.

Download Full-text

THE ROLE OF SERUM CK-18, MMP-9 AND TIPM-1 LEVELS IN PREDICTING R0 RESECTION IN PATIENTS WITH GASTRIC CANCER

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1401 ◽

2018 ◽

Vol 31 (4) ◽

Cited By ~ 1

Author(s):

Sevki PEDUK ◽

Mursit DINCER ◽

Cihad TATAR ◽

Bahri OZER ◽

Ahmet KOCAKUSAK ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Clinical Stage ◽

Perioperative Period ◽

R0 Resection ◽

Advanced Imaging ◽

Curative Surgery ◽

Common Cause ◽

Curative Therapy

ABSTRACT Background: Gastric cancer is the 3rd most common cause of death in men and the 5th common in women worldwide. Today, surgery is the only curative therapy. Currently available advanced imaging modalities can predict R0 resection in most patients, but it can only be detected with certainty in the perioperative period. Aim: To determine the role of serum CK18, MMP9, TIMP1 levels in predicting R0 resection in patients with gastric cancer. Methods: Fifty consecutive patients scheduled for curative surgery with gastric adenocarcinoma diagnosed between 2013-2015 were included. One ml of blood was taken from the patients to analyze CK18, MMP9 and TIMP1. Results: CK18, MMP9 and TIMP1 levels were positively correlated with pathological N and the stage (p<0,05). CK-18, MMP-9 and TIMP-1 averages in positive clinical lymph nodes and in clinical stage 3, were found to be higher than the averages of those with negative clinical lymph nodes and in clinical stage 2 (p<0,05). Conclusion: Although serum CK-18, MMP-9 and TIMP-1 preoperatively measured in patients scheduled for curative surgery did not help to evaluate gastric tumor resectability, they were usefull in predicting N3-stage.

Download Full-text

Carcinoma of the Anterior Tongue

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948209100121 ◽

1982 ◽

Vol 91 (1) ◽

pp. 94-97 ◽

Cited By ~ 17

Author(s):

Bruce Leipzig ◽

Charles W. Cummings ◽

Jonas T. Johnson ◽

Chung T. Chung ◽

Robert H. Sagerman

Keyword(s):

Lymph Nodes ◽

Clinical Stage ◽

Stage I ◽

High Rate ◽

Stage Iii ◽

Clinical Staging ◽

Management Problem ◽

Cervical Lymph Nodes ◽

Posterior Tongue ◽

Therapy Treatment

We have reviewed 126 patients with squamous cell carcinoma of the anterior tongue. Our experience suggests that carcinoma of the anterior tongue is a highly aggressive disease. It is no less aggressive and dangerous than carcinoma of the posterior tongue. The clinically negative neck is a problem. Many clinical stage I and II cancers are, in fact, stage III when analyzed by the pathologist. This difficulty in clinical staging results in a significant management problem when stage III carcinomas are treated as stage I and stage II disease. Management, if it is to cure, must be aggressive. An adequate, wide surgical resection will control early carcinoma of the anterior tongue. Advanced cancers of the anterior tongue, clinical stages III and IV, should be widely excised; the cervical lymph nodes on the side of the primary lesion must be treated by surgery and radiation therapy. Treatment of the opposite side of the neck is indicated based on a high rate of metastases to contralateral lymph nodes in this series. Those patients treated with irradiation who had recurrence did so predominantly at the primary site of disease. Patients treated surgically tended to have recurrence in the regional cervical lymphatics.

Download Full-text

How to improve the lymph node detection and staging accuracy in gastric cancer patients: A randomized controlled trial in single center.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15577 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15577-e15577

Author(s):

Zengwu Yao ◽

Lixin Jiang

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cancer Patients ◽

Carbon Nanoparticles ◽

Gastrointestinal Surgery ◽

Lymph Node Resection ◽

Staging Accuracy ◽

Radical Lymph Node ◽

Gastric Cancer Patients

e15577 Background: To evaluate the effects of carbon nanoparticles by subserosa injection and different Lymph node retrievals by surgeon or pathologist in improving the positive and total lymph node detection and staging accuracy in patients who undergone the standard D2 gastrectomy. Methods: We collected 200 gastric cancer patients who undergone the standard D2 radical lymph node resection gastrectomy from November 2013 to November 2014 in Gastrointestinal Surgery Ward of Yantai Yuhuangding Hospital. The cases were randomly devidided into 4 groups (N = 50): Pathologist group(PA), surgeon group(SU), surgeon plus carbon nanoparticles group(SU+CN), pathologist plus carbon nanoparticles group (PA+CN) . The number of lymph nodes and the proportion of TNM stages were calculated respectively. Results: In the positive and total number of lymph nodes in all cases, it is significantly higher in Group SU than Group PA (3.64±4.32 VS 2.63±3.45),( 25.46±5.24 VS 20.23±6.32),Group SU+CN than Group PA (4.56±3.86 VS 2.63±3.45 ),(30.76±8.42 VS 20.23±6.32), Group PA+CN than Group PA(3.83±2.09 VS 2.63±3.45),(24.98±6.01 VS 20.23±6.32), Group SU+CN than Group SU(4.56±3.86 VS 2.63±3.45),(30.76±8.42 VS 25.46±5.24), Group SU+CN than Group PA+CN(4.56±3.86 VS 3.83±2.09),( 30.76±8.42 VS 24.98±6.01) (P < 0.05). The proportion of each TNM stage is significantly different in Group SU VS Group PA, Group SU+CN VS Group PA, Group PA+CN VS Group PA, Group SU+CN VS Group SU, Group SU+CN VS Group PA+CN(P < 0.05), while it is similar in Group PA+CN VS Group SU(P < 0.05). The highest proportion of Stage I and II and the lowest proportion of Stage III is in Group PA, and in Group SU+CN by contrary. Multivariate analysis shows carbon nanoparticles by subserosa injection and lymph node retrievals by surgeon are independent factors. Conclusions: Carbon nanoparticles by subserosa injection and lymph node retrievals by surgeon could be used as independent factors to improve the number of positive and total lymph nodes in standard D2 radical lymph node resection gastrectomy. It may also improve the accuracy of pathological staging of gastric cancer patients. Clinical trial information: ChiCTR-TRC-14876411.

Download Full-text

The Role of Serum CK18, TIMP1, and MMP-9 Levels in Predicting R0 Resection in Patients with Gastric Cancer

Disease Markers ◽

10.1155/2018/5604702 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Sevki Peduk ◽

Cihad Tatar ◽

Mursit Dincer ◽

Bahri Ozer ◽

Ahmet Kocakusak ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Cause Of Death ◽

Clinical Stage ◽

Perioperative Period ◽

R0 Resection ◽

Advanced Imaging ◽

Curative Surgery ◽

Common Cause

Gastric cancer is the third most common cause of death in men and the fifth common cause of death in women worldwide. Currently, available advanced imaging modalities can predict R0 resection in most patients in the perioperative period. The aim of this study is to determine the role of serum CK18, MMP-9, and TIMP1 levels in predicting R0 resection in patients with gastric cancer. Fifty consecutive patients scheduled for curative surgery with gastric adenocancer diagnosis between 2013 and 2015 were included in the study. One milliliter of blood was taken from the patients included in the study to examine CK18, MMP-9, and TIMP1. CK18, MMP-9, and TIMP1 levels were positively correlated with pathological N and the stage (P<0.05). The CK18, MMP-9, and TIMP1 averages of those with positive clinical lymph nodes and those in clinical stage 3 were found to be higher than the averages of those with negative clinical lymph nodes and those in clinical stage 2 (P<0.05). Although serum CK18, MMP-9, and TIMP1 preop measurements in patients scheduled for curative surgery due to gastric adenocarcinoma did not help to gain any idea of tumor resectability, we concluded that our study had valuable results in significantly predicting N3 stage.

Download Full-text

Indications for Dissection of Lymph Nodes Located in the Splenic Hilus and Around the Splenic Artery According to Clinical Stage of Gastric Cancer.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.27.869 ◽

1994 ◽

Vol 27 (4) ◽

pp. 869-875

Author(s):

Hideki Ura ◽

Ryuichi Denno ◽

Koichi Hirata

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Splenic Artery ◽

Clinical Stage ◽

Splenic Hilus

Download Full-text

P-OGC23 Significance of neoadjuvant downstaging in gastric adenocarcinoma

British Journal of Surgery ◽

10.1093/bjs/znab430.151 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Pooja Prasad ◽

Ashwin Sivaharan ◽

Shajahan Wahed ◽

Alexander Phillips

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Clinical Outcomes ◽

Gastric Adenocarcinoma ◽

Clinical Stage ◽

Neoadjuvant Treatment ◽

High Volume ◽

Recurrence Rates ◽

The Impact

Abstract Background Neoadjuvant chemotherapy is established in the treatment of gastric adenocarcinoma. Histopathological regression as a result of neoadjuvant treatment can potentially have important prognostic implications in gastric cancer. There is little data comparing the clinical outcomes of patients with gastric adenocarcinoma at the same pathological stage with and without neoadjuvant treatment. The aim of this study is to determine the impact of neoadjuvant chemotherapy upon the prognosis of patients being treated for gastric adenocarcinoma. Methods Consecutive patients with gastric cancer treated in a single, tertiary high-volume centre between 2007 and 2017 were evaluated. All patients with gastric adenocarcinoma were treated with either a subtotal or total gastrectomy with D2 lymphadenectomy. A stage-by-stage comparison of the extent of pathological downstaging was conducted for patients who received neoadjuvant treatment (ypTNM) and those that did not (pTNM). The pTNM and ypTNM stages were defined as per the TNM 8th Edition. Results Among 384 patients undergoing gastrectomy for gastric adenocarcinoma, 141 patients received neoadjuvant chemotherapy. Of them, 86 patients (58.1%) benefitted from a downstaging effect. Patients with downstaged disease had improved overall survival compared to patients who did not respond to neoadjuvant chemotherapy (NR vs 66 months, p < 0.001). Downstaging by > 3 stages was the strongest independant predictor of overall survival (hazard ratio: 0.17; 95% Confidence Interval (CI) 0.062-0.44). Overall survival was significantly better when a stage-by-stage comparison was performed between patients in the ypTNM and pTNM groups. Conclusions Pathological staging following neoadjuvant chemotherapy is a more accurate predictor of prognosis compared to pre-neoadjuvant chemotherapy clinical stage with downstaged patients benefitting from lower recurrence rates and improved overall survival. Patients downstaged due to neoadjuvant chemotherapy receipt can potentially have more favourable clinical outcomes compared to stage-matched patients who did not receive this.

Download Full-text