Lymph node retrieval in a randomized trial on western-type versus Japanese-type surgery in gastric cancer.

1996 ◽  
Vol 14 (8) ◽  
pp. 2289-2294 ◽  
Author(s):  
A M Bunt ◽  
J Hermans ◽  
C J van de Velde ◽  
M Sasako ◽  
F A Hoefsloot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Randomized Trial ◽  
Tnm Classification ◽  
Tnm Staging ◽  
Nodal Status ◽  
Lymph Node Status ◽  
Lymph Node Retrieval ◽  
Status Assessment

PURPOSE In the tumor-node-metastasis (TNM) staging system, no recommendations are provided on what lymph node retrieval technique is to be used to determine lymph node status, which leads to variability in nodal status assessment and TNM staging. PATIENT AND METHODS Lymph node retrieval was quantitated using data from 237 curatively resected gastric cancer patients, from a prospective, randomized trial that compared the Western resection with limited (D1) and the Japanese resection with extended lymphadenectomy (D2), and compared data from the literature. Moreover, the efficacy of different lymph node retrieval techniques was determined. RESULTS The mean yield of lymph nodes was 15 in D1 and 30 in D2, which is similar to results from German investigators, but substantially lower than results from Japanese investigators (60 in D2). Use of a fat-clearance technique significantly increased (P = .01) nodal yields compared with conventional retrieval. Significantly higher yields (P < .001) were obtained by a Japanese surgeon using conventional retrieval directly postoperatively. Experience of surgicopathologic teams with processing resection specimens did not influence nodal yields. Further analysis showed that reference values for nodal yields per anatomically defined station as reported in the literature were contradicted by our results and indicated the ambiguity of such standards. CONCLUSION Despite some anatomical variability in the distribution of lymph nodes, advice on the number of nodes to examine per N level, feasible in all patients, should be incorporated into the TNM classification to standardize nodal status assessment. Based on our findings, we advocate retrieval of nodes immediately postoperatively by the surgeon.

scholarly journals Study of Survival in Gastric Cancer with Emphasis on Lymph Node Status as an Independent Prognostic Factor

2019 ◽  
Vol 4 (4) ◽  
pp. 185-189
Author(s):  
Nicolae Suciu ◽  
Orsolya Bauer ◽  
Zalán Benedek ◽  
Radu Ghenade ◽  
Marius Coroș ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Vascular Invasion ◽  
Lymph Node Ratio ◽  
Independent Prognostic Factor ◽  
Lymph Node Status ◽  
Node Ratio ◽  
Gastric Cancer Patients

Abstract Background: Lymph node status in gastric cancer is known as an independent prognostic factor that guides the surgical and oncological treatment and independently influences long-term survival. Several studies suggest that the lymph node ratio has a greater importance in survival than the number of metastatic lymph nodes. Aim: The aim of this study was to evaluate the clinical and morphological factors that can influence the survival of gastric cancer patients, with an emphasis on nodal status and the lymph node ratio. Material and methods: We conducted a retrospective study in which 303 patients with gastric cancer admitted to the Department of Surgery of the Mureș County Hospital between 2008 and 2018 were screened for study enrolment. Data were obtained from the records of the department and from the histopathological reports. The examined variables included: age, gender, tumor localization, T stage, histological type, grade of differentiation, surgical procedure, lympho-vascular invasion, excised lymph nodes, metastatic lymph nodes, lymph node ratio. After screening, the study included a total number of 100 patients, for which follow-up data was available. Results: The mean age of the study population was 66.43 ± 10 years, and 71% were males. The average survival period was 21.42 months. Statistical analysis showed that the localization of the tumor (p = 0.021), vascular invasion (p ---lt---0.001), T (p = 0.004) and N (p ---lt---0.001) stages, type of surgery (partial gastrectomy 59% vs. total gastrectomy 41%, p = 0.005), as well as the lymph node ratio (p ---lt---0.001) were prognostic factors for survival in patients with gastric cancer undergoing surgical therapy. Conclusions: The survival of gastric cancer patients is significantly influenced by tumor localization, T stage, vascular invasion, type of surgery, N stage and the lymph node ratio based on univariate analysis. Also, the lymph node ratio proved to be an independent prognostic factor for survival.

Prognostic impact of lymph node retrieval and ratio in gastric cancer: A single-center U.S. experience.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 17-17
Author(s):  
Joyce Wong ◽  
Shams Rahman ◽  
Nadia Saeed ◽  
Hui-Yi Lin ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Free Survival ◽  
Lymph Node Retrieval ◽  
Node Ratio ◽  
Disease Free

17 Background: Recommendations for extended lymphadenectomy in gastric cancer is thought to be associated with improved overall survival (OS), although defining adequate lymphadenectomy remains controversial. Methods: A single-institution, prospectively-maintained database of patients referred for surgical care of gastric cancer was reviewed. Patients were stratified by number of examined lymph nodes (eLN): <5, 6-10, 11-15, and >15 and positive LNs (LN+) stratified by 0, 1-2, 3-6, 7-15, and >15. Lymph node ratio (LN+:eLN) was evaluated, stratified by 0, 0.01-0.2, 0.21-0.5, and >0.5. Disease-free-survival (DFS) and OS were the primary endpoints, determined by Kaplan-Meier analyses. Results: From 1997-2012, 222 patients were included; most were male (N=122, 55%) with median age 67 (range 17-92) years. Of 220 (99%) patients surgically explored, 164 (74%) ultimately underwent resection. Median OS of the entire cohort was 22 months. Gender, ethnicity, and smoking status did not impact OS. Pathologic factors such as perineural invasion, lymphovascular invasion, and poor differentiation adversely affected OS, P<0.05. A median 14 lymph nodes (LN) were retrieved (range 0-45), with a median of one positive LN (range 0-31). No OS or disease-free survival (DFS) difference was observed when comparing <5, 6-10, 11-15, and >15 eLN, P=0.30. LN+ affected both OS and DFS: median OS was 52 months for 0 LN+ and decreased to 21 months with 1-2 LN+, 34 months 3-6 LN+, 25 months 7-15 LN+, and 11.5 months with >15 LN+. Similarly, median DFS decreased from 35 months with 0 LN+ to 19 months with 1-2 LN+, 9 months with 3-6 LN+, 13.5 months with 7-15 LN+, and 7.5 months with >15 LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months for ratio of 0, 37 months for 0.01-0.2, 27 months for 0.21-0.5, and 12 months for >0.5, P<0.0001. DFS was similar: 35months for ratio of 0, 22 months for 0.01-0.2, 13 months for 0.21-0.5, and 7 months for >0.5, P<0.0001. Conclusions: Extent of lymphadenectomy does not impact OS or DFS. Presence of LN+ adversely impacts OS and DFS. Lymph node ratio may be a better prognostic indicator than number of eLN or LN+ in gastric cancer.

scholarly journals Nodal Status and Clinical Outcomes in a Large Cohort of Patients With Triple-Negative Breast Cancer

2011 ◽  
Vol 29 (19) ◽  
pp. 2628-2634 ◽  
Author(s):  
Leonel F. Hernandez-Aya ◽  
Mariana Chavez-MacGregor ◽  
Xiudong Lei ◽  
Funda Meric-Bernstam ◽  
Thomas A. Buchholz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Clinical Outcomes ◽  
Tumor Size ◽  
Large Cohort ◽  
Nodal Status ◽  
Lymph Node Status ◽  
Significant Difference ◽  
Positive Lymph Nodes

Purpose To evaluate the clinical outcomes and relationship between tumor size, lymph node status, and prognosis in a large cohort of patients with confirmed triple receptor–negative breast cancer (TNBC). Patients and Methods We reviewed 1,711 patients with TNBC diagnosed between 1980 and 2009. Patients were categorized by tumor size and nodal status. Kaplan-Meier product limit method was used to calculate overall survival (OS) and relapse-free survival (RFS). A Sidak adjustment was used for multiple group comparisons. Cox proportional hazards models were fit to determine the association of tumor size and nodal status with survival outcomes after adjustment for other patient and disease characteristics. Results Median age was 48 years (range, 21 to 87 years). At a median follow-up of 53 months (range, 0.7 to 317 months), there were 614 deaths and 747 recurrences. The 5-year OS was 80% for node-negative patients (N0), 65% for one to three positive lymph nodes (N1), 48% for four to nine positive lymph nodes (N2), and 44% for ≥ 10 positive lymph nodes (N3; P < .0001). The 5-year RFS rates were 67% for N0, 52% for N1, 36% for N2, and 33% for N3 (P < .0001). Pairwise comparison by nodal status showed that when comparing N0 with node-positive disease, there was a significant difference in OS and RFS (P < .001 all comparisons). However, when comparing N1 with N2 and N3 disease regardless of tumor size, there were no significant differences in OS or RFS. Conclusion In patients with TNBC, once there is evidence of lymph node metastasis, the prognosis may not be affected by the number of positive lymph nodes.

Safety in numbers? Gastric cancer survival varies with total retrieved lymph nodes.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4058-4058
Author(s):  
Omidreza Tabatabaie ◽  
Gyulnara G. Kasumova ◽  
Stijn van Roessel ◽  
Promise Ukandu ◽  
Sing Chau Ng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Cox Proportional Hazards ◽  
Curative Surgery ◽  
Lymph Node Count ◽  
Risk Of Death ◽  
Lymph Node Retrieval

4058 Background: Recently published AJCC 8thTNM-staging guidelines recommend a minimum of 16 lymph nodes be assessed in gastric cancer surgery with more lymph nodes ( 30) being desirable. However, the independent effects of greater numbers of lymph nodes excised on the overall survival of patients with gastric adenocarcinoma are understudied. Methods: National Cancer Database (NCDB) was reviewed from 2010 to 2014 for patients who underwent potentially curative surgery for gastric adenocarcinoma. Patients with zero or unknown number of harvested lymph nodes were excluded, as were those with metastatic or in-situ disease, or who received neoadjuvant chemo- or radiotherapy. Cox proportional hazards modeling was used for multivariate survival analysis. Results: Of the 12,507 patients who met selection criteria, 4,880 (39.0%) were female. The median age was 69 years [IQR: 59-77]. Median number of lymph nodes examined for each clinical T and N-stage is provided in the table. Overall, 51.0% of patients had < 16 lymph nodes examined. After adjusting for clinical T and N-stages, sex, age, tumor size, grade, facility type, receipt of adjuvant chemotherapy, resection type and race, and compared to patients with < 16 nodes examined, the hazard ratios for death in patients with 16-29, 30-44 and ≥45 examined lymph nodes were 0.87 (95% CI = 0.82-0.93), 0.79 (95% CI = 0.71-0.88) and 0.68 (95% CI = 0.56-0.83), respectively. Conclusions: Total lymph node count is an important independent predictor of overall survival in resectable gastric cancer, with an increased number of excised lymph nodes being associated with progressively decreased risk of death. These findings support the latest AJCC guidelines that higher number of lymph node retrieval is desirable. The recommended oncologic standard for at least 16 nodes to be assessed pathologically is not attained in more than half of upfront gastric resections performed for cancer. [Table: see text]

Cohort Study Based on the Seventh Edition of the TNM Classification for Gastric Cancer: Proposal of a New Staging System

2011 ◽  
Vol 29 (17) ◽  
pp. 2364-2371 ◽  
Author(s):  
Viktoria S. Warneke ◽  
Hans-Michael Behrens ◽  
Jörg T. Hartmann ◽  
Harald Held ◽  
Thomas Becker ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Survival Data ◽  
Esophagogastric Junction ◽  
Tnm Classification ◽  
Staging System ◽  
Lymph Node Status ◽  
Stage Migration ◽  
Seventh Edition ◽  
Stage Grouping

Purpose We investigated the effect of the new TNM classification on gastric cancer staging. Patients and Methods From hospital records, information from patients with gastric cancer, who had undergone either total or partial gastrectomy for adenocarcinomas of the stomach or esophagogastric junction, was retrieved. The pathologic TNM stage was determined according to the sixth and seventh editions of the International Union Against Cancer guidelines and was based on surgical pathologic examination. Results Five hundred fifty-four patients (338 men and 216 women; median age, 68 years) had undergone partial or complete gastrectomy for intestinal (n = 209) or diffuse (n = 249) adenocarcinoma of the esophagogastric junction and stomach. Survival data and date of death were available for all patients. Patient death correlated significantly with age at diagnosis, tumor type, histologic grade, local tumor growth (T category), number of metastatic lymph nodes, lymph node ratio, lymph node status (N category), and tumor stage. No major difference was noted between the sixth and seventh editions of the TNM classification. On the basis of survival data, we revised the stage grouping system; stage I and II tumors were confined to nonmetastatic tumors, and stage III and IV tumors were confined to metastatic tumors. The Kaplan-Meier plots of this modified stage grouping showed statistically significant differences between individual stage subgroups without crossing curves and demonstrated improved survival of patients with stage II disease. Conclusion The seventh edition of the TNM classification is associated with a stage migration in 60% of patients with esophagogastric and stomach cancer. This change did not improve the assessment of patient prognosis, and therefore, a revised staging system is proposed.

A Modified Prognostic Score for Patients with Curatively Resected Gastric Cancer

2005 ◽  
Vol 91 (3) ◽  
pp. 221-226 ◽  
Author(s):  
Luigi Mariani ◽  
Rosalba Miceli ◽  
Lara Lusa ◽  
Maria Di Bartolomeo ◽  
Federico Bozzetti
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Tnm Classification ◽  
Prognostic Score ◽  
Tnm Staging ◽  
Nodal Status ◽  
Prognostic Information ◽  
Curative Surgery ◽  
Nodal Stage ◽  
Gastric Cancer Patients

Aims and background Gastric cancer is the second leading cause of cancer death worldwide; the risk of dying depends on several patient and disease characteristics. An existing prognostic score predicts survival in gastric cancer patients undergoing curative resection based on patient age, tumor site, extent of wall invasion and nodal status, categorized as simply as negative or positive. Methods Our aim was to modify the original prognostic score by incorporating information on nodal stage according to the latest TNM classification (number of involved nodes), based on a retrospective series of 610 chemotherapy-naïve gastric cancer patients recruited to a surgical clinical trial. We then tested the modified score on an independent series of 136 gastric cancer patients. Results Nodal stage added significant prognostic information to the nodal status classification (P <0.001), and was therefore included in the modified score. With the latter, we were able to identify three risk groups with overall five-year survival varying from more than 70% to less than 30%. The prognostic performance of the modified score was better than that achieved with the AJCC-UICC TNM staging. Conclusions The modified score, based on established prognostic factors, is proposed as a simple tool for prognostic grouping of gastric cancer patients undergoing curative surgery.

scholarly journals COLORECTAL CANCER AND LYMPH NODE COUNT: IS THE NUMBER RECOMMENDED FOR STAGING RETRIEVED?

2020 ◽  
pp. 60-64
Author(s):  
Suhail Saleem ◽  
Vijayalakshmi Nair
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Staging System ◽  
Tnm Staging ◽  
Lymph Node Count ◽  
Lymph Node Retrieval ◽  
Modifiable Factors ◽  
Pathologic Characteristic ◽  
Lymph Node Harvesting

Background Colorectal cancer (CRC) ranks as the third most commonly diagnosed cancer in males and the second in females. According to the TNM staging system, status of the draining lymph nodes is a key pathologic characteristic. Inadequate lymph node harvesting may result in under treatment of patients. The purpose of the present study was to evaluate the factors that influence the number of lymph nodes retrieved in colorectal cancer specimens. Methods Sixty five patients with histologically proven colorectal adenocarcinoma over a period of 18 months were included. All patients underwent surgical resection for their disease. All significant patient, tumour and treatment variables were assessed for their impact on the average total number of lymph node harvested. Further, the efficacy of the GEWF solution (glacial acetic acid, ethanol, distilled water, formaldehyde) in lymph node retrieval was also assessed. Results In this study, 43 men and 22 women with a median age of 61 years were included. The median total number of lymph nodes examined was 17. 87.6% had adequate (≥ 12) lymph nodes examined, and 12.4% had <12 nodes examined. The number of lymph nodes were found to be higher and statistically significant in under 60-year-old group (p=0.001), tumours of size > 5cm (p=0.002), tumours of the ascending colon (p=0.025) and cases operated on by super specialist surgeons (p=0.017).Factors such as gender (p=0.23),BMI (p=0.22),tumour differentiation (p=0.348) and T staging (p=0.026) had no statistically significant association with lymph node harvest. Mean LN count was significantly higher (p = 0.0001) regrossing by a senior pathologist. However a statistically significant increase in LN harvest was not seen (p=0.159) when specimens were further subjected to GEWF treatment. Conclusions This study indicates that several modifiable factors impact LN retrieval and hence gives scope for improvement. Refinement of surgical and pathological care is suggested especially in challenging cases like rectal cancer and elderly patients.

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.

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