Impact of Total Lymph Node Count on Staging and Survival After Gastrectomy for Gastric Cancer: Data From a Large US-Population Database

2005 ◽  
Vol 23 (28) ◽  
pp. 7114-7124 ◽  
Author(s):  
David D. Smith ◽  
Rebecca R. Schwarz ◽  
Roderich E. Schwarz
Keyword(s):  
Gastric Cancer ◽  
Linear Trend ◽  
Stage Migration ◽  
Population Database ◽  
Curative Gastrectomy ◽  
Data Set ◽  
Lymph Node Count ◽  
Cancer Data ◽  
Survival Difference ◽  
The Impact

Background Prognosis of potentially curable (M0), completely resected gastric cancer is primarily determined by pathologic T and N staging criteria. The optimal regional dissection extent during gastrectomy for gastric adenocarcinoma continues to be debated. Methods A gastric cancer data set was created through structured queries to the Surveillance, Epidemiology, and End Results database (1973 to 1999). Relationships between the number of lymph nodes (LNs) examined and survival were analyzed for the stage subgroups T1/2N0, T1/2N1, T3N0, and T3N1. Results In every stage subgroup, overall survival was highly dependent on the number of LNs examined. Multivariate prognostic variables in the T1/2N0M0 subgroup were number of LNs examined, age (for both, P < .0001), race (P = .0004), sex (P = .0006), and tumor size (P = .02). A linear trend for superior survival based on more LNs examined could be confirmed for all four stage subgroups. Baseline model–predicted 5-year survival with only one LN examined was 56% (T1/2N0), 35% (T1/2N1), 29% (T3N0), or 13% (T3N1). For every 10 extra LNs dissected, survival improved by 7.6% (T1/2N0), 5.7% (T1/2N1), 11% (T3N0), or 7% (T3N1). A cut-point analysis yielded the greatest survival difference at 10 LNs examined but continued to detect significantly superior survival differences for cut points at up to 40 LNs, always in favor of more LNs examined. Conclusion Although the impact of stage migration versus improved regional disease control cannot be separated on basis of the available information, the data provide support in favor of extended lymphadenectomy during potentially curative gastrectomy for gastric cancer.

scholarly journals The impact of lymph node count on survival in gastric cancer

2018 ◽  
Vol 14 (2) ◽  
pp. 120-127
Author(s):  
Ha Rim Ahn ◽  
Se Wung Han ◽  
Doo Hyun Yang ◽  
Chan Young Kim
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Count ◽  
Node Count ◽  
The Impact

scholarly journals The Incidence of Postoperative Complications after Gastrectomy Increases in Proportion to the Amount of Preoperative Visceral Fat

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Kazuyuki Okada ◽  
Tatsuto Nishigori ◽  
Kazutaka Obama ◽  
Shigeru Tsunoda ◽  
Koya Hida ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Visceral Fat ◽  
Visceral Obesity ◽  
Continuous Variable ◽  
University Hospital ◽  
Curative Gastrectomy ◽  
Visceral Fat Area ◽  
The Impact ◽  
The Relationship

Background. Visceral obesity is a risk factor for complications after gastrectomy in patients with gastric cancer. However, it is unclear whether postoperative complications decrease with preoperative reduction of visceral fat without the achievement of a nonobese state. This is because previous studies have performed categorical comparisons of obesity and nonobesity. The current study was performed to estimate the impact of the preoperative visceral fat area (VFA) as a continuous variable on postoperative complications after gastrectomy. Methods. Consecutive patients with gastric cancer who underwent curative gastrectomy between June 2006 and August 2017 at the Kyoto University Hospital were included in this retrospective study. The VFA at the level of the umbilicus was measured using preoperative computed tomography. The relationship between postoperative complications and VFA was investigated with univariate and multivariate analyses. Results. total of 566 patients were included in the study. Their mean VFA was 110 ± 58 cm2, and postoperative complications occurred in 121 patients (21.4%). The larger the VFA (<50, 50–99, 100–149, and ≥150 cm2), the higher the incidence of postoperative complications (11%, 14%, 21%, and 38%, respectively, P<0.001). Multivariate logistic regression analyses showed that the VFA was associated with postoperative complications (odds ratio: 1.009, 95% confidence interval (CI): 1.004–1.013, P<0.001), with an incidence of postoperative complications that was 9% (95% CI: 4%–12%) higher for every 10 cm2 increase in the VFA. Conclusion. The incidence of postoperative complications after gastrectomy increases in proportion to an increase in the preoperative VFA.

scholarly journals 964 Stage Migration in Newly Diagnosed Oesophago-Gastric Cancer During the First Wave Of COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Khan ◽  
R Chuntamongkol ◽  
C McCollum ◽  
L Gall ◽  
M Forshaw
Keyword(s):  
Gastric Cancer ◽  
Emergency Admission ◽  
Stage Migration ◽  
Newly Diagnosed ◽  
Gastric Cancers ◽  
Negative Effect ◽  
Gastric Cancer Patients ◽  
The Uk ◽  
Treatment Intent ◽  
The Impact

Abstract Aim Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes. Method A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown. Results 349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups. More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p &lt; 0.001). Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035). Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008). Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005). Conclusions The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during Covid-19 pandemic.

Survival Analysis with Extended Lymphadenectomy for Gastric Cancer: Removing Stage Migration from the Equation

2017 ◽  
Vol 83 (10) ◽  
pp. 1074-1079 ◽  
Author(s):  
Brooke Vuong ◽  
Amanda N. Graff-baker ◽  
Ahmed Dehal ◽  
Stacey Stern ◽  
Manabu Fujita ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Survival Analysis ◽  
Confidence Interval ◽  
Survival Benefit ◽  
National Cancer Data Base ◽  
Stage Migration ◽  
Extended Lymphadenectomy ◽  
Entire Cohort ◽  
Cancer Data

The survival benefit of an extended versus standard lymphadenectomy for gastric cancer (GC) is often attributed to upstaging when more lymph nodes (LNs) are removed, i.e., stage migration. An extended lymphadenectomy is defined as 30 or more LNs examined, a surrogate for a D2 dissection. The aim of this study is to examine whether the survival benefit of extended lymphadenectomy persists when stage migration is not possible. The National Cancer Data Base was queried to identify patients with pathologic N3 (pN3, ≥7 positive LNs) gastric adenocarcinoma. Overall survival (OS) was compared by extent of lymphadenectomy (7–14, 15–29, and ≥30 LN) and stratified by Tstage. Of 2101 pN3 patients, 419 (19.9%) had 7 to 14 LNs examined, 1164 (55.4%) had 15 to 29 LNs examined, and 518 (24.7%) had ≥30 LNs examined. Unadjusted three-year OS in the entire cohort was 24.6, 27.3, 30.5 per cent for 7 to 14 LNs, 15 to 29 LNs, and ≥30 LNs, respectively (P = 0.003). On adjusted survival analysis by stage for patients with pT1-T2N3 disease, removing ≥30 LNs significantly improved OS compared with removing 7 to 14 LNs (hazard ratio [HR] 2.45, 95% confidence interval = 1.25–4.82, P = 0.009). Extended lymphadenectomy may confer a survival benefit in select patients with pT1N3 and pT2N3 GC, highlighting the importance of the number of LNs examined rather than stage migration on survival. For the majority of the N3 population, pT3-pT4, the extent of lymphadenectomy did not significantly improve the OS.

Effect of body mass index in patients undergoing resection for gastric cancer: A single-center U.S. experience.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 25-25
Author(s):  
Joyce Wong ◽  
Shams Rahman ◽  
Nadia Saeed ◽  
Hui-Yi Lin ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Disease Free Survival ◽  
Technical Difficulty ◽  
Tumor Location ◽  
Normal Weight ◽  
Lymph Node Count ◽  
Clinicopathologic Factors ◽  
The Impact

25 Background: With the rise of obesity in the U.S., the impact of body mass index (BMI) on surgical outcomes and survival in gastric cancer remains undetermined. Methods: An IRB-approved, prospectively-maintained institutional database of patients referred for surgical evaluation of gastric cancer was reviewed. Patients were stratified according to BMI: <18.5 (underweight), 18.5-25 (normal weight), 25.1-30 (overweight), and >30 (obese). Clinicopathologic factors and overall survival (OS) were analyzed using polytomous regression, Pearsons correlation and Kaplan Meier when appropriate. Results: From 1997-2012, 222 patients underwent exploration for gastric adenocarcinoma. Of these, 186 (84%) patients had BMI recorded: 9 (5%) with BMI<18.5, 72 (39%) 18.5-25, 62 (33%) 25.1-30, and 43 (23%) >30. 135 (73%) ultimately underwent resection. Operative factors including American Society of Anesthesiology (ASA) score and blood loss were not significantly associated with BMI. Increased BMI was associated with longer operative time, P=0.02. Pathologic factors including proximal tumor location, perineural invasion (PNI), lymphovascular invasion (LVI), positive surgical margins, and positive lymph nodes (LN+) were all associated with a worse OS. Although increased BMI was associated with a lower total lymph node count, P=0.004, the number of LN+ was not associated with BMI. Tumor location, PNI, LVI, margin status, and final pathologic stage were not significantly associated with BMI. Additionally, the use of neoadjuvant or adjuvant chemotherapy was not associated with BMI. Median OS for the group was 22 months. When stratified by BMI, median OS was improved with increased BMI: 21 months for <18.5, 13 months for 18.5-25, 28 months for 25-30, and 34 months for >30, P=0.02. Similarly, disease free survival (DFS) improved with increasing BMI: 2 months for <18.5, 7 months for 18.5-25, 15 months for 25.1-30, and 15 months for >30, P=0.02. Conclusions: Although BMI may impact the technical difficulty of resection for gastric cancer, increasing BMI is not associated with more aggressive disease. In this experience, increased BMI does not adversely impact OS or DFS.

scholarly journals Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China

2021 ◽  
Vol 11 ◽  
Author(s):  
Hua-Yang Pang ◽  
Lin-Yong Zhao ◽  
Hui Wang ◽  
Xiao-Long Chen ◽  
Kai Liu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Negative Impact ◽  
Infectious Complications ◽  
Curative Gastrectomy ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

BackgroundThis study aimed to evaluate the impact of postoperative complication and its etiology on long-term survival for gastric cancer (GC) patients with curative resection.MethodsFrom January 2009 to December 2014, a total of 1,667 GC patients who had undergone curative gastrectomy were analyzed. Patients with severe complications (SCs) (Clavien–Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer) were separated into a “complication group.” Univariate and multivariate analyses were performed to reveal the relationship between postoperative complications and long-term survival. A 2:1 propensity score matching (PSM) was used to balance baseline parameters between the two groups.ResultsSCs were diagnosed in 168 (10.08%) patients, including different etiology: infectious complications (ICs) in 111 (6.66%) and non-infectious complications (NICs) in 71 (4.26%) patients. Multivariate analysis showed that presence of SCs (P=0.001) was an independent prognostic factor for overall survival, and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P=0.004) rather than NICs (P=0.068). After PSM, patients with SCs (p=0.002) still had a significantly decreased overall survival, and the presence of ICs (P=0.002) rather than NICs (P=0.067) showed a negative impact on long-term survival.ConclusionSerious complications, particularly of an infectious type, may have a negative impact on overall survival of GC patients. However, additional multicenter prospective studies with larger sample size are required to verify this issue.

scholarly journals Identification of Five m6A-Relevant mRNAs Signature and Risk Score for The Prognostication of Gastric Cancer

2021 ◽  
Author(s):  
Dongwei Sun ◽  
Xiaorong Hang ◽  
Jun Ren ◽  
Qiannan Sun ◽  
Zhu Liu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Risk Score ◽  
Risk Scores ◽  
Survival Prediction ◽  
Hub Genes ◽  
Data Set ◽  
Gastrointestinal Malignancies ◽  
Rna Methylation ◽  
Cancer Data ◽  
Cox Analysis

Abstract Introduction: N6-methyladenosine (m6A) is the most abundant form of methylation modification in eukaryotic cell mRNA. However, the role of m6A in gastric cancer is unclear, which is one of the most common gastrointestinal malignancies. The m6A-relevant mRNA signatures and risk scores are determined to predict the prognosis of gastric cancer in this study.Methods: The expression profiles and clinical information of 367 patients were downloaded from the Cancer Genome. Cluster analysis and univariate Cox analysis were used to identify the regulatory factors of RNA methylation associated with gastric cancer prognosis. The co-expression network was constructed by the WGCNA package in R. Then, the correlations between module eigengenes and clinical traits were calculated to identify the relevant modules. We used univariate Cox analysis to screen for genes that were significantly associated with prognosis in the module (P < 0.01 was considered significant). We identified hub genes by LASSO and multivariate analysis, and developed a Cox prognostic model. Finally, the hub gene expression values weighted by the coefficients from the LASSO regression generated a risk score for each patient, receiver operating characteristic (ROC) and Kaplan-Meier curves were used to assess the prognostic capacity of the risk scores.Results: HNRNPC was shown as P<0.05 and HR>1 in the TCGA gastric cancer data set, which might be a pathogenic factor affecting the prognosis of gastric cancer. The results indicated that AARD, ASPN, SLAMF9, MIR3117 and DUSP1 were hub genes affecting the prognosis of gastric cancer patients, and the m6A methylation of these mRNAs might be regulated by HNRNPC. The risk score = − (0.166195281×AARD + 0.016850602×ASPN + 0.591607997×SLAMF9 + 0.591607997×MIR3117 + 0.00276337×DUSP1), and our results indicated a bad performance of the five-gene signature for survival prediction (P < 0.05).Conclusion: HNRNPC (a m6A RNA methylation regulator) can participate in the serious progression of gastric cancer by regulating the m6A of AARD, ASPN, SLAMF9, MIR3117 and DUSP1, which may be used for prognosis stratification and treatment strategy formulation.

The Impact of Preoperative Lymph Node Size on Long-Term Outcome Following Curative Gastrectomy for Gastric Cancer

2012 ◽  
Vol 20 (5) ◽  
pp. 1598-1603 ◽  
Author(s):  
Masanori Tokunaga ◽  
Norihiko Sugisawa ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
Taiichi Kawamura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Curative Gastrectomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lymph Node Size ◽  
The Impact ◽  
Node Size

Prognostic significance of tumour infiltration growth pattern in patients with advanced gastric cancer

2018 ◽  
Vol 72 (2) ◽  
pp. 165-171 ◽  
Author(s):  
Bochao Zhao ◽  
Jiale Zhang ◽  
Di Mei ◽  
Xinyu Huang ◽  
Shihui Zou ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Growth Pattern ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Curative Gastrectomy ◽  
Japanese Classification ◽  
Node Metastases ◽  
Infiltration Growth ◽  
Tumour Infiltration ◽  
The Impact

AimsThe prognostic significance of infiltration growth pattern (INF) in patients with gastric cancer (GC) remains controversial. In the present study, we evaluated the impact of INF pattern on the prognosis of patients with advanced GC.MethodsA total of 1455 patients with advanced GC who underwent curative gastrectomy in our institution were retrospectively analysed. All patients were histopathologically classified as INFa/b and INFc pattern according to the Japanese Classification of Gastric Cancer. The prognostic difference between two patterns was compared and clinicopathological features were analysed.ResultsThe prognosis of the patients with INFc pattern was poorer than that of those with INFa/b pattern (5-year disease-free survival, INFa/b: 48.4% vs INFc: 33.5%, p < 0.001), even when they were stratified according to lymph node metastasis and the tumour, node, metastases stage. In addition, the subgroup analysis indicated that INFc pattern was significantly associated with poorer prognosis of T2–T3 stage patients (T2, INFa/b: 72.7% vs INFc: 55.4%; T3, INFa/b: 47.4% vs INFc: 33.5%; p<0.001). However, a similar result was not observed among T4a stage patients (INFa/b: 26.8% vs INFc: 24.8%, p>0.05). The prognosis of T2 stage patients with INFc pattern was similar to that of T3 stage patients with INFa/b pattern (p>0.05). Also, there was no significantly prognostic difference between T3 stage patients with INFc pattern and T4a stage patients (p>0.05). The multivariate analysis indicated that INF pattern was an independent prognostic factor for patients with advanced GC (HR 1.259, 95%CI 1.089 to 1.454).ConclusionIn view of its prognostic significance, histopathological evaluation of INF pattern in surgically resected specimens should be recommended in patients with advanced GC.

scholarly journals O-OGC02 Stage Migration in Newly Diagnosed Oesophago-gastric Cancer during the first wave of COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khurram Khan ◽  
Lewis Gall ◽  
Rongkagorn Chuntamongkol ◽  
Catherine McCollum ◽  
Stephan Dreyer ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Emergency Admission ◽  
Stage Migration ◽  
Newly Diagnosed ◽  
Gastric Cancers ◽  
Negative Effect ◽  
Gastric Cancer Patients ◽  
The Uk ◽  
Treatment Intent ◽  
The Impact

Abstract Background Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes. Methods A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown. Results 349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups. More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p &lt; 0.001). Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035). Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008). Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005). Conclusions The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during the Covid-19 pandemic.

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