The prognostic significance of Cerb-B2 determination in gastric cancer.

e14713 Background: The Cerb-B2/HER2 marker, is a glycoprotein encoded by the ERBB2 oncogene, belongs to the family of epidermal growth factor receptors (EGFR), which has based its application on tests of new therapeutic modalities (target therapy). Apart from this interest has been invoked its value as a marker of tumor aggressiveness, due to his role as a regulator of cell proliferation and migration and consequent invasiveness and metastization. However, the results as to the meaning prognosis of this molecular marker are controversial and with variations depending on the geographical zone. Results: From a total of 50 pts. with advanced resectable gastric cancer that underwent surgery with D2 lymphadenectomy, 38 pts. had a total gastrectomy, and 12 pts. had subtotal gastrectomy. A mean of 35.7 lymph nodes/pt were resected at surgery. In 68% of pts. positive lymph node metastases were present. Tumor HER2-neu overexpression was observed in 16 pts (32%), several other parameters of tumor aggressiveness were also present, without any statistical significance or relevance. Methods: To determine if the Cerb-B2 played a prognostic role in gastric cancer, a total of 50 pts. with advanced resectable gastric cancer, were submitted to gastrectomy with D2 lymphadenectomy. In all cases assessment for tumor HER2-neu overexpression was performed using immunohistochemistry (IHC). FISH was used as a confirmation method in tumors with 2+ expression by IHC. A correlation was made between the tumor HER2-neu expression and the following parameters: tumor location, size, histological type, depth of invasion, lymph node metastases and clinical staging. Results: From a total of 50 pts. with advanced resectable gastric cancer that underwent surgery with D2 lymphadenectomy, 38 pts. had a total gastrectomy, and 12 pts. had subtotal gastrectomy. A mean of 35.7 lymph nodes/pt were resected at surgery. In 68% of pts. positive lymph node metastases were present.Tumor HER2-neu overexpression was observed in 16 pts (32%), several other parameters of tumor aggressiveness were also present, without any statistical significance or relevance. Conclusions: The determination of Cerb-B2 / HER2 expression has not shown prognostic significance in this study.

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Risk Factors for Lymph Node Metastases and their Prognostic Significance in Early Gastric Cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC)

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hye107 ◽

2001 ◽

Vol 31 (10) ◽

pp. 495-499 ◽

Cited By ~ 99

Author(s):

S. Folli

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Early Gastric Cancer ◽

Research Group ◽

Lymph Node Metastases ◽

Prognostic Significance ◽

Node Metastases

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Is D2 Lymphadenectomy Alone Suitable for Gastric Cancer With Bulky N2 and/or Para-Aortic Lymph Node Metastases After Preoperative Chemotherapy?

Frontiers in Oncology ◽

10.3389/fonc.2021.709617 ◽

2021 ◽

Vol 11 ◽

Author(s):

Wei Xu ◽

Wentao Liu ◽

Lingquan Wang ◽

Changyu He ◽

Sheng Lu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Preoperative Chemotherapy ◽

Lymph Node Metastases ◽

Survival Duration ◽

D2 Lymphadenectomy ◽

D2 Gastrectomy ◽

Aortic Lymph Node ◽

Node Metastases ◽

Bulky N2

BackgroundFor gastric cancer (GC) with extensive lymph node metastasis (bulky N2 and/or para-aortic lymph node metastases), there is no standard therapy worldwide. In Japan, preoperative chemotherapy (PCT) followed by D2 gastrectomy plus para-aortic lymph node dissection (PAND) is considered the standard treatment for these patients. However, in China, the standard operation for GC patients with only bulky N2 metastases was D2 gastrectomy. Besides, after PCT, whether doing PAND improves survival or not is debatable for GC patients with para-aortic lymph node (PAN) metastases. Therefore, we conducted this study to investigate whether D2 lymphadenectomy alone is suitable for these patients after PCT.MethodsWe retrospectively collected data on patients from our electronic medical record system. GC patients with bulky N2 and/or PAN metastases who underwent D2 lymphadenectomy alone after PCT were enrolled. The survival outcomes and chemotherapy responses were analyzed and compared with the results of the JCOG0405 study.ResultsFrom May 2009 to December 2017, a total of 83 patients met all eligibility criteria and were enrolled. The median survival duration for all patients was 40.0 months. The 3-year and 5-year OS rates for all patients were 50.3% and 45.6%, respectively. For patients with only bulky N2 metastasis, the 3-year and 5-year OS rates were 77.1% and 71.6%, respectively, which were similar to the results of the JCOG0405 study (82.7% and 73.4%). For patients with only PAN metastases, the 3-year and 5-year OS rates were 50.0% and 50.0%, respectively, which seemed to be lower than those of the JCOG0405 study (64.3% and 57.1%). For patients with bulky N2 and PAN metastases, the 3-year and 5-year OS rates were 7.4% and 0.0%, respectively, which were lower than those of the JCOG0405 study (20.0% and 20.0%).ConclusionThe results of our study suggest that D2 lymphadenectomy alone is suitable for GC patients with only bulky N2 metastasis after PCT. However, D2 lymphadenectomy alone perhaps is not suitable for patients with bulky N2 and PAN metastases after PCT.

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Prognostic Significance of Level and Number of Lymph Node Metastases in Patients with Gastric Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-006-9314-3 ◽

2007 ◽

Vol 14 (5) ◽

pp. 1688-1693 ◽

Cited By ~ 55

Author(s):

Hiroaki Saito ◽

Yoji Fukumoto ◽

Tomohiro Osaki ◽

Kenji Fukuda ◽

Shigeru Tatebe ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Prognostic Significance ◽

Node Metastases

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Number of lymph node metastases and its prognostic significance in early gastric cancer: A multicenter italian study

Journal of Surgical Oncology ◽

10.1002/jso.20566 ◽

2006 ◽

Vol 94 (4) ◽

pp. 275-280 ◽

Cited By ~ 97

Author(s):

Franco Roviello ◽

Simone Rossi ◽

Daniele Marrelli ◽

Corrado Pedrazzani ◽

Giovanni Corso ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Early Gastric Cancer ◽

Lymph Node Metastases ◽

Prognostic Significance ◽

Italian Study ◽

Node Metastases

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Prediction of Lymph Node Metastases in Gastric Cancer by Serum APE1 Expression

Journal of Cancer ◽

10.7150/jca.18615 ◽

2017 ◽

Vol 8 (8) ◽

pp. 1492-1497 ◽

Cited By ~ 12

Author(s):

Xi Wei ◽

Yi-bo Li ◽

Ying Li ◽

Ben-cheng Lin ◽

Xiao-Min Shen ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Node Metastases

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Incidence and Prognostic Significance of Carcinoid Lymph Node Metastases

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2018.05.044 ◽

2018 ◽

Vol 106 (4) ◽

pp. 981-988 ◽

Cited By ~ 6

Author(s):

Peter J. Kneuertz ◽

Mohamed K. Kamel ◽

Brendon M. Stiles ◽

Benjamin E. Lee ◽

Mohamed Rahouma ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastases ◽

Prognostic Significance ◽

Node Metastases

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18F-FDG PET/CT Radiomics for Preoperative Prediction of Lymph Node Metastases and Nodal Staging in Gastric Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.723345 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qiufang Liu ◽

Jiaru Li ◽

Bowen Xin ◽

Yuyun Sun ◽

Dagan Feng ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Fdg Pet ◽

Fixed Ratio ◽

Preoperative Prediction ◽

Pet Ct ◽

N Stage ◽

Node Metastases ◽

Fdg Pet Ct

ObjectivesThe accurate assessment of lymph node metastases (LNMs) and the preoperative nodal (N) stage are critical for the precise treatment of patients with gastric cancer (GC). The diagnostic performance, however, of current imaging procedures used for this assessment is sub-optimal. Our aim was to investigate the value of preoperative 18F-FDG PET/CT radiomic features to predict LNMs and the N stage.MethodsWe retrospectively collected clinical and 18F-FDG PET/CT imaging data of 185 patients with GC who underwent total or partial radical gastrectomy. Patients were allocated to training and validation sets using the stratified method at a fixed ratio (8:2). There were 2,100 radiomic features extracted from the 18F-FDG PET/CT scans. After selecting radiomic features by the random forest, relevancy-based, and sequential forward selection methods, the BalancedBagging ensemble classifier was established for the preoperative prediction of LNMs, and the OneVsRest classifier for the N stage. The performance of the models was primarily evaluated by the AUC and accuracy, and validated by the independent validation methods. Analysis of the feature importance and the correlation were also conducted. We also compared the predictive performance of our radiomic models to that with the contrast-enhanced CT (CECT) and 18F-FDG PET/CT.ResultsThere were 185 patients—127 men, 58 women, with the median age of 62, and an age range of 22–86 years. One CT feature and one PET feature were selected to predict LNMs and achieved the best performance (AUC: 82.2%, accuracy: 85.2%). This radiomic model also detected some LNMs that were missed in CECT (19.6%) and 18F-FDG PET/CT (35.7%). For predicting the N stage, four CT features and one PET feature were selected (AUC: 73.7%, accuracy: 62.3%). Of note, a proportion of patients in the validation set whose LNMs were incorrectly staged by CECT (57.4%) and 18F-FDG PET/CT (55%) were diagnosed correctly by our radiomic model.ConclusionWe developed and validated two machine learning models based on the preoperative 18F-FDG PET/CT images that have a predictive value for LNMs and the N stage in GC. These predictive models show a promise to offer a potentially useful adjunct to current staging approaches for patients with GC.

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Prognostic performance of three lymph node staging systems in patients after D2 lymphadenectomy for gastric cancer

International Surgery ◽

10.9738/intsurg-d-15-00250.1 ◽

2020 ◽

Author(s):

Ze-ping Huang ◽

Wen-jun Zhang ◽

Zi-xian Wang ◽

Hai-peng Liu ◽

Xiang-Ting Zeng ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Optimal System ◽

Ca 125 ◽

D2 Lymphadenectomy ◽

Concordance Index ◽

Internal Validation ◽

Preoperative Serum ◽

Staging Systems ◽

Resectable Gastric Cancer

Background: Accurate staging of lymph node (LN) status is essential for predicting prognosis in patients with gastric cancer. Recent proposals suggest that lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) may have superior accuracy in predicting survival by minimizing stage migration. The aim of the present study was to compare the prognostic performances of the UICC (pN), LNR and LODDS staging systems and incorporate the optimal system into a nomogram for predicting individual survival in patients with resectable gastric cancer. Methods: The study cohort comprised of 423 patients who had undergone D2 lymphadenectomy. The discriminatory powers of the different LN staging systems were compared using the concordance index (C-index). The optimal system was incorporated into a prognostic nomogram with other independent prognosticators, and bootstrap validation was performed. Results: When LN status was assessed as a continuous variable, the LNR system (C-index: 0.712) was superior to pN (C-index: 0.695) and LODDS (C-index: 0.704). Age, LNR, and preoperative serum CA 19-9 and CA 125 were incorporated into a nomogram for predicting 2-year overall survival. Internal validation of the nomogram revealed good predictive abilities, with a bootstrap-corrected concordance index of 0.704. Conclusion: Overall, LNR was the optimum predicator of survival in patients with resectable gastric cancer on the basis of LN status. LNR was incorporated into a nomogram along with age and preoperative serum CA 19-9 and CA 125. Internal validation confirmed the predictive ability of this nomogram.

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