Factors associated with recurrence in lymph node-negative gastric adenocarcinoma: Results from the U.S. Gastric Cancer Collaborative.

80 Background: Lymph node (LN) status is a predictor of recurrence after gastrectomy for gastric adenocarcinoma. Clinicopathologic predictors of recurrence in patients with node-negative disease are less well established. Methods: Patients who underwent surgery with curative intent for gastric adenocarcinoma from between 2000-2012 from participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. Patients who died within 30 days of surgery were excluded. Univariate (UV) and multivariate (MV) analysis of clinicopathologic factors was associated with recurrence was performed. Results: Nine-hundred sixty-five patients from seven institutions were included in the analysis. Three-hundred forty-five (36%) had LN- disease, of whom 63 (18%) had disease recurrence after a median follow-up of 24 months. The most common patterns of recurrence were: peritoneal alone (44%), liver (22%), or combined liver/peritoneal (9%). This distribution did not differ significantly from LN+ disease. UV analysis identified tumor size, linitis plastica, diffuse histology, poor differentiation, signet ring histology, T stage ≥3, perineural invasion, and lymphvascular invasion as risk factors for recurrence (Table). On MV analysis, T stage≥3 (OR 3.6, 95% CI=1.7-7.5) and poorly differentiated histology (OR 2.4, 95% CI=1.2-4.9) were independent predictors of recurrence. Conclusions: Despite the presence of negative lymph nodes, patients with T stage ≥3 and poorly differentiated histology are at high risk of recurrence after gastrectomy for adenocarcinoma of the stomach. These factors, along with other patient and treatment-related variables, may be used to select patients who may benefit from more aggressive adjuvant therapy and to guide subsequent monitoring for disease recurrence. [Table: see text]

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Disease recurrence and oncological outcome of patients treated surgically with curative intent for estrogen receptor positive, lymph node negative breast cancer

Surgical Oncology ◽

10.1016/j.suronc.2021.101531 ◽

2021 ◽

Vol 37 ◽

pp. 101531

Author(s):

M.G. Davey ◽

É.J. Ryan ◽

P.F. McAnena ◽

M.R. Boland ◽

M.K. Barry ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Lymph Node ◽

Oncological Outcome ◽

Disease Recurrence ◽

Positive Lymph Node ◽

Curative Intent ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Estrogen Receptor Positive

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Lymph node micrometastasis of poorly differentiated node-negative gastric cancer risks a worse-than-expected survival outcome under standard management algorithm

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.11.117 ◽

2021 ◽

Author(s):

Shu-Fang Huang ◽

Tse-Ching Chen ◽

Jun-Te Hsu ◽

Chun-Yi Tsai ◽

Keng-Hao Liu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Survival Outcome ◽

Cancer Risks ◽

Node Negative ◽

Management Algorithm ◽

Lymph Node Micrometastasis ◽

Standard Management ◽

Poorly Differentiated

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Prognostic Significance of Number of Lymph Nodes Harvested in Patients with Node Negative Antral Gastric Adenocarcinoma Undergoing Laparoscopic Curative Resection

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45112.14228 ◽

2020 ◽

Author(s):

Ümit Mercan ◽

Ogün Eren ◽

Cemil Yüksel ◽

Salim Demirci

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Gastric Adenocarcinoma ◽

Disease Free Survival ◽

Free Survival ◽

Node Negative ◽

T Stage ◽

Patient Prognosis ◽

Clinicopathological Variables ◽

Disease Free

Introduction: The most important parameters affecting patient prognosis in gastric cancer are the T stage and regional lymph node invasion. Although it is known that lymph node positive patients have poor long-term survival and recurrence and metastasis rates are higher than patients with lymph node negative, recurrence and metastasis may also develop in lymph node negative patients. Studies have found that the most likely causes of this situation are mictometastases which cannot be detected in routine pathological examination and the inability to remove a sufficient number of lymph nodes. There is no clear consensus regarding the number of lymph nodes to be removed and there are very few studies in the literature on this subject. Aim: To determine the effect of the number of lymph nodes harvested in laparoscopically resected, lymph node negative, early stage antral gastric adenocarcinoma on patient prognosis. Materials and Methods: A retrospective study was conducted from January 2015 to January 2020 in which 62 patients with pT1N0, pT2N0 and pT3N0 tumour located in gastric antrum were included. Distal gastrectomy, partial omentectomy and lymph node dissection were performed to all patients. The number of lymph nodes harvested were determined from pathology reports. The patients were divided into two groups according to the number of lymph nodes as below 15 or above 15 and clinicopathological variables and overall and disease-free survival rates were compared between these two groups. X2 or Fisher-Exact test and Student-T or Mann-Whitney U test were used for comparing clinicopathological variables and Kaplan-Meier survival curves and Cox regression model for survival analysis. All p-values less than 0.05 were considered statistically significant. Results: It has been found that the mean overall survival in groups with lymph node removal ≥ and <15 was 55.07±2.28 (95% CI: 50.60 ~ 59.55) months and 34.80±4.26 (95% CI: 26.43 ~ 43.17) months and mean disease-free survival was 59.43±1.10 (95% CI: 57.26 ~ 61.59) months and 27.85±4.19 (95% CI: 19.63 ~ 36.07) months, respectively. The difference was statistically significant (p=0.001, p=0.002). Conclusion: Present study concludes that removal of a minimum of 15 lymph nodes in radical gastrectomy and lymphadenectomy is effective on overall and disease-free survival, regardless of the T stage. In addition, removal of 15 or more lymph nodes can provide more accurate and appropriate staging and affect patients’ decision to be directed towards adjuvant therapy.

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The effect of postoperative morbidity on survival after resection for gastric adenocarcinoma: Results from the U.S. Gastric Cancer Collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.5 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 5-5

Author(s):

Linda X. Jin ◽

Lindsey E. Moses ◽

Yan Yan ◽

Malcolm Hart Squires ◽

Sharon M. Weber ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Therapy ◽

Gastric Adenocarcinoma ◽

Negative Impact ◽

Perioperative Complications ◽

Disease Free Survival ◽

Oncologic Outcomes ◽

Rank Test ◽

Curative Intent ◽

The U.S

5 Background: The negative impact of postoperative complications (POCs) on survival is well documented for many cancer types, but has not been well described in gastric cancer. Here, we evaluated the effect of POCs on survival after surgery for gastric cancer in a cohort of patients from a multi-institutional database. Methods: Patients who underwent surgery with curative intent for gastric adenocarcinoma between 2000-2012 from participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. Patients who died within 30 days of surgery were excluded. Ninety-day postoperative complication data were collected. Survival probabilities were estimated by Kaplan-Meier analysis and compared using the log-rank test. Results: A total of 853 patients from seven institutions met inclusion criteria. Median follow-up was 32 months. The overall complication rate was 40% (n=344). The most frequent complications were: infectious (25%, including surgical site infection [8%]), and anastomotic leak (6%). 7% of patients underwent reoperation during the same hospitalization. Five-year overall survival (OS) for patients without perioperative complications was 54%, compared with 39% for patients with POCs (p=0.001). Disease free survival (DFS) at five years was 61% for patients without POCs compared to 49% in patients with POCs (p=0.002). Patients without POCs were significantly more likely to receive adjuvant therapy (55% vs 42%; p<0.001). Conclusions: In a large, multi-institutional cohort, POCs were associated with decreased survival in patients undergoing surgery for gastric adenocarcinoma. This may be due, in part, to the negative impact of complications on the receipt of adjuvant therapy. Efforts aimed at reducing perioperative morbidity are important not only for short-term surgical outcomes, but also for enhancing long-term oncologic outcomes in patients with gastric cancer. [Table: see text]

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

Scientific Reports ◽

10.1038/s41598-021-81663-0 ◽

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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The Prognostic Impact of Occult Lymph Node Metastasis in Node-negative Gastric Cancer: A Systematic Review and Meta-analysis

Annals of Surgical Oncology ◽

10.1245/s10434-013-3021-7 ◽

2013 ◽

Vol 20 (12) ◽

pp. 3927-3934 ◽

Cited By ~ 22

Author(s):

Jin-yu Huang ◽

Ying-ying Xu ◽

Min Li ◽

Zhe Sun ◽

Zhi Zhu ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Meta Analysis ◽

Prognostic Impact ◽

Node Negative ◽

Node Metastasis ◽

Occult Lymph Node Metastasis

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The Prognostic Value of Lymph Nodes Dissection Number on Survival of Patients with Lymph Node-Negative Gastric Cancer

Gastroenterology Research and Practice ◽

10.1155/2014/603194 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Wu Song ◽

Yujie Yuan ◽

Liang Wang ◽

Weiling He ◽

Xinhua Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Lymph Node ◽

Lymph Nodes ◽

Tumor Invasion ◽

Prognostic Value ◽

Operation Time ◽

Invasion Depth ◽

Node Negative ◽

Tumor Invasion Depth

Objective.The study was designed to explore the prognostic value of examined lymph node (LN) number on survival of gastric cancer patients without LN metastasis.Methods.Between August 1995 and January 2011, 300 patients who underwent gastrectomy with D2 lymphadenectomy for LN-negative gastric cancer were reviewed. Patients were assigned to various groups according to LN dissection number or tumor invasion depth. Some clinical outcomes, such as overall survival, operation time, length of stay, and postoperative complications, were compared among all groups.Results.The overall survival time of LN-negative GC patients was50.2±30.5months. Multivariate analysis indicated that LN dissection number(P<0.001)and tumor invasion depth(P<0.001)were independent prognostic factors of survival. The number of examined LNs was positively correlated with survival time(P<0.05)in patients with same tumor invasion depth but not correlated with T1 stage or examined LNs>30. Besides, it was not correlated with operation time, transfusion volume, length of postoperative stay, or postoperative complication incidence(P>0.05).Conclusions.The number of examined lymph nodes is an independent prognostic factor of survival for patients with lymph node-negative gastric cancer. Sufficient dissection of lymph nodes is recommended during surgery for such population.

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Clinical Value of Energy Spectrum Curves of Dual-energy CT in Evaluating Pathological Grading of Gastric Adenocarcinoma

10.21203/rs.2.12786/v1 ◽

2019 ◽

Author(s):

Zhihua Lu ◽

Suying Wu ◽

Jianwei Chen ◽

Chuan Yan ◽

Yueming Li

Keyword(s):

Gastric Cancer ◽

Energy Spectrum ◽

Gastric Adenocarcinoma ◽

Dual Energy ◽

Dual Energy Ct ◽

Clinical Value ◽

Pathological Differentiation ◽

Dual Source ◽

Venous Phase ◽

Poorly Differentiated

Abstract Backgroud: Accurate diagnosis of cancer staging and pathological differentiation are critical for the formulation of individualized treatment and prognosis of gastric cancer. It is vital to explore non-invasive preoperative imaging techniques to evaluate the pathological differentiation degree of gastric cancer tissues, and provide better diagnostic basis and decision-making reference for treatment. The purpose of this study was to explore the clinical value of energy spectrum curves of dual-source dual-energy CT in the quantitative evaluation of different pathological grades of gastric adenocarcinoma. Methods: A total of 62 patients with 1 well, 25 moderately and 36 poorly differentiated gastric adenocarcinomas pathologically confirmed by surgery were collected, and they underwent dual-source dual-energy CT plain scanning and enhanced scanning before operation. Dual-Energy software was used to measure the slope of the energy spectrum curves (λ) in arterial and venous phases after image reconstruction. Patients were divided into two groups according to the pathological results, including well and moderately differentiated gastric adenocarcinoma group and poorly differentiated gastric adenocarcinoma group. Data of each group were analyzed by independent sample t-test. The receiver operating characteristic curve was plotted to evaluate the diagnostic efficiency of the corresponding parameters. Results: There were significant differences in λ values of 40-50keV, 40-60keV, 40-80keV, 40-90keV, 40-100keV, 40-120keV, 40-130keV, 40-140keV and 40-150keV energy ranges in venous phase between the well and moderately differentiated group and poorly differentiated group (P<0.05), but no significant differences in λ values of different energy ranges in arterial phase between the two groups (P>0.05). And the area under curve in 40-120keV energy range was the largest in venous phase. K40-120keV =2.69 was selected as the diagnostic threshold with the maximum Youden index, the sensitivity and specificity were 61.1% and 76%, respectively. Conclusion: The energy spectrum curve of dual-energy CT had certain diagnostic value in the quantitative evaluation of pathological grading of gastric adenocarcinoma.

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