ASO Author Reflections: Lymph Node Staging of Patients with Remnant Gastric Cancer

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.

Download Full-text

The Effect of the Change in Lymph Flow Following Gastrectomy for Initial Disease on the Prognosis of Remnant Gastric Cancer

10.21203/rs.3.rs-941649/v1 ◽

2021 ◽

Author(s):

Yoshihiko Kakiuchi ◽

Satoru Kikuchi ◽

Shinji Kuroda ◽

Masahiko Nishizaki ◽

Shunsuke Kagawa ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Poor Prognosis ◽

Malignant Disease ◽

Univariate Analysis ◽

Lymph Flow ◽

University Hospital ◽

Gastric Disease ◽

Remnant Gastric Cancer ◽

Initial Surgery

Abstract Background: Remnant gastric cancer (RGC) has been increasing for various reasons such as longer life span, medical progress, and others. It generally has a poor prognosis, and its mechanism of occurrence is unknown. The purpose of this study was to evaluate the clinicopathological features of and clarify the prognostic factors of RGC.Methods: Between January 2002 and January 2017, 39 patients with RGC following distal gastrectomy underwent curative surgical resection at the Okayama University Hospital; their medical records and immunohistochemically stained extracted specimens were used for retrospective analysis. Results: On univariate analysis, initial gastric disease, pathological lymph node metastasis, and pathological stage were the significant factors associated with a poor overall survival (OS) (p=0.0139, 0.0061, and 0.0158, respectively). Multivariate analysis of these 3 factors showed that only initial gastric disease caused by malignant disease was an independent factor associated with a poor prognosis (p=0.0141, odds ratio [OR]:4.151, 95% confidence interval [CI]:1.333-12.93). In addition, the presence of a left gastric artery (LGA), and tumor-infiltrating CD8+ T cell expression were higher in the benign disease group than in the malignant group (p<0.0001 and p=0.0485, respectively).Conclusion: The lymph flow change caused by lymph node dissection for malignant disease in initial surgery might have an effect on the suppression of tumor immunity and the poor prognosis of RGC.

Download Full-text

Comparison of the 8th union for international cancer control lymph node staging system for gastric cancer with two other lymph node staging systems

Oncology Letters ◽

10.3892/ol.2018.9694 ◽

2018 ◽

Author(s):

Huihua Cao ◽

Zhaoqing Tang ◽

Zhan Yu ◽

Qing Wang ◽

Zhong Li ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Cancer Control ◽

Staging System ◽

Lymph Node Staging ◽

Staging Systems

Download Full-text

Proposal of a new lymph node staging system for gastric cancer: study from two institutions in China

Medical Oncology ◽

10.1007/s12032-014-0229-8 ◽

2014 ◽

Vol 31 (10) ◽

Cited By ~ 2

Author(s):

Jizhun Zhang ◽

Kewei Jiang ◽

Yong Liu ◽

Yingjiang Ye ◽

Liang Lv ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Staging System ◽

Lymph Node Staging ◽

Cancer Study ◽

Gastric Cancer Study

Download Full-text

Validation study of sentinel lymph node mapping using radio- and dye-guided methods in gastric cancer: 431 cases at a single institution.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.76 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 76-76

Author(s):

M. Niihara ◽

H. Takeuchi ◽

S. Kamiya ◽

T. Kaburagi ◽

T. Oyama ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Early Gastric Cancer ◽

Lymph Nodes ◽

False Negative ◽

Tumor Diameter ◽

Remnant Gastric Cancer ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph

76 Background: Some papers have reported that sentinel lymph node (SLN) concept can be applied in patients with early gastric cancer, in particular clinically T1N0M0 or T2N0M0 with a tumor diameter of 4cm or less. Little is, however, available on the SLN study with the other criteria than listed above. The aim of the present work was to investigate the accuracy of the SLN biopsy of gastric cancer with various stages and evaluate the indication for SLN navigated gastrectomy. Methods: A total of 431 consecutive patients were diagnosed with operable gastric cancer during the period April 1999 through December 2007. Reasons for inclusion were, in principle, T1N0M0 or T2N0M0 gastric cancer. However, several patients diagnosed preoperatively with T3N0M0, T2N1M0, remnant gastric cancer, multiple gastric cancers and additional treatment after endoscopic therapy were also enrolled in this study according to their request. All patients underwent a radical gastrectomy with SLN mapping with an informed consent. The SLNs were identified using both radio-guided and dye-guided method. Results: Detection rate of hot and/or blue node was 95.8% (413/431). The accuracy of metastatic status based on SLN was 97.6% (403/413). In six of 10 false-negative cases, some clinical backgrounds and problems were present; scirrhous gastric cancer, the tumor penetration of serosa, multiple lesions, remnant gastric cancer after partial resection and the technical issue of tracer injection. Nine of these 10 false-negative cases had the metastatic lymph nodes within only the sentinel basins. Specifically, in the group of clinically T1N0M0 untreated gastric cancer with a tumor diameter of 4 cm or less, there were only 3 false- negative cases. In addition, all the metastatic lymph nodes of the 3 cases located within the sentinel basins. Conclusions: Our study suggested that SLN concept for untreated early gastric cancer could be validated. The sentinel basin dissection might be used to advantage to improve curativity for gastric cancer. No significant financial relationships to disclose.

Download Full-text

Comparison of lymph node staging system in gastric cancer using time-dependent ROC analysis with Harrell’s concordance index.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.12 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 12-12

Author(s):

Etsuro Bando ◽

Norihiko Sugisawa ◽

Masanori Tokunaga ◽

Yutaka Tanizawa ◽

Taiichi Kawamura ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Survival Rate ◽

Roc Analysis ◽

Staging System ◽

Time Dependent ◽

Lymph Node Staging ◽

Anatomical Location ◽

Node Negative ◽

Staging Systems

12 Background: The aim this study was to clarify what the most informative pathologic lymph node staging system in gastric cancer is, by using time-dependent receiver operating characteristic (ROC) analysis with Harrell’s concordance (c) index. Methods: This study enrolled 2747 primary gastric cancer patients, without prior chemotherapy, who underwent R0 or R1 macroscopically curative resection. We calculated concordance indices of different 3 nodal staging systems (anatomical level based on JPN 13th edition vs. numbers of metastatic nodes based upon TNM 7th edition vs. ratio of metastatic nodes; derived from Yu’s definition {Yu et al. Br J Surg;1997,N0:0, N1;0-0.1, N2;0.1-0.25, N3;0.25-}) for survival. Results: (Anatomical level) Harrell’s c-index was 0.754 with 5-year survival rate of N0; 93%, N1; 73%, N2; 51%, N3; 19%. C-index without node-negative patients was 0.628. (Numbers of positive nodes) C-index was 0.767 with 5-year survival rate of N0; 93%, N1; 81%, N2; 68%, N3; 37%. C-index without node-negative patients was 0.669. (Ratio of nodal involvement) C-index was 0.770 with 5-year survival rate of N0; 93%, N1; 80%, N2; 63%, N3; 29%. C-index without node-negative patients was 0.691, which is significantly larger than those in anatomical level or numbers of positive nodes (p<0.001, p=0.014, respectively). (Comparison of Staging System) If combined pT category with ratio grading system without pStage IA, new staging system is the significantly most informative (c-index; 0.760) than JPN 13th (c-index; 0.735) or TNM 7th (c-index; 0.742) (p=0.009, p=0.023, respectively). Conclusions: Lymph node staging system based on the conception of ratio of metastatic nodes is the most informative staging system than those with anatomical location or numbers of metastatic nodes. These results suggested that in gastric cancer pathologic staging system in next TNM classification should include the ratio of metastatic nodes.

Download Full-text

A novel simplified approach to incorporating lymph node ratio into gastric cancer staging.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.24 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 24-24

Author(s):

Sarah B. Fisher ◽

Malcolm Hart Squires ◽

Sameer H. Patel ◽

David A. Kooby ◽

Kenneth Cardona ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Ratio ◽

Staging System ◽

Cancer Staging ◽

Lymph Node Staging ◽

Cox Regression Analysis ◽

Simplified Approach ◽

Staging Systems ◽

Node Ratio

24 Background: Previous investigators have reported on the value of lymph node ratio (LNR, defined as the number of positive nodes divided by the total number of nodes assessed) in gastric adenocarcinoma (GAC) staging. Given the complexity of previously proposed staging systems, it has not gained widespread acceptance. The aim of our study was to offer a novel simplified approach to incorporating LNR into gastric cancer staging. Methods: 131 patients who underwent curative intent resection with lymphadenectomy for GAC between 1/00-6/11 were identified. Clinicopathologic factors were assessed. Primary outcome was overall survival (OS). Results: Median age was 64 yrs, 51% were male. Median tumor size was 3.5 cm, 67% were poorly differentiated, 20% had perineural invasion, 31% had lymphovascular invasion, and 6% had a positive margin. Locoregional nodal metastases were present in 59% (n=77, N0: 41%, N1: 18%, N2: 22%, N3a: 14%, N3b: 5%). Median number of lymph nodes (LN) assessed was 15.5. Mean FU was 27.3 mos, median OS was 29.3 mos. Median LNR was 0.4 (.04-1). Patients with LNR ≥0.4 had decreased OS as compared to patients with LNR <0.4 (15.1 vs 41.5 mos, p<0.0001); the survival of patients with LNR <0.4 was similar to that of node negative pts (48 mos, p=0.882). On Cox regression analysis, LNR ≥0.4 was more strongly associated with decreased OS (HR 3.09, 95%CI: 1.81-5.26; p<0.0001) compared to the AJCC 7th edition N stage (HR 1.36, 95%CI: 1.11-1.68; p=0.004). In the subset of patients who were inadequately staged and had <16 nodes examined, a LNR ≥0.4 was associated with reduced survival compared to a LNR <0.4 (17.3 vs 41.5 mos, p=.04). Conclusions: Compared to the current lymph node staging system, a lymph node ratio using 0.4 as the cutoff may more accurately predict survival outcomes. It seems to be particularly useful in patients who have inadequate nodal assessment. This simplified approach to lymph node ratio may be a more valuable staging tool than the current AJCC nodal staging system for gastric cancer and needs to be validated.

Download Full-text