scholarly journals Prognosis of Stage IIB early gastric cancer has a unique and dismal property putatively requiring post operative adjuvant chemothrapy

2017 ◽  
Author(s):  
Hideki Ushiku ◽  
Keishi Yamashita ◽  
Akira Ema ◽  
Natsuya Katada ◽  
Kei Hosoda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cancer Prognosis ◽  
Node Metastasis ◽  
Dismal Prognosis

Abstract Background Pathological T1 (pT1) gastric cancer showed excellent prognosis, however lymph node metastasis sometimes reflects patients with dismal prognosis. In this study, we investigated prognosis of pT1 gastric cancer with lymph node metastasis to identify prognostic factors. Patients and Methods Among 1,442 gastric cancer patients between 2002 and 2010, 73 (5%) of pT1 with lymph node metastasis were identified. Univariate prognostic factors were applied to multivariate Cox proportional hazards model. Results (1) Among the 1,442 patients, pT1 was composed of 333 patients with pT1a and 423 patients with pT1b, which included 9 (2.7%) and 64 cases (15.1%) with lymph node metastasis, respectively. (2) Ten (13.7%) patients of the 73 patients with lymph node metastasis showed tumor relapse.　　Univariate negative prognostic factors were tumor size (p=0.03), intraoperative bleeding (p=0.03), and perioperative transfusion (POT)(p=0.001), as well as 14th JGCA Stage (p<0.0001), and multivariate analysis identified 14th JGCA Stage (p=0.0004) and POT (p=0.03) as independent prognostic factors. (3) pT1 gastric cancer representing pN3 (Stage IIB) was rare (n=4) and unique entity from a prognostic point of view, exhibiting dismal prognosis (0% at 5 years). We thereafter identified 17 such cases from 5,204 gastric cancer including the earliest cases. Prognosis of such 17 patients was very unique, in that recurrences occurred even 5 years after curative operation, and the frequent recurrent sites were bone. Conclusion pT1 gastric cancer prognosis is robustly affected by pN3 and POT, and Stage IIB disease showed unique prognosis requiring special attention even after 5 years of operation.

scholarly journals Moving beyond the Cox proportional hazards model in survival data analysis: a cervical cancer study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e033965
Author(s):  
Lixian Li ◽  
Zijing Yang ◽  
Yawen Hou ◽  
Zheng Chen
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Figo Stage ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Time Varying ◽  
Node Metastasis ◽  
Hazards Model

ObjectivesThis study explored the prognostic factors and developed a prediction model for Chinese-American (CA) cervical cancer (CC) patients. We compared two alternative models (the restricted mean survival time (RMST) model and the proportional baselines landmark supermodel (PBLS model, producing dynamic prediction)) versus the Cox proportional hazards model in the context of time-varying effects.Setting and data sourcesA total of 713 CA women with CC and available covariates (age at diagnosis, International Federation of Gynecology and Obstetrics (FIGO) stage, lymph node metastasis and radiation) from the Surveillance, Epidemiology and End Results database were included.DesignWe applied the Cox proportional hazards model to analyse the all-cause mortality with the proportional hazards assumption. Additionally, we applied two alternative models to analyse covariates with time-varying effects. The performances of the models were compared using the C-index for discrimination and the shrinkage slope for calibration.ResultsOlder patients had a worse survival rate than younger patients. Advanced FIGO stage patients showed a relatively poor survival rate and low life expectancy. Lymph node metastasis was an unfavourable prognostic factor in our models. Age at diagnosis, FIGO stage and lymph node metastasis represented time-varying effects from the PBLS model. Additionally, radiation showed no impact on survival in any model. Dynamic prediction presented a better performance for 5-year dynamic death rates than did the Cox proportional hazards model.ConclusionsWith the time-varying effects, the RMST model was suggested to explore diagnosis factors, and the PBLS model was recommended to predict a patient’s w-year dynamic death rate.

scholarly journals Significance of the dissection of common hepatic arterial lymph nodes in patients with oesophageal carcinoma: a multicentre retrospective study

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e050280
Author(s):  
Huang-He He ◽  
Zhexue Hao ◽  
Zhuoyi Li ◽  
Fei Cheng ◽  
Junhui Fu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Node Dissection ◽  
Node Metastasis ◽  
Enhanced Ct ◽  
Coeliac Trunk

ObjectivesTo explore the significance of intraoperative common hepatic arterial lymph node dissection in patients with ooesophageal squamous carcinoma (ESCC) without coeliac trunk lymph node metastasis indicated by abdominal enhanced CT.MethodsPatients aged 18–75 years who underwent oesophagectomy in three medical centres from June 2012 to June 2015, for whom R0 resection was completed and lymph node metastasis in the abdominal trunk was not identified before the operation were retrospectively analysed. The effects of the application value of common hepatic arterial lymph node dissection on survival were evaluated in patients with ESCC without coeliac trunk lymph node metastasis indicated by preoperative CT. According to the eighth version ofAmerican Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging, we selected patients with a Pathological Tumor Node Metastasis (pTNM) stage ranging from IA to IVA for analysis.ResultsAmong the 816 qualified patients, 577 did not have coeliac trunk lymph node metastasis based on preoperative abdominal enhanced CT, and common hepatic arterial lymph node dissection was performed during the operation (observation group). Two hundred and thirty-nine preoperative CT examinations indicated no coeliac trunk lymph node metastasis, and common hepatic arterial lymph node dissection was not performed during the operation (control group). A multifactor Cox proportional hazards model showed no risk factors for overall survival (OS) (adjusted HR (HRadj)=0.91; p=0.404) or disease-free survival (DFS) (HRadj=0.86; p=0.179), regardless of whether common hepatic arterial lymph node dissection was performed. For patients with positive left gastric arterial lymph node metastasis, a multifactor Cox proportional hazards model indicated that common hepatic arterial lymph node dissection was a risk factor for OS (HRadj=0.63; p=0.035) and DFS (HRadj=0.58; p=0.026).ConclusionsFor patients with ESCC without celiac trunk metastasis indicated by abdominal enhanced CT, common hepatic arterial lymph node dissection conferred no survival benefits. However, for patients with left gastric arterial lymph node metastasis, common hepatic arterial lymph node dissection was beneficial.

scholarly journals Cir-ITCH inhibits gastric cancer migration, invasion and proliferation by regulating the Wnt/β-catenin pathway

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yang Peng ◽  
Hong Hong Wang
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Prognosis ◽  
Luciferase Reporter ◽  
Circular Rnas ◽  
Node Metastasis ◽  
Cancer Tissues

Abstract Circular RNAs (circRNAs) are differentially expressed in various tumours, but the expression and regulatory mechanisms of circular RNA ITCH (cir-ITCH) in gastric cancer remain unclear. For this reason, in the present study, we assessed the expression of cir-ITCH and the associated regulatory mechanism of cir-ITCH in gastric cancer. Through RTq-PCR assays, we observed that cir-ITCH expression was attenuated in gastric cancer cell lines and tissues, with cir-ITCH expression in gastric cancer tissues with lymph node metastasis being considerably lower than that observed in gastric cancer tissues without lymph node metastasis. In addition, we demonstrated that cir-ITCH or linear ITCH may be a useful marker for gastric cancer prognosis by Kaplan–Meier survival analysis. We also showed that cir-ITCH overexpression could increase linear ITCH expression through miR-17 via RNA immunoprecipitation (RIP) and luciferase reporter assays. Moreover, in vivo and in vitro experimental results showed that cir-ITCH can act as a tumour suppressor to prevent gastric cancer tumourgenesis by sponging miR-17. The Wnt/β-catenin pathway plays a crucial role during the carcinogenesis of cancers, and we observed that cir-ITCH could negatively regulate Wnt/β-catenin signalling, which could be restored by miR-17. In summary, cir-ITCH was shown to prevent gastric cancer tumourgenesis through the Wnt/β-catenin signalling pathway by sequestering miR-17.

The survival outcome after hepatic resection in patients with liver metastasis from gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 161-161
Author(s):  
Taichi Tatsubayashi ◽  
Yuichiro Miki ◽  
Wataru Takagi ◽  
Fumiko Hirata ◽  
Hayato Omori ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Survival Rate ◽  
Liver Metastasis ◽  
Lymph Node Metastasis ◽  
Hepatic Resection ◽  
Treatment Strategy ◽  
Survival Outcome ◽  
Node Metastasis

161 Background: Optimal treatment strategy for patients with liver metastasis from gastric cancer (LMGC) has not yet been established. Although systemic chemotherapy remains mainstay of treatment for LMGC, complete resection of primary tumor and LMGC may improve survival outcome. Thus, the aim of this study is to investigate survival outcome and prognostic factors of patients who underwent hepatic resection for LMGC. Methods: From September 2002 to February 2014, 30 patients underwent hepatic resection for LMGC in our hospital. Indications of hepatic resection were as follows; (1) hepatic lesion is not more than three, (2) without extrahepatic metastasis other than lymph node metastasis, (3) adequate liver function. We investigated the overall median survival time (MST) and 5-year survival rate of all eligible patients. Univariate and multivariate analyses were performed to assess the association between each clinicopathological features and overall survival time. Results: There were 25 males and 5 females with a median age of 72 (range, 39-86). There were 16 synchronous LMGCs and 14 metachronous LMGCs. With respect to the number of LMGC, 22 patients had 1 lesion, 7 patients had 2 lesions, and 1 patient had 3 lesions. Overall MST and 5 year survival rates after hepatic resection were 2.8 years and 31.0%, respectively. The significant prognostic factors were age (70 years or older, p=0.029) and blood transfusion (p=0.013). Multivariate analysis showed that lymph node metastasis was an only independent indicator of poor prognosis (HR=6.13, p=0.026). Conclusions: Hepatic resection for patients with LMGC might be a promising treatment strategy, with 5-year survival rate of 31.0%. Lymph node metastasis was an only independent prognostic factor. A multi-institutional confirmatory study will be required to evaluate the role of hepatic resection in patients with LMGC.

scholarly journals The Predictive and Prognostic Factors in Patients with Gastric Cancer Accompanied by Gastric Outlet Obstruction

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Hongliang Zu ◽  
Huiling Wang ◽  
Chunfeng Li ◽  
Wendian Zhu ◽  
Yingwei Xue
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Outlet Obstruction ◽  
Clinicopathological Features ◽  
Depth Of Invasion ◽  
Node Metastasis ◽  
Distal Gastric Cancer

Purpose. This study is aimed at evaluating the clinicopathological features and prognostic significance of gastric outlet obstruction (GOO) in patients with distal gastric cancer. Methods. A retrospective review of 1564 individuals with distal gastric cancer from 2002 to 2010 was performed. In total, 157 patients had GOO. The clinicopathological features of the patients with GOO were compared with those of the patients without GOO. A Kaplan-Meier survival analysis and Cox proportional hazard model were used to assess the overall survival. Results. The patients with distal gastric cancer with GOO generally presented more aggressive pathologic features, a poorer nutritional status, more duodenal infiltration, and peritoneal dissemination than those with cancer without GOO. In the univariate analysis, curability, GOO, age, prealbumin, albumin, hemoglobin (Hb), the tumor size, the macroscopic type, lymph node metastasis, and the depth of invasion had a statistically significant influence on prognosis. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. Conclusions. Gastric cancer with GOO exhibits aggressive biological features and has poor outcomes. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. The gastric outlet status should be considered in the selection of surgical treatment methods for patients with gastric cancer.

Surgical outcomes and survival for T4 gastric cancer extending to the transverse colon

2020 ◽  
Author(s):  
Gang-Cheng Wang ◽  
Chong-Qing Gao ◽  
You-cai Wang ◽  
Hui-Fang Lv ◽  
Bei-Bei Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Surgical Outcomes ◽  
Transverse Colon ◽  
Curative Resection ◽  
Node Metastasis ◽  
T4 Gastric Cancer

Abstract Purpose Extended multi-organ resection for locally advanced (T4) gastric cancer remains controversial. Herein we aimed to evaluate the surgical outcomes and survival of patients with T4 gastric cancer extending to the transverse colon. Materials and Methods Between 2011 and 2015, forty patients had undergone curative resection for T4 gastric cancer extending to the transverse colon. Patient characteristics, related complications, long-term survival, and prognostic factors for T4 gastric cancer were analyzed. Results ost-operative morbidity occurred in 5 (12.5%) patients. The 1-, 3-, and 5-year overall survival rates were 75.0%, 49.2%, and 36.9%, respectively. Univariate analysis revealed that tumor size ( P =0.049), advanced T stage ( P =0.013), and lymph node metastasis ( P =0.006) are poor prognostic factors of overall survival. Based on multivariate analysis, advanced T stage and lymph node metastasis were identified as independent prognosis factors. Conclusions Patients with T4 gastric cancer extending to the transverse colon might benefit from curative resection with acceptable morbidity and mortality.

scholarly journals Lymph node metastasis-derived gastric cancer cells educate bone marrow-derived mesenchymal stem cells via YAP signaling activation by exosomal Wnt5a

Oncogene ◽  
2021 ◽  
Vol 40 (12) ◽  
pp. 2296-2308
Author(s):  
Mei Wang ◽  
Xinxin Zhao ◽  
Rong Qiu ◽  
Zheng Gong ◽  
Feng Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Stem Cells ◽  
Bone Marrow ◽  
Mesenchymal Stem Cells ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Metastatic Gastric Cancer ◽  
Gastric Cancer Cells ◽  
Node Metastasis ◽  
Signaling Activation

AbstractLymph node metastasis (LNM), a common metastatic gastric-cancer (GC) route, is closely related to poor prognosis in GC patients. Bone marrow-derived mesenchymal stem cells (BM-MSCs) preferentially engraft at metastatic lesions. Whether BM-MSCs are specifically reprogrammed by LNM-derived GC cells (LNM-GCs) and incorporated into metastatic LN microenvironment to prompt GC malignant progression remains unknown. Herein, we found that LNM-GCs specifically educated BM-MSCs via secretory exosomes. Exosomal Wnt5a was identified as key protein mediating LNM-GCs education of BM-MSCs, which was verified by analysis of serum exosomes collected from GC patients with LNM. Wnt5a-enriched exosomes induced YAP dephosphorylation in BM-MSCs, whereas Wnt5a-deficient exosomes exerted the opposite effect. Inhibition of YAP signaling by verteporfin blocked LNM-GC exosome- and serum exosome-mediated reprogramming in BM-MSCs. Analysis of MSC-like cells obtained from metastatic LN tissues of GC patients (GLN-MSCs) confirmed that BM-MSCs incorporated into metastatic LN microenvironment, and that YAP activation participated in maintaining their tumor-promoting phenotype and function. Collectively, our results show that LNM-GCs specifically educated BM-MSCs via exosomal Wnt5a-elicited activation of YAP signaling. This study provides new insights into the mechanisms of LNM in GC and BM-MSC reprogramming, and will provide potential therapeutic targets and detection indicators for GC patients with LNM.

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