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Tong YX, Ye X, Chen YQ, You YR, Zhang HJ, Chen SX, Wang LL, Xue YJ, Chen LH. A nomogram model of spectral CT quantitative parameters and clinical characteristics predicting lymphovascular invasion of gastric cancer. Heliyon 2024; 10:e29214. [PMID: 38601586 PMCID: PMC11004867 DOI: 10.1016/j.heliyon.2024.e29214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
Objective The study established a nomogram based on quantitative parameters of spectral computed tomography (CT) and clinical characteristics, aiming to evaluate its predictive value for preoperative lymphovascular invasion (LVI) in gastric cancer (GC). Methods From December 2019 to December 2021, 171 patients with pathologically confirmed GC were retrospectively collected with corresponding clinical data and spectral CT quantitative data. Patients were divided into LVI-positive and LVI-negative groups based on their pathological results. The univariate and multivariate logistic regression analyses were used to identify the risk factors and construct a nomogram. The calibration curve and receiver operating characteristic (ROC) curve were adopted to evaluate the predictive accuracy of nomogram. Results Four clinical characteristics or spectral CT quantitative parameters, including Borrmann classification (P = 0.039), CA724 (P = 0.007), tumor thickness (P = 0.031), and iodine concentration in the venous phase (VIC) (P = 0.004) were identified as independent factors for LVI in GC patients. The nomogram was established based on the four factors, which had a potent predictive accuracy in the training, internal validation and external validation cohorts, with the area under the ROC curve (AUC) of 0.864 (95% CI, 0.798-0.930), 0.964 (95% CI, 0.903-1.000) and 0.877 (95% CI, 0.759-0.996), respectively. Conclusion This study constructed a comprehensive nomogram consisting spectral CT quantitative parameters and clinical characteristics of GC, which exhibited a robust efficiency in predicting LVI in GC patients.
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Affiliation(s)
- Yong-Xiu Tong
- Department of Radiology, Provincial Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Xiao Ye
- Department of Radiology, Fujian Provincial Geriatric Hospital, Fuzhou, 350001, China
| | - Yong-Qin Chen
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Ya-ru You
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Hui-Juan Zhang
- Department of Radiology, Provincial Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Shu-Xiang Chen
- Department of Radiology, Provincial Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Li-Li Wang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, 350001, China
| | - Yun-Jing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, 350001, China
| | - Li-Hong Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, 350001, China
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Maheshwari U, Sharma M, Goel V, Goyal P, Jain P, Agarwal C, Jajodia A, Talwar V, BP A, Joga S, Doval DC, Pasricha S, Koyyala VPB. Clinical Profile and Outcomes of Treatment in Gastric Cancer in Young Patients in India. ASIAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.1055/s-0042-1744451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction Gastric cancer poses an enormous burden across the globe and India in terms of cancer-related mortality. There is paucity of epidemiological and survival data among young gastric cancer patients in India. In this study, we retrospectively analyzed the general characteristics, clinical profile, and survival data of gastric cancer in young patients < 30 years at tertiary care institution at New Delhi, India.
Materials and Methods Young gastric cancer patients (≤30 years) who were registered over a period of 7 years (2010–2017) were analyzed at a tertiary care center. Total of 2,735 patients of gastric cancers were registered out of which 70 cases were younger than 30 years, of which 63 patients were available for final analysis and data was missing for the remaining 7 cases. All patients underwent standard diagnostic and staging investigation and were staged as per American Joint Committee on Cancer 7 staging system. Lymph node ratio was calculated as number of positive nodes by the number of lymph nodes removed and were categorized as ≤0.6 and >0.6. Minimum follow-up of 1 year was required for inclusion in the study. Twelve patients were lost to follow-up and were not included for survival analysis.
Results Younger patients (≤30 years) with gastric cancer were 2.5% of total gastric cancer patients. Mean age was 24.9 years with males being involved twice as commonly as females (2.15:1). Positive family history was present in 14.2% patients and smoking was present in 57.1% patients. Metastatic disease at presentation was present in 69.8% patients, while only 6.4% patients presented with stage I/II disease. Fourteen patients underwent surgery, out of which six patients underwent partial gastrectomy and remaining eight underwent total gastrectomy with D2 nodal dissection. Median overall survival was 10.8 months (8.8–12.8) and 2-year overall survival was 15.1%.
Conclusion Incidence of stomach cancer in young patients is more than expected and more than global average in India. Most of these young patients are presenting in advanced stage and survival is poor compared with typical aged patients
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Affiliation(s)
| | - Manish Sharma
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Varun Goel
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Pankaj Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Parveen Jain
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Chaturbhuj Agarwal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Ankush Jajodia
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Vineet Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Amrit BP
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Srujana Joga
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, India
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Watson MD, Trufan S, Benbow JH, Gower NL, Hill JS, Salo JC. Effect of Surgical Approach on Node Harvest in Gastrectomy: Analysis of the National Cancer Database. World J Surg 2021; 44:3061-3069. [PMID: 32474624 DOI: 10.1007/s00268-020-05590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gastrectomy is the cornerstone of treatment for gastric cancer. Recent studies demonstrated significant surgical outcome advantages for patients undergoing minimally invasive versus open gastrectomy. Lymph node harvest is an indicator of adequate surgical resection, and greater harvest is associated with improved staging and patient outcomes. This study evaluated lymph node harvest based on surgical approach. METHODS Gastric adenocarcinoma patients were identified from NCDB who underwent gastrectomy between 2010 and 2016. Patients were classified by surgical approach into three cohorts: robotic, laparoscopic, or open gastrectomy. Clinical and demographic data were collected. Lymph node harvest was compared with univariate analysis and multivariable generalized linear mixed model. Univariate analysis with propensity matching was also performed to control for differences in patient population across cohorts. RESULTS We identified 10,690 patients that underwent gastrectomy for gastric adenocarcinoma, with 68% males and median age of 66 (IQR 5774) years. 7161 (67%) underwent open, 2841 (26.6%) laparoscopic, and 688 (6.4%) robotic gastrectomy. Multivariable analysis revealed robotic was associated with a significantly higher median node harvest (18, IQR 1326) compared to laparoscopic (17, IQR 1125) and open gastrectomy (16, IQR 1023). Laparoscopic was also associated with significantly higher node harvest then open gastrectomy. Propensity-matched analysis (6950 patients) showed robotic gastrectomy was still associated with significantly higher node harvest (18, IQR 1226) compared to laparoscopic (17, IQR 1125) and open (17, IQR 1124); however, laparoscopic and open were not significantly different. CONCLUSION Robotic approach is associated with increased node harvest compared to laparoscopic and open approach in gastrectomy patients.
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Affiliation(s)
- Michael D Watson
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Sally Trufan
- Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Jennifer H Benbow
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Nicole L Gower
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Joshua S Hill
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Jonathan C Salo
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
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Wang H, Qi H, Liu X, Gao Z, Hidasa I, Aikebaier A, Li K. Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection. Sci Rep 2021; 11:2022. [PMID: 33479327 PMCID: PMC7820341 DOI: 10.1038/s41598-021-81663-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/18/2020] [Indexed: 12/28/2022] Open
Abstract
The 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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Affiliation(s)
- Honghu Wang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Hao Qi
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Xiaofang Liu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Ziming Gao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Iko Hidasa
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Ailixier Aikebaier
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Kai Li
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China.
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Huang Z, Chen Y, Zhang W, Liu H, Wang Z, Zhang Y. Modified Gastric Cancer AJCC Staging with a Classification Based on the Ratio of Regional Lymph Node Involvement: A Population-Based Cohort Study. Ann Surg Oncol 2020; 27:1480-1487. [DOI: 10.1245/s10434-019-08098-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Indexed: 08/30/2023]
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Bilici A, Selcukbiricik F, Seker M, Oven BB, Olmez OF, Yildiz O, Olmuscelik O, Hamdard J, Acikgoz O, Cakir A, Kapran Y, Balik E, Oncel M. Prognostic Significance of Metastatic Lymph Node Ratio in Patients with pN3 Gastric Cancer Who Underwent Curative Gastrectomy. Oncol Res Treat 2019; 42:209-216. [PMID: 30870846 DOI: 10.1159/000496746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lymph node involvement is an important prognostic factor in patients with gastric cancer. The aim of this study was to determine the prognostic significance of metastatic lymph node ratio (MLNR) and compare it to the number of lymph node metastasis in pN3 gastric cancer. METHODS We retrospectively analyzed 207 patients with pN3 gastric cancer who had undergone radical gastrectomy. Prognostic factors and MLNR were evaluated by univariate and multivariate analysis. RESULTS An MLNR of 0.75 was found to be the best cut-off value to determine the prognosis of patients with pN3 gastric cancer (p = 0.001). The MLNR was significantly higher in patients with large-sized and undifferentiated tumors, vascular, lymphatic and perineural invasion, and total gastrectomy. In multivariate analysis, MLNR (p = 0.041), tumor differentiation (p = 0.046), and vascular invasion (p = 0.012) were found to be independent prognostic factors for disease-free survival, while both MLNR (p < 0.001) and pN stage (p = 0.002) were independent prognostic indicators, as was tumor size, for overall survival. There was significant difference with respect to the recurrence patterns between MLNR groups. Lymph node and peritoneal recurrences were significantly higher in patients with MLNR > 0.75 compared to the MLNR < 0.75 group (p < 0.05). However, recurrence patterns were similar between pN3a and pN3b. CONCLUSION Our results showed that MLNR was a useful indicator to determine the prognosis and recurrence patterns of patients with radically resected gastric cancer. Moreover, MLNR is a beneficial and reliable technique for evaluating lymph node metastasis.
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Affiliation(s)
- Ahmet Bilici
- Medipol University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey,
| | - Fatih Selcukbiricik
- Koc University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Mesut Seker
- Bezmialem Vakif University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Basak B Oven
- Bahcesehir University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Omer Fatih Olmez
- Medipol University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Ozcan Yildiz
- Medipol University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Oktay Olmuscelik
- Medipol University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Jamshid Hamdard
- Medipol University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Ozgur Acikgoz
- Medipol University, Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Asli Cakir
- Medipol University, Medical Faculty, Department of Pathology, Istanbul, Turkey
| | - Yersu Kapran
- Koc University, Medical Faculty, Department of Pathology, Istanbul, Turkey
| | - Emre Balik
- Koc University, Medical Faculty, Department of Surgical Oncology, Istanbul, Turkey
| | - Mustafa Oncel
- Medipol University, Medical Faculty, Department of Surgical Oncology, Istanbul, Turkey
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Ishii S, Yamashita K, Harada H, Ushiku H, Tanaka T, Nishizawa N, Yokoi K, Washio M, Ema A, Mieno H, Moriya H, Hosoda K, Waraya M, Katoh H, Watanabe M. The H19-PEG10/IGF2BP3 axis promotes gastric cancer progression in patients with high lymph node ratios. Oncotarget 2017; 8:74567-74581. [PMID: 29088808 PMCID: PMC5650363 DOI: 10.18632/oncotarget.20209] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022] Open
Abstract
We previously demonstrated that the lymph node ratio (LNR) is a prognostic factor associated with EGFR expression, among first priority genes amplified or overexpressed in cancer. Here, we investigated the associations between high LNR and second, third, and fourth priority genes. We performed mRNA expression microarray analysis of tumor tissue from patients with stage III gastric cancer and high or low LNRs. Candidate high LNR-associated genes were further evaluated in 39 patients with stage III gastric cancer. The functional relevance of these genes was evaluated in gastric cancer cell lines. We focused on five genes: H19,PEG10, IGF2BP3, CD177, and PGA3. H19 and PEG10 were confirmed as high LNR-associated genes. H19, PEG10, and IGF2BP3 were found to promote each other’s expression. Knocking down H19 or PEG10 using RNAi decreased cell proliferation, invasion, anchorage-independent growth, and chemoresistance. These genes had a mutual relationship in MKN7 cells. H19 knockdown decreased expression of epithelial-mesenchymal transition-associated genes in MKN74 cells to suppress transformation. Thus, H19 promotes epithelial-mesenchymal transition in gastric cancer and is a potential therapeutic target.
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Affiliation(s)
- Satoru Ishii
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keishi Yamashita
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroki Harada
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hideki Ushiku
- Department of Surgery, Kitasato University Medical Center, Saitama, Japan
| | - Toshimichi Tanaka
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuyuki Nishizawa
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keigo Yokoi
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Marie Washio
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akira Ema
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroaki Mieno
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiromitsu Moriya
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kei Hosoda
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mina Waraya
- Department of Surgery, Sagamino Hospital, Sagamihara, Japan
| | - Hiroshi Katoh
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Bouliaris K, Rachiotis G, Diamantis A, Christodoulidis G, Polychronopoulou E, Tepetes K. Lymph node ratio as a prognostic factor in gastric cancer patients following D1 resection. Comparison with the current TNM staging system. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2017; 43:1350-1356. [PMID: 28433495 DOI: 10.1016/j.ejso.2017.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 01/03/2017] [Accepted: 03/10/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Nodal ratio (NR) has been demonstrated to be an independent prognostic factor in patients with gastric cancer. We evaluated the prognostic role of NR comparing it with the current TNM (2010) classification in gastric cancer patients treated with curative (R0) D1 resection. MATERIALS AND METHODS We retrospectively reviewed 110 patients who underwent R0 resection for gastric cancer at University Hospital of Larissa between 2002 and 2011. All patients had a D1 lymphadenectomy plus the nodes along the left gastric artery. Factors affecting survival as well as correlations between the N status, NR status and resected nodes were investigated. RESULTS In univariate analysis the N and NR status but not the numbers of retrieved nodes were significant prognostic factors. Inside N1 and N2 categories, patients with different NR groups were present and survival of some of these subpopulations was statistically different at long-rank test. There was a correlation between the nodes retrieved and N status but not with the NR category. In multivariate analysis both N status (HR=1.45; 95% C.I. = 1.19-1.89) and NR (HR=4.53; 95% C.I. = 1.86-11.03) found to be independent prognostic factors of survival. CONCLUSION Prognostic significance of N status and NR status was comparable. Unlike N status, NR is independent by the number of resected nodes, and therefore it is particularly useful in case of conventional lymphadenectomy.
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Affiliation(s)
- K Bouliaris
- Surgical Department, University Hospital of Larissa, Mezurlo 41110, Thessaly, Greece.
| | - G Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty School of Health Science, University of Thessaly, Larissa 41222, Greece.
| | - A Diamantis
- Surgical Department, University Hospital of Larissa, Mezurlo 41110, Thessaly, Greece.
| | - G Christodoulidis
- Surgical Department, University Hospital of Larissa, Mezurlo 41110, Thessaly, Greece.
| | - E Polychronopoulou
- Internal Medicine Department, University Hospital of Larissa, Mezurlo 41110, Thessaly, Greece.
| | - K Tepetes
- Surgical Department, University Hospital of Larissa, Mezurlo 41110, Thessaly, Greece.
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Zhu X, Tian X, Yu C, Shen C, Yan T, Hong J, Wang Z, Fang JY, Chen H. A long non-coding RNA signature to improve prognosis prediction of gastric cancer. Mol Cancer 2016; 15:60. [PMID: 27647437 PMCID: PMC5029104 DOI: 10.1186/s12943-016-0544-0] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/07/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing evidence suggests long non-coding RNAs (lncRNAs) are frequently aberrantly expressed in cancers, however, few related lncRNA signatures have been established for prediction of cancer prognosis. We aimed at developing alncRNA signature to improve prognosis prediction of gastric cancer (GC). METHODS Using a lncRNA-mining approach, we performed lncRNA expression profiling in large GC cohorts from Gene Expression Ominus (GEO), including GSE62254 data set (N = 300) and GSE15459 data set (N = 192). We established a set of 24-lncRNAs that were significantly associated with the disease free survival (DFS) in the test series. RESULTS Based on this 24-lncRNA signature, the test series patients could be classified into high-risk or low-risk subgroup with significantly different DFS (HR = 1.19, 95 % CI = 1.13-1.25, P < 0.0001). The prognostic value of this 24-lncRNA signature was confirmed in the internal validation series and another external validation series, respectively. Further analysis revealed that the prognostic value of this signature was independent of lymph node ratio (LNR) and postoperative chemotherapy. Gene set enrichment analysis (GSEA) indicated that high risk score group was associated with several cancer recurrence and metastasis associated pathways. CONCLUSIONS The identification of the prognostic lncRNAs indicates the potential roles of lncRNAs in GC biogenesis. Our results may provide an efficient classification tool for clinical prognosis evaluation of GC.
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Affiliation(s)
- Xiaoqiang Zhu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
| | - Xianglong Tian
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
| | - Chenyang Yu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
| | - Chaoqin Shen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
| | - Tingting Yan
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
| | - Jie Hong
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
| | - Zheng Wang
- Department of gastrointestinal surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Jing-Yuan Fang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
| | - Haoyan Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai, 200001 China
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Yamashita K, Hosoda K, Ema A, Watanabe M. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol 2016; 42:1253-60. [PMID: 27017273 DOI: 10.1016/j.ejso.2016.03.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 01/02/2016] [Accepted: 03/01/2016] [Indexed: 12/14/2022] Open
Abstract
TNM staging is no doubt the most critical prognostic factors, representing tumor (T)/lymph node metastasis (N)/distant metastasis (M) in gastric cancer. Lymph node ratio-based N system (Nr) has been repeatedly reported to be of prognostic relevance in advanced gastric cancer independent of stage in the multivariate analysis world-wide, and proposed as more sophisticated than N with regard to predicting accurate prognosis. As a result, proposed TNrM system may predict survival more accurately than the present TNM staging system for patients undergoing limited lymph node analysis. It could adjust stage migration when the lymph node number was used as staging factor. Although correlation of the number of metastatic lymph nodes and lymph node ratio is obvious, biological characteristics other than that could also have been reflected on. It may indicate how successful the operation of lymph node dissection was, or it may be revealing the potential of the patient's lymph node immune-reaction. Recently, high lymph node ratio is closely associated with EGFR expression in advanced gastric cancer. When efficiency of applying lymph node ratio as a biomarker is verified and confirmed in an expansive research, and when cancer causing molecules are identified, as well as the competence as a treatment target is studied, the new biomarker, namely, lymph node ratio, could find itself in a limelight in gastric cancer treatment in the future.
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Affiliation(s)
- K Yamashita
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan.
| | - K Hosoda
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan
| | - A Ema
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan
| | - M Watanabe
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan
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Kavaliauskas P, Maziukas R, Samalavicius NE, Kuliavas J, Lunevicius R. Subtotal gastrectomy with conventional D2 lymphadenectomy for carcinoma of the distal gastric portion: A retrospective cohort study on clinical outcomes. Ann Med Surg (Lond) 2016; 6:36-41. [PMID: 27141301 PMCID: PMC4840235 DOI: 10.1016/j.amsu.2016.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/28/2015] [Accepted: 01/16/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The study was aimed to delineate the postoperative morbidity, mortality and long-term follow-up results after R0 subtotal gastrectomy with D2 lymphadenectomy for invasive non-disseminated adenocarcinoma of the distal gastric portion. METHODS Between January 2005 and December 2007, 228 patients with median age at hospitalisation 66.6 ± 11.4 years underwent the above mentioned surgery for histologically proven distal gastric adenocarcinoma. RESULTS Postoperative morbidity was documented in 92 (40.4%) of patients within 30 days. An anastomotic leakage was diagnosed in two (0.9%), peritonitis in two (0.9%), anastomositis in five (2.2%), and prolonged ileus in six (2.6%) patients. Nine patients died (3.9%). The overall 1-year survival rate was 83.8%, and the 5-year survival rate was 54.4%. Gender, age, TNM stage, pN, and N ratio were independent factors predicting a long-term prognosis for patients. CONCLUSIONS A R0 type distal subtotal gastrectomy with standard D2 lymphadenectomy for a histologically proven invasive adenocarcinoma of the distal gastric portion without distant metastasis offers acceptable postoperative morbidity and mortality, and considerably high overall cumulative 5-year survival rate. The probability of cumulative survival decreases five times when the ratio between metastatic and examined lymph nodes is > 0.25.
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Affiliation(s)
- Povilas Kavaliauskas
- School of Medicine, Vilnius University, 21 M.K.Ciurlionio str., LT-03101, Vilnius, Lithuania
| | - Rytis Maziukas
- School of Medicine, Vilnius University, 21 M.K.Ciurlionio str., LT-03101, Vilnius, Lithuania
| | - Narimantas Evaldas Samalavicius
- Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, National Cancer Institute, 1 Santariskiu Str, LT-08660, Vilnius, Lithuania
| | - Justas Kuliavas
- Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, National Cancer Institute, 1 Santariskiu Str, LT-08660, Vilnius, Lithuania
| | - Raimundas Lunevicius
- Emergency General Surgery and Major Trauma Centre, General Surgery Department, University of Liverpool, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
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Melis M, Masi A, Pinna A, Cohen S, Hatzaras I, Berman R, Pachter LH, Newman E. Does lymph node ratio affect prognosis in gastroesophageal cancer? Am J Surg 2015; 210:443-50. [DOI: 10.1016/j.amjsurg.2014.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/03/2014] [Accepted: 12/29/2014] [Indexed: 12/19/2022]
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13
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Huang Z, Zhang N, Zha L, Mao HC, Chen X, Xiang JF, Zhang H, Wang ZW. Aberrant expression of the autocrine motility factor receptor correlates with poor prognosis and promotes metastasis in gastric carcinoma. Asian Pac J Cancer Prev 2014; 15:989-97. [PMID: 24568530 DOI: 10.7314/apjcp.2014.15.2.989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AMFR, autocrine motility factor receptor, also called gp78, is a cell surface cytokine receptor which has a dual role as an E3 ubiquitin ligase in endoplasmic reticulum-associated degradation. AMFR expression is associated with tumor malignancy. We here investigated the clinical significance of AMFR and its role in metastasis and prognosis in gastric cancer. Expression of AMFR, E-cadherin and N-cadherin in cancer tissues and matched adjacent normal tissues from 122 gastric cancer (GC) patients undergoing surgical resection was assessed by immunohistochemistry. Levels of these molecules in 17 cases selected randomly were also analysed by Western blotting. AMFR expression was significantly increased in gastric cancer tissues, and associated with invasion depth and lymph node metastasis. Kaplan-Meier analysis showed AMFR expression correlated with poor overall survival and an increased risk of recurrence in the GC cases. Cox regression analysis suggested AMFR to be an independent predictor for overall and recurrence-free survival. E-cadherin expression was decreased in gastric cancer tissues; conversely, N-cadherin was increased. Expression of AMFR negatively correlated with E-cadherin expression, whereas N-cadherin expression showed a significant positive correlation with AMFR expression. AMFR might be involved in the regulation of epithelial-mesenchymal transition, with aberrant expression correlating with a poor prognosis and promoting invasion and metastasis in GCs.
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Affiliation(s)
- Zhen Huang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China E-mail :
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Zhang BY, Yuan J, Cui ZS, Li ZW, Li XH, Lu YY. Evaluation of the prognostic value of the metastatic lymph node ratio for gastric cancer. Am J Surg 2013; 207:555-65. [PMID: 24124661 DOI: 10.1016/j.amjsurg.2013.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 05/30/2013] [Accepted: 05/30/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prognostic value of metastatic lymph node (LN) ratio (LNR) compared with pathologic node (pN) category. METHODS Three hundred ninety-nine patients with gastric cancer with R0 resection were reviewed. LNR, pN, and the number of retrieved LNs were evaluated in node-positive groups with ≥15 or <15 LNs resected and a node-negative group, respectively, by univariate and multivariate analyses. Associations of pN and LNR with the number of retrieved LNs were determined using Spearman's rank correlation test. RESULTS LNR and pN were correlated with overall survival. For the node-positive group with ≥15 LNs retrieved, pN and LNR were independent prognostic factors, with the hazard ratio higher for LNR; neither was correlated with the number of retrieved LNs. For the group with <15 LNs retrieved, LNR but not pN was an independent prognostic factor, with LNR uncorrelated with the number of LNs retrieved. For the node-negative group, the number of LNs retrieved retained an independent prognostic factor. CONCLUSIONS LNR is an independent prognostic factor in node-positive patients with gastric cancer with R0 resection, and it is uninfluenced by the number of LNs retrieved. It may be superior to pN.
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Affiliation(s)
- Bao-Yan Zhang
- Department of Pathology, 117 Hospital of Chinese PLA, Hangzhou, China
| | - Jing Yuan
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Zhen-Shuang Cui
- Cadre Ward of Internal Medicine, Chinese PLA General Hospital of Beijing Military Area, Beijing, China
| | - Zhong-Wu Li
- Department of Pathology, Peking University Cancer Hospital, 52 Fucheng Road, 100142 Beijing, China
| | - Xiang-Hong Li
- Department of Pathology, Peking University Cancer Hospital, 52 Fucheng Road, 100142 Beijing, China.
| | - You-Yong Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fucheng Road, 100142 Beijing, China.
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Peng CW, Wang LW, Zeng WJ, Yang XJ, Li Y. Evaluation of the staging systems for gastric cancer. J Surg Oncol 2013; 108:93-105. [PMID: 23813573 DOI: 10.1002/jso.23360] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/13/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Some staging systems for gastric cancer (GC) have been developed as alternatives to the 6th and 7th TNM staging systems, including the Hybrid, tumor-ratio-metastasis (TRM), and Kiel staging systems. This study evaluated the overall performance of these systems for GC. METHODS A total of 540 GC patients undergoing surgical resection were staged using these five systems. Homogeneity, discrimination power, predictive accuracy, and complexity of these systems were compared. RESULTS Multivariate analyses showed that all of 7th pT, pN, and pM classifications were independent factors for GC prognosis (P < 0.001 for all). Compared with the other four systems, 7th TNM system had improved stage groups homogeneity (7 of 8 stage groups homogeneous), enhanced discrimination power (4 of 5, 5 of 7, 4 of 7, 3 of 7, and 1 of 4 adjacent stage groups were differentiated by the 6th, 7th TNM, Hybrid, TRM, and Kiel systems, respectively), and better prediction value for GC patients' outcome (AUC = 0.801, P < 0.001). In addition, the 7th TNM system did not increase the staging complexity (9 groups and 21 subgroups). CONCLUSIONS The 7th TNM staging system represents advancement in GC staging system for better prediction of clinical outcomes.
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Affiliation(s)
- Chun-Wei Peng
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan, PR China
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Sugimoto M, Kinoshita T, Shibasaki H, Kato Y, Gotohda N, Takahashi S, Konishi M. Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer. Surg Endosc 2013; 27:4291-6. [PMID: 23793806 DOI: 10.1007/s00464-013-3045-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/28/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic distal gastrectomy for gastric cancer has been firmly established in recent decades but still is a difficult procedure, especially for obese patients, as with open surgery. This study aimed to evaluate the perioperative outcome of total laparoscopic distal gastrectomy (TLDG) for early gastric cancer patients with a body mass index (BMI) exceeding 25 kg/m(2) and to consider countermeasures to this. METHODS Perioperative outcomes were compared between 42 patients with a BMI exceeding 25 kg/m(2) [overweight or obese group (OWG)] and 174 patients with a BMI lower than 25 kg/m(2) [normal or underweight group (NWG)] who underwent TLDG between September 2010 and December 2012. RESULTS The BMI was 26.0 ± 1.4 kg/m(2) in the OWG group and 22.0 ± 2.1 kg/m(2) in the NWG group (P < 0.001). The groups did not differ in terms of age, sex, American Society of Anesthesiologists score, presence of diabetes, number of retrieved lymph nodes, number of metastatic lymph nodes, or metastatic lymph node ratio. The two groups did not differ significantly with respect to the extent of lymph node dissection [OWG: D1 (11.9 %), D1+ (66.7 %), D2 (21.4 %) vs NWG: D1 (5.2 %), D1+ (51.7 %), D2 (43.1 %); P = 0.020] or tumor size (OWG: 25.5 ± 20.2 mm vs NWG: 33.0 ± 17.2 mm; P = 0.037). Differences in operation time (OWG: 212 ± 31 min vs NWG: 200 ± 35 min; P = 0.005) and estimated blood loss (OWG: 15 ± 22 ml vs NWG: 10 ± 34 ml; P = 0.013) seemed to have a minimal impact clinically. Postoperative complications including infectious complications and recovery after surgery did not differ between the two groups. CONCLUSIONS For overweight and obese patients, TLDG was managed safely. The procedure was considered to be difficult but sufficiently feasible.
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Affiliation(s)
- Motokazu Sugimoto
- Department of Digestive Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan,
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Lee SR, Kim HO, Park YL, Shin JH. Lymph node ratio predicts local recurrence for periampullary tumours. ANZ J Surg 2013; 84:353-8. [PMID: 23521761 DOI: 10.1111/ans.12129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND To better define the prognostic role of nodal disease, evaluation of metastatic lymph node ratio (MLR) has been performed, and this method has recently gained prominence in various gastrointestinal cancers. The present study attempts to identify prognostic factors and evaluate the independent prognostic influence of MLR in patients who have undergone curative pancreaticoduodenectomy. METHODS In our institution within the study period, 111 patients received curative pancreaticoduodenectomy for periampullary cancers. Clinicopathologic data were collected and MLR was calculated for each of the patients. Patients were then divided into four groups based on MLR value: MLR 1 = 0; MLR 2 = 0.01-0.2; MLR 3 0.21-0.4; and MLR 4 >0.4. RESULTS Increasing MLR correlates with high recurrence rate and lower overall survival (OS) with significance (P < 0.001, P < 0.001). The recurrent group showed significantly lower OS than the non-recurrent group (P < 0.001). In the multivariate analysis for recurrence, MLR was identified as the only independent prognostic factor (P < 0.001). CONCLUSIONS The simple and easily obtainable MLR is well qualified as a prognostic factor in patients who undergo curatively radical resection for periampullary cancer. Furthermore, MLR can overcome the limitations of evaluation of lymph nodes status, allowing it to be used as a potential prognostic factor.
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Affiliation(s)
- Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Huang Q. Carcinoma of the gastroesophageal junction in Chinese patients. World J Gastroenterol 2012; 18:7134-7140. [PMID: 23326117 PMCID: PMC3544014 DOI: 10.3748/wjg.v18.i48.7134] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/15/2012] [Accepted: 11/06/2012] [Indexed: 02/06/2023] Open
Abstract
Carcinoma of the gastroesophageal junction (GEJ) is defined as carcinoma that crosses the GEJ line, irrespective of where the tumor epicenter is located. This group of cancer is rare but controversial. Based on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries, this cancer is believed to arise from Barrett’s esophagus (BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology, clinicopathology, and molecular pathobiology in relation to BE. As such, the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma (EA). This mandate has been challenged recently by the data from several studies carried out mainly in Chinese patients. The emerging evidence derived from those studies suggests: (1) both BE and EA are uncommon in the Chinese population; (2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer, not those of EA; (3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients’ prognosis effectively; and (4) prognostic factors of GEJ cancer in Chinese are similar, but not identical, to those of EA. In conclusion, the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from EA. Further investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.
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Batista TP, de Mendonça LM, Fassizoli-Fonte AL. The role of perioperative radiotherapy in gastric cancer. Oncol Rev 2012; 6:e23. [PMID: 25992221 PMCID: PMC4419630 DOI: 10.4081/oncol.2012.e23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/03/2012] [Accepted: 12/06/2012] [Indexed: 02/08/2023] Open
Abstract
Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment.
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Affiliation(s)
| | - Lucas Marques de Mendonça
- Department of Radiotherapy, FPS/IMIP - Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Recife/PE, Brazil
| | - Ana Luiza Fassizoli-Fonte
- Department of Radiotherapy, FPS/IMIP - Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Recife/PE, Brazil
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20
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Reim D, Loos M, Vogl F, Novotny A, Schuster T, Langer R, Becker K, Höfler H, Siveke J, Bassermann F, Friess H, Schuhmacher C. Prognostic implications of the seventh edition of the international union against cancer classification for patients with gastric cancer: the Western experience of patients treated in a single-center European institution. J Clin Oncol 2012; 31:263-71. [PMID: 23213098 DOI: 10.1200/jco.2012.44.4315] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Validity of the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging systems for gastric cancer has been evaluated in several studies, mostly in Asian patient populations. Only few data are available on the prognostic implications of the new classification system on a Western population. Therefore, we investigated its prognostic ability based on a German patient cohort. PATIENTS AND METHODS Data from a single-center cohort of 1,767 consecutive patients surgically treated for gastric cancer were classified according to the seventh edition and were compared using the previous TNM/UICC classification. Kaplan-Meier analyses were performed for all TNM stages and UICC stages in a comparative manner. Additional survival receiver operating characteristic analyses and bootstrap-based goodness-of-fit comparisons via Bayesian information criterion (BIC) were performed to assess and compare prognostic performance of the competing classification systems. RESULTS We identified the UICC pT/pN stages according to the seventh edition of the AJCC/UICC guidelines as well as resection status, age, Lauren histotype, lymph-node ratio, and tumor grade as independent prognostic factors in gastric cancer, which is consistent with data from previous Asian studies. Overall survival rates according to the new edition were significantly different for each individual's pT, pN, and UICC stage. However, BIC analysis revealed that, owing to higher complexity, the new staging system might not significantly alter predictability for overall survival compared with the old system within the analyzed cohort from a statistical point of view. CONCLUSION The seventh edition of the AJCC/UICC classification was found to be valid with distinctive prognosis for each stage. However, the AJCC/UICC classification has become more complex without improving predictability for overall survival in a Western population. Therefore, simplification with better predictability of overall survival of patients with gastric cancer should be considered when revising the seventh edition.
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Affiliation(s)
- Daniel Reim
- Klinikum Rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
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Deng J, Liang H, Zhang R, Sun D, Pan Y, Zhang L, Hao X. Clinicopathologic characteristics and outcomes of surgery of middle-third gastric cancer. Tumour Biol 2012; 33:2091-2098. [PMID: 22869239 DOI: 10.1007/s13277-012-0468-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/23/2012] [Indexed: 12/13/2022] Open
Abstract
Many issues of middle-third gastric cancer need to be address for obtaining preferably clinical treatment. The objective of this retrospective study was to analyze clinicopathologic characteristics and results of surgery for 113 middle-third gastric cancer patients admitted to our hospital. Retrospective cohort analyses of clinicopathologic data and postoperative prognosis of 113 middle-third gastric cancer patients who underwent curative resection between January 1997 and December 2003 were reviewed. Compared with lower-third gastric cancer patients, middle-third gastric cancer patients had significantly lower 5-year survival rate (P < 0.001) and higher recurrence rate (P < 0.001). With the Cox proportional hazards model analysis, the types of gastrectomy (hazard ratio (HR) = 0.495, P = 0.012) and ratio between metastatic and dissected lymph nodes (RML) (HR = 1.681, P < 0.001) were identified as the independent predictors of overall survival (OS) of middle-third gastric cancer patients. Besides, only RML (HR = 3.026, P < 0.001) was an independent predictor of recurrence for middle-third gastric cancer patients after surgery identified using the logistic regression analysis. The prognosis of middle-third gastric cancer was significantly worse than lower-third gastric cancer. RML was a key indicator for OS and recurrence of middle-third gastric cancer.
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Affiliation(s)
- Jingyu Deng
- Department of Gastric Cancer Surgery, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
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Using the K-nearest neighbor algorithm for the classification of lymph node metastasis in gastric cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:876545. [PMID: 23150740 PMCID: PMC3488413 DOI: 10.1155/2012/876545] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/19/2012] [Indexed: 02/06/2023]
Abstract
Accurate tumor, node, and metastasis (TNM) staging, especially N staging in gastric cancer or the metastasis on lymph node diagnosis, is a popular issue in clinical medical image analysis in which gemstone spectral imaging (GSI) can provide more information to doctors than conventional computed tomography (CT) does. In this paper, we apply machine learning methods on the GSI analysis of lymph node metastasis in gastric cancer. First, we use some feature selection or metric learning methods to reduce data dimension and feature space. We then employ the K-nearest neighbor classifier to distinguish lymph node metastasis from nonlymph node metastasis. The experiment involved 38 lymph node samples in gastric cancer, showing an overall accuracy of 96.33%. Compared with that of traditional diagnostic methods, such as helical CT (sensitivity 75.2% and specificity 41.8%) and multidetector computed tomography (82.09%), the diagnostic accuracy of lymph node metastasis is high. GSI-CT can then be the optimal choice for the preoperative diagnosis of patients with gastric cancer in the N staging.
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Zhang YF, Shi J, Yu HP, Feng AN, Fan XS, Lauwers GY, Mashimo H, Gold JS, Chen G, Huang Q. Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus. World J Gastroenterol 2012; 18:3602-9. [PMID: 22826627 PMCID: PMC3400864 DOI: 10.3748/wjg.v18.i27.3602] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 04/09/2012] [Accepted: 04/20/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinicopathologic features which predict surgical overall survival in patients with proximal gastric carcinoma involving the esophagus (PGCE).
METHODS: Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009. Each retrieved pathology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were selected as PGCE. Each tumor was re-staged, following the guidelines on esophageal adenocarcinoma, according to the 7th edition of the American Joint Commission on Cancer Staging Manual. All histology slides were studied along with the pathology report for a retrospective analysis of 13 clinicopathologic features, i.e., age, gender, Helicobacter pylori (H. pylori) infection, surgical modality, Siewert type, tumor Bormann’s type, size, differentiation, histology type, surgical margin, lymphovascular and perineural invasion, and pathologic stage in relation to survival after surgical resection. Prognostic factors for overall survival were assessed with uni- and multi-variate analyses.
RESULTS: Patients’ mean age was 65 years (range: 47-90 years). The male: female ratio was 3.3. The 1-, 3- and 5-year overall survival rates were 87%, 61% and 32%, respectively. By univariate analysis, age, male gender, H. pylori, tumor Bormann’s type, size, histology type, surgical modality, positive surgical margin, lymphovascular invasion, and pT stage were not predictive for overall survival; in contrast, perineural invasion (P = 0.003), poor differentiation (P = 0.0003), > 15 total lymph nodes retrieved (P = 0.008), positive lymph nodes (P = 0.001), and distant metastasis (P = 0.005) predicted poor post-operative overall survival. Celiac axis nodal metastasis was associated with significantly worse overall survival (P = 0.007). By multivariate analysis, ≥ 16 positive nodes (P = 0.018), lymph node ratio > 0.2 (P = 0.003), and overall pathologic stage (P = 0.002) were independent predictors for poor overall survival after resection.
CONCLUSION: Patients with PGCE showed worse overall survival in elderly, high nodal burden and advanced pathologic stage. This cancer may be more accurately staged as gastric, than esophageal, cancer.
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Lee SR, Kim HO, Son BH, Shin JH, Yoo CH. Prognostic significance of the metastatic lymph node ratio in patients with gastric cancer. World J Surg 2012; 36:1096-1101. [PMID: 22382768 DOI: 10.1007/s00268-012-1520-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In gastric cancer, the classification of lymph node status is still a controversial prognostic factor. Recent studies have proposed a new prognostic factor (metastatic lymph node ratio: MLR) for gastric cancer patients who undergo curative resection. The present study tested the hypothesis that MLR was better than the current pN staging system by analyzing the correlation between MLR and the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system, by analyzing the correlation between MLR and 5-year overall survival (OS), by comparing area under the curve (AUC), and by performing univariate and multivariate analyses for OS. METHODS Of 409 patients who were diagnosed with gastric adenocarcinoma between January 2003 and December 2006, 370 patients underwent curative resection and were included in this study. The prognostic significance of the number of metastatic lymph nodes and the metastatic lymph node ratio were compared in AUC and univariate and multivariate Cox regression analyses. RESULTS MLR was significantly correlated with the depth of invasion and the number of lymph node metastases (p < 0.001). Increasing MLR also was statistically correlated with a lower 5-year OS rate (p < 0.001). The AUC of MLR and the number of lymph node metastases were not significantly different (p = 0.825). MLR was an independent prognostic factor on multivariate analysis, but the number of metastatic lymph nodes was not. CONCLUSIONS MLR can be a prognostic factor in patients who undergo radical resection for gastric cancer and can overcome the limitations of existing prognostic factors.
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Affiliation(s)
- Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Ku, Seoul, 110-746, South Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Ku, Seoul, 110-746, South Korea
| | - Byung Ho Son
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Ku, Seoul, 110-746, South Korea
| | - Jun Ho Shin
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Ku, Seoul, 110-746, South Korea
| | - Chang Hak Yoo
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Ku, Seoul, 110-746, South Korea.
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Comparison of a lymph node ratio-based staging system with the 7th AJCC system for gastric cancer: analysis of 18,043 patients from the SEER database. Ann Surg 2012; 255:478-85. [PMID: 22330040 DOI: 10.1097/sla.0b013e31824857e2] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The American Joint Committee on Cancer (AJCC) staging system for gastric cancer bases N status on absolute number of metastatic nodes, regardless of the number of examined nodes. We examined a modified staging system utilizing node ratio (Nr), the ratio of metastatic to examined nodes. METHODS A total of 18,043 gastric cancer patients who underwent gastrectomy were identified from the US Surveillance, Epidemiology, and End Results (SEER) database. A training set was divided into 5 Nr groups, and a TNrM staging system was constructed. Median survival and overall survival, based on 7th edition AJCC and TNrM staging systems, were compared, and the analysis was repeated in a validation set. RESULTS Median examined nodes were 10 to 11. For the training set, overall survival for all 5 AJCC N categories was significantly different when subgrouped into 15 or fewer versus more than 15 examined nodes, but overall survival was similar regardless of the number of examined nodes in 4 of 5 Nr categories. Seven AJCC stages had statistically different overall survival between subgroups, whereas only 1 TNrM stage had statistically different overall survival between subgroups. When misclassification was defined as any subgroup in which median survival fell outside the 95% confidence interval of the group's overall median survival, AJCC staging misclassified 57% of patients and TNrM staging misclassified only 12%. Similar results were found in the validation set. CONCLUSIONS The AJCC system classifies SEER gastric cancer patients into stages in which subgroups often have wide variations in survival. For patients undergoing limited lymph node analysis, the proposed TNrM system may predict survival more accurately.
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Xiao LB, Yu JX, Wu WH, Xu FF, Yang SB. Superiority of metastatic lymph node ratio to the 7th edition UICC N staging in gastric cancer. World J Gastroenterol 2011; 17:5123-30. [PMID: 22171148 PMCID: PMC3235597 DOI: 10.3748/wjg.v17.i46.5123] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 03/29/2011] [Accepted: 04/05/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare and evaluate the appropriate prognostic indicators of lymph node basic staging in gastric cancer patients who underwent radical resection.
METHODS: A total of 1042 gastric cancer patients who underwent radical resection and D2 lymphadenectomy were staged using the 6th and 7th edition International Union Against Cancer (UICC) N staging methods and the metastatic lymph node ratio (MLNR) staging. Homogeneity, discriminatory ability, and gradient monotonicity of the various staging methods were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations. The area under the curve (AUC) was calculated to compare the predictive ability of the aforementioned three staging methods.
RESULTS: Optimal cut-points of the MLNR were calculated as MLNR0 (0), MLNR1 (0.01-0.30), MLNR2 (0.31-0.50), and MLNR3 (0.51-1.00). In univariate, multivariate, and stratified analyses, MLNR staging was superior to the 6th and 7th edition UICC N staging methods. MLNR staging had a higher AUC, higher linear trend and likelihood ratio χ2 scores and lower AIC values than the other two staging methods.
CONCLUSION: MLNR staging predicts survival after gastric cancer more precisely than the 6th and 7th edition UICC N classifications and should be considered as an alternative to current pathological N staging.
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Lee SM, Shin JS, Choi HJ, Park KJ, Roh YH, Kwon HC, Roh MS, Lee HS, Kim C. Prognostic implication of metastatic lymph node ratio in node-positive rectal cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80:260-6. [PMID: 22066045 PMCID: PMC3204678 DOI: 10.4174/jkss.2011.80.4.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 08/31/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the prognostic significance of the ratio between metastatic and examined lymph nodes (LNs) in patients with stage III rectal cancer. METHODS A review was made of 175 (male, 98) patients with stage III rectal cancer of R0 resection. LN disease was stratified both by the American Joint Committee on Cancer/International Union Against Cancer nodal classification (pN) and by quartiles of the lymph node ratio (LNR). Disease-free survivals (DFS) were made using Kaplan-Meier curves and assessed by the log rank test and multivariate analysis was performed using the Cox proportional hazards model. RESULTS Patients ranged in age from 29 to 83 (median, 60) years with median follow-up of 47 months (range, 13 to 181 months). months. There was a significant correlation between the number of metastatic LNs and the LNR (r = 0.8681, P < 0.0001). Cut-off points of LNR quartiles best to separate patients with regard to 5-year DFS were between quartile 2 and 3, and between 3 and 4 (LNR1, 2, and 3); the 5-year DFS according to such stratification was 89.6%, 55.8%, and 18.2% in LNR1, 2, and 3, respectively (P < 0.0001). Cox model identified the LNR as the most significant independent prognostic covariate; LNR2 showed 3.6 times (95% confidence interval [CI], 1.682 to 7.584; P = 0.0009) and LNR3, 18.7 times (95% CI, 6.872 to 50.664; P < 0.0001) more risky than LNR1. CONCLUSION This study suggests that ratio-based LN staging, which reflects the number of LNs examined and the quality of LN dissection, is a simple and reliable system for prognostic LN stratification in patients with stage III rectal cancer.
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Affiliation(s)
- Sang-Min Lee
- Department of Surgery, Dong-A University Medical Center, Busan, Korea
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28
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Petrelli F, Borgonovo K, Barni S. The emerging issue of ratio of metastatic to resected lymph nodes in gastrointestinal cancers: An overview of literature. Eur J Surg Oncol 2011; 37:836-47. [DOI: 10.1016/j.ejso.2011.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 03/25/2011] [Accepted: 07/25/2011] [Indexed: 12/21/2022] Open
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Wang W, Xu D, Li Y, Guan Y, Sun X, Chen Y, Kesari R, Huang C, Li W, Zhan Y, Zhou Z. Tumor–ratio–metastasis staging system as an alternative to the 7th edition UICC TNM system in gastric cancer after D2 resection—results of a single-institution study of 1343 Chinese patients. Ann Oncol 2011; 22:2049-2056. [DOI: 10.1093/annonc/mdq716] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Bennett G, Sadlier D, Doran PP, Macmathuna P, Murray DW. A functional and transcriptomic analysis of NET1 bioactivity in gastric cancer. BMC Cancer 2011; 11:50. [PMID: 21284875 PMCID: PMC3041777 DOI: 10.1186/1471-2407-11-50] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 02/01/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND NET1, a RhoA guanine exchange factor, is up-regulated in gastric cancer (GC) tissue and drives the invasive phenotype of this disease. In this study, we aimed to determine the role of NET1 in GC by monitoring the proliferation, motility and invasion of GC cells in which NET1 has been stably knocked down. Additionally, we aimed to determine NET1-dependent transcriptomic events that occur in GC. METHODS An in vitro model of stable knockdown of NET1 was achieved in AGS human gastric adenocarcinoma cells via lentiviral mediated transduction of short-hairpin (sh) RNA targeting NET1. Knockdown was assessed using quantitative PCR. Cell proliferation was assessed using an MTS assay and cell migration was assessed using a wound healing scratch assay. Cell invasion was assessed using a transwell matrigel invasion assay. Gene expression profiles were examined using affymetrix oligonucleotide U133A expression arrays. A student's t test was used to determine changes of statistical significance. RESULTS GC cells were transduced with NET1 shRNA resulting in a 97% reduction in NET1 mRNA (p < 0.0001). NET1 knockdown significantly reduced the invasion and migration of GC cells by 94% (p < 0.05) and 24% (p < 0.001) respectively, while cell proliferation was not significantly altered following NET1 knockdown. Microarray analysis was performed on non-target and knockdown cell lines, treated with and without 10 μM lysophosphatidic acid (LPA) allowing us to identify NET1-dependent, LPA-dependent and NET1-mediated LPA-induced gene transcription. Differential gene expression was confirmed by quantitative PCR. Shortlisted NET1-dependent genes included STAT1, TSPAN1, TGFBi and CCL5 all of which were downregulatd upon NET1 downregulation. Shortlisted LPA-dependent genes included EGFR and PPARD where EGFR was upregulated and PPARD was downregulated upon LPA stimulation. Shortlisted NET1 and LPA dependent genes included IGFR1 and PIP5K3. These LPA induced genes were downregulated in NET1 knockdown cells. CONCLUSIONS NET1 plays an important role in GC cell migration and invasion, key aspects of GC progression. Furthermore, the gene expression profile further elucidates the molecular mechanisms underpinning NET1-mediated aggressive GC cell behaviour.
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Affiliation(s)
- Gayle Bennett
- UCD Clinical Research Centre, UCD School of Medicine and Medical Sciences, Misericordiae University Hospital, Dublin 7, Ireland
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31
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Fukuda N, Sugiyama Y, Midorikawa A, Mushiake H. Prognostic significance of the metastatic lymph node ratio in gastric cancer patients. World J Surg 2010; 33:2378-82. [PMID: 19760318 DOI: 10.1007/s00268-009-0205-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Lymph node metastasis is considered one of the most important prognostic factors in gastric cancer. However, the optimal system for accurate staging of lymph node metastasis for patients with gastric cancer remains controversial. This study was designed to investigate the prognostic significance of the metastatic lymph node ratio (MLR), which is calculated by dividing the number of metastatic lymph nodes by the total number of nodes harvested from patients with gastric cancer. METHODS We retrospectively analyzed the clinical data of 186 consecutive patients diagnosed with gastric cancer who underwent curative gastrectomy at our hospital. The lymph node status was classified according to three systems:the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) system; the Japanese Gastric Cancer Association (JGCA) system; and an MLR-based system (MLR0: 0, MLR1: 0.01-0.19, MLR2: >or=0.2). The influence of the MLR on patient survival was determined using univariate Kaplan-Meier survival analysis, the generalized Wilcoxon test, and analysis with the multivariate Cox proportional hazards model. RESULTS The 5-year survival rate of the patients with MLR0, MLR1, and MLR2 was 88.6%, 59.4%, and 13.4%, respectively. In addition to the MLR, the UICC/AJCC N category,JGCA n category, tumor stage (pT category), and tumor diameter significantly influenced the 5-year survival rate, as determined by univariate analysis. Multivariate analyses revealed that of the three factors used to stage lymph node involvement, MLR was the most significant prognostic factor. CONCLUSIONS The MLR is an important and easy-to-assess prognostic factor that should be considered for staging lymph node metastasis in patients with gastric cancer.
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Affiliation(s)
- Naoto Fukuda
- Department of Surgery, University Hospital of Mizonokuchi, Teikyo University School of Medicine, Takatsu-ku, Kawasaki, Japan.
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32
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de Bree E, Charalampakis V, Melissas J, Tsiftsis DD. The extent of lymph node dissection for gastric cancer: a critical appraisal. J Surg Oncol 2010; 102:552-562. [PMID: 20976727 DOI: 10.1002/jso.21646] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The extent of lymphadenectomy during therapeutic gastrectomy for gastric cancer remains a protracted and controversial issue. While traditionally extended lymphadenectomy is performed in Eastern Asia, limited lymphadenectomy is advocated by most western surgeons. Two large western randomized trials, meta-analyses and a recent systematic review were unable to demonstrate overall benefit from extended lymphadenectomy. In this review, the currently available data on this topic are critically evaluated, while ongoing studies and future perspective are discussed.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece.
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33
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The node ratio as prognostic factor after curative resection for gastric cancer. J Gastrointest Surg 2010; 14:614-9. [PMID: 20101526 DOI: 10.1007/s11605-009-1142-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 12/14/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The depth of the tumor invasion and nodal involvement are the two main prognostic factors in gastric cancer. Staging systems differ among countries and new tools are needed to interpret and compare results and to reduce stage migration. The node ratio (NR) has been proposed as a new prognostic factor. MATERIALS AND METHODS We retrospectively reviewed 282 patients who underwent curative resection for gastric cancer at Parma University Hospital between 2000 and 2007. TNM stage, NR, overall survival, survival according to nodal status, and survival according to the total number of nodes retrieved were calculated. RESULTS At univariate analysis, the TNM stage, number of metastatic nodes, NR, and depth of tumor invasion, but not the number of nodes retrieved, were significant prognosis factors. Patients with more than 15 nodes retrieved in the specimen survived significantly longer (p < 0.04). This was confirmed for all N or NR classes within N groups. There was a correlation between the number of nodes retrieved and N but not with the NR category. NR was an independent prognostic factor at Cox regression. CONCLUSION NR is a reliable and sensitive tool to differentiate patients with similar characteristics, probably more so than the TNM system. NR is not strictly related to the number of nodes retrieved and this may potentially decrease the stage migration phenomenon. More trials are needed to validate this factor.
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Deng J, Liang H, Wang D, Sun D, Ding X, Pan Y, Liu X. Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes. Ann Surg Oncol 2010; 17:1043-1051. [PMID: 20039218 DOI: 10.1245/s10434-009-0863-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of the negative lymph node (NLN) count on the prognostic prediction of the ratio between positive and examined lymph nodes (RML) in gastric cancer after curative resection. METHODS The positive and negative node counts were determined for 456 patients who underwent curative resection for gastric cancer. Overall survival was examined according to clinicopathologic variables. The correlation between the NLN count and the aforementioned best variable for prediction the disease-specific overall survival was examined. RESULTS The NLN count cutoffs were designed as 0-9, 10-14, and > or =15, with the 5-year survival rate 4.1, 30.7, and 74.8%, respectively. RML of 98 patients who had an NLN count of nine or fewer was > or =40%. The median survival of these patients was 12 months. Of 88 patients who had 10 to 14 NLN count, 7 had 74-month median survival with 0.1-10% RML, 52 had 47-month median survival with 10.1-40% RML, and 29 had 22-month median survival with >40% RML. Of 270 patients who had > or =15 NLN count, 157 had 114-month median survival without positive nodes, 62 had 98-month median survival with 0.1-10% RML, 45 had 40-month median survival with 10.1-40% RML, and 6 had 14-month median survival with >40% RML. CONCLUSIONS The NLN count is a key factor for improvement of survival prediction of RML in gastric cancer.
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Affiliation(s)
- Jingyu Deng
- Gastric Cancer Surgery Division, Tianjin Medical University Cancer Hospital and City Key Laboratory of Tianjin Cancer Center, Tianjin, China
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35
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Fukuda N. Moving from lymph node metastasis in gastric cancer to biological markers: reply to letter. World J Surg 2010; 34:1142-3. [PMID: 20155265 DOI: 10.1007/s00268-010-0461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Maduekwe UN, Lauwers GY, Fernandez-Del-Castillo C, Berger DL, Ferguson CM, Rattner DW, Yoon SS. New metastatic lymph node ratio system reduces stage migration in patients undergoing D1 lymphadenectomy for gastric adenocarcinoma. Ann Surg Oncol 2010; 17:1267-77. [PMID: 20099040 DOI: 10.1245/s10434-010-0914-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system for gastric cancer incorporates the absolute number of metastatic lymph nodes (N status) and is optimally used when >or=15 nodes are examined. The ratio of metastatic to examined nodes (N ratio) is an effective prognostic tool, but has not been examined in Western patients undergoing primarily D1 lymphadenectomy. METHODS Two hundred and fifty seven patients with gastric adenocarcinoma who underwent gastric resection between 1995 and 2005 at our institution were examined. Novel N ratio intervals were determined using the best cutoff approach (Nr0: N ratio = 0 and >or=15 nodes examined; Nr1: 0 <or= N ratio <or= 0.3; Nr2: 0.3 < N ratio <or= 0.7; and Nr3: N ratio > 0.7). Overall survival was examined according to N status and N ratio. RESULTS 83% of patients underwent D1 lymphadenectomy with a median of 14 lymph nodes examined. Overall survival stratified by N status was significantly different in patients with <15 nodes examined compared with those with >or=15 nodes examined. When we stratified by N ratio intervals, there was no significant difference in overall survival in patients with <15 versus >or= 15 nodes examined. On multivariate analysis, N ratio but not N status was retained as an independent prognostic factor. CONCLUSIONS The use of N status for staging patients undergoing primarily D1 lymphadenectomy results in significant stage migration due to varying numbers of nodes examined. Use of N ratio reduces stage migration and may be a more reliable method of staging these patients.
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Affiliation(s)
- Ugwuji N Maduekwe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Bilici A, Seker M, Ustaalioglu BBO, Yilmaz B, Doventas A, Salepci T, Gumus M. Determining of metastatic lymph node ratio in patients who underwent D2 dissection for gastric cancer. Med Oncol 2009; 27:975-84. [PMID: 19885750 DOI: 10.1007/s12032-009-9319-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 09/18/2009] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to determine outcome of the ratio of metastatic lymph nodes to the total number of dissected lymph nodes (MLR) in patients with gastric cancer. We retrospectively analyzed 111 patients who underwent D(2) lymph node dissection. The prognostic factors including UICC/AJCC TNM classification and MLR were evaluated by univariate and multivariate analysis. The MLR was significantly higher in patients with a larger tumor, lymphatic vessel invasion, blood vessel invasion and perineural invasion, and advanced stage. Moreover, the MLR was significantly associated with the depth of invasion and the number of lymph node metastasis. The univariate analysis revealed for overall survival (OS) that stage of disease, lymphatic vessel invasion, blood vessel invasion, perineural invasion, lymph node metastasis (UICC/AJCC pN stage) and MLR were relevant prognostic indicators. Furthermore, both UICC/AJCC pN stage and MLR were detected as prognostic factor by multivariate analysis, as was perineural invasion. Our results indicated that MLR and UICC/AJCC pN staging system were important prognostic factors for OS of patients with D(2) lymph node dissection in gastric cancer in a multivariate analysis. MLR may be useful for evaluating the status of lymph node metastasis in gastric cancer.
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Affiliation(s)
- Ahmet Bilici
- Department of Medical Oncology, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
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38
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Kim CY, Yang DH. Adjustment of N stages of gastric cancer by the ratio between the metastatic and examined lymph nodes. Ann Surg Oncol 2009; 16:1868-74. [PMID: 19434459 DOI: 10.1245/s10434-009-0430-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 02/18/2009] [Accepted: 02/18/2009] [Indexed: 12/25/2022]
Abstract
BACKGROUND The present study attempted to determine whether N stage could be adjusted for the differences in survival rates based on the ratio between the examined and metastatic lymph nodes (LN ratio). METHODS Five hundred and twenty-nine patients with both >15 lymph nodes examined and >or= N1 after R0 resection were enrolled in the present study. To determine the cutoff LN ratio, the ratios at each N stage were compared at intervals of 10% with the log-rank test of Kaplan-Meier estimates of the survival curves. RESULTS The 5-year survival rate of patients with N1 was 71.7%. Those of N2 patients with LN ratio of <60% (n = 116) and >or=60% (n = 3) were 37.0% and 0%, respectively. Those of N3 patients with LN ratio of <30% (n = 32), between 30% and 60% (n = 67), and >or=60% (n = 26) were 31.0%, 16.3%, and 0%, respectively. Thus, adjusted N2 was obtained from the sum of N2 < 60% and N3 < 30%. N3 with an LN ratio between 30% and 60% was regarded as adjusted N3. N2 and N3 patients with an LN ratio of >or=60% were regarded as adjusted T4. The 5-year survival rate in patients with adjusted N2, N3, and N4 were 35.7%, 16.3%, and 0%, respectively. Multivariate analysis showed adjusted N stage and tumor depth were significant independent prognostic factors. CONCLUSIONS The results of this study suggest that, since stage migration can be induced in the N staging system, such stage migration can be adjusted by the LN ratio based on the survival rate.
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Affiliation(s)
- Chan-Young Kim
- Department of Surgery, Chonbuk National University Medical School, Chonju, Chonbuk, Korea
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Wang X, Wan F, Pan J, Yu GZ, Chen Y, Wang JJ. Prognostic value of the ratio of metastatic lymph nodes in gastric cancer: An analysis based on a Chinese population. J Surg Oncol 2009; 99:329-34. [DOI: 10.1002/jso.21247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Dixit S, Tilston M, Peter WM. Risk stratification for recurrence in patients with esophageal and junctional carcinoma treated with neoadjuvant chemotherapy and surgery. Med Oncol 2009; 27:242-8. [PMID: 19308739 DOI: 10.1007/s12032-009-9199-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 03/04/2009] [Indexed: 11/24/2022]
Abstract
AIM To stratify the risk for recurrence in patients with esophageal cancer treated with neoadjuvant chemotherapy and surgery. MATERIALS AND METHODS The prognostic and predictive factors were analyzed in 62 patients who underwent curative resection following chemotherapy. The factors found significant on multivariate analysis were stratified into good, intermediate and high risk groups for recurrence. RESULTS Kaplan-Meier survival at 3 and 5 years was 32% and 20%, respectively, with a median survival of 19 months. Pathological response and percent node positive were the significant factors on multivariate analysis. Three groups were formed and their recurrence free survivals were calculated using Kaplan-Meier method. The low risk composed of good responders and patients with less than 20% positive lymph node; the intermediate risk composed of non-responders and patients with less than 20% positive lymph node and the high risk group composed of non-responders and patients with more than 20% positive lymph node. The median recurrence time was 8 months for the high risk group, 39 months for the intermediate group, and it has not reached in the low risk group. Hazard ratio was 0.39(95% C.I. 0.09-0.98) for the risk group low to intermediate, 0.1(95% C.I. 0.04-0.25) for the low to high risk group and 0.26(95% C.I. 0.11-0.66) for the intermediate to high risk group. CONCLUSIONS Pathological response rate and percent node positive were significant predictive factors on multivariate analysis. Stratification based on these two predictive factors may help in optimizing any adjuvant treatment.
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Affiliation(s)
- S Dixit
- Department of Clinical Oncology, Castle Hill Hospital, Hull & East Yorkshire NHS Trust, Castle Road, Cottingham, Hull HU16 JQ, UK.
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Xu DZ, Geng QR, Long ZJ, Zhan YQ, Li W, Zhou ZW, Chen YB, Sun XW, Chen G, Liu Q. Positive lymph node ratio is an independent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol 2008; 16:319-26. [PMID: 19050970 DOI: 10.1245/s10434-008-0240-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 10/19/2008] [Accepted: 10/19/2008] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to clarify the outcome of the ratio between metastatic and examined lymph nodes (N ratio) in gastric cancer patients with < or =15 examined lymph nodes after D2 lymphadenectomy. A retrospective study was performed in 906 patients with gastric cancer who had undergone D2 resection. Patients with < or =15 examined lymph nodes (group 1, n = 729) and those with >15 lymph nodes (group 2, n = 177) were analyzed separately. N ratio categories were identified as follows: N ratio 0, 0%; N ratio 1, 1% to 9%; N ratio 2, 10% to 25%; N ratio 3, >25%. Univariate analysis found that both the tumor, node, metastasis system (N staging system) and N ratio system well classified patients with significantly different prognosis. By multivariate analysis, only the N ratio classification was retained as an independent prognostic factor in both group 1 and 2 compared with the N stage system. Furthermore, when patients were divided into four groups according to the number of lymph nodes examined (1 to 3, 4 to 7, 8 to 11, and 12 to 15), the 5-year survival rates remained similar between groups according to the same N ratio (p > .05). Positive N ratio classification is a better prognostic tool compared with N staging system after D2 resection in patients with gastric cancer. It can prevent stage migration and can be used regardless of the examined number of lymph nodes.
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Affiliation(s)
- Da-zhi Xu
- State Key Laboratory of Oncology in South China, Guangzhou.
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Liu C, Lu Y, Jun Z, Zhang R, Yao F, Lu P, Jin F, Li H, Xu H, Wang S, Chen J. Impact of total retrieved lymph nodes on staging and survival of patients with gastric cancer invading the subserosa. Surg Oncol 2008; 18:379-84. [PMID: 18954972 DOI: 10.1016/j.suronc.2008.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Revised: 08/10/2008] [Accepted: 09/18/2008] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate the impact of total retrieved lymph nodes (tLNs) on staging and survival in patients with pT2b gastric cancer according to the nodal status. METHODS Clinicopathological characteristics and prognostic outcomes of 392 patients with pT2b gastric cancer between 1980 and 2005 were retrospectively investigated based on the nodal status. RESULTS The number of metastatic lymph nodes (mLNs) was highly correlated with the number of tLNs (P<0.001). The overall 5-year and 10-year survival rates were 39.0% (153/392) and 17.9% (70/392), respectively. The survival rates in patients with pN0 cancers did not differ significantly from that in patients with pN1 cancer when the tLNs were 25 or less. However, the survival rate in patients with N0 cancers was significantly greater than that in patients with pN1 cancers when the tLNs were more than 25 (64.3% vs. 36.9%, chi(2)=4.339, P=0.037). Moreover, both 5- and 10-year survival rates differed significantly among patients with pN1, pN2 and pN3 gastric cancer regardless of tLNs. Multivariate analysis revealed that age, tumor focus number, tumor location, and mLN, but not tLNs, were independent prognostic predictors in patients with pT2b gastric cancer. CONCLUSIONS To improve the accuracy of staging, no less than 15 tLNs should be pathologically examined in patients with pN1-3, and 25 tLNs for the patients with N0. More tLNs may not be associated with a better prognosis in pT2b disease because the extent of lymph node dissection is pre-defined for the operation.
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Affiliation(s)
- Caigang Liu
- Department of Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province 110001, China
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Huang CM, Lin BJ, Lu HS, Zhang XF, Li P, Xie JW. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus. World J Gastroenterol 2008; 14:4383-4388. [PMID: 18666330 PMCID: PMC2731193 DOI: 10.3748/wjg.14.4383] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 06/02/2008] [Accepted: 06/09/2008] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. METHODS Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients. RESULTS The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (c2 = 4.26, P = 0.0389), tumor size (c2 = 18.48, P < 0.001), Borrmann type (c2 = 7.41, P = 0.0065), histological grade (c2 = 5.07, P = 0.0243), pT category (c2 = 49.42, P < 0.001), pN category (c2 = 87.7, P < 0.001), total number of retrieved lymph nodes (c2 = 8.22, P = 0.0042) and MLR (c2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (c2 = 7.985, P = 0.018), pT category (c2 = 30.82, P < 0.001) and MLR (c2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple linear regression (beta = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%. CONCLUSION The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.
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Wang X, Wan F, Wang JJ. A Common Misuse of Stepwise Regression in Studies of Ratio of Metastatic Lymph Nodes for Gastric Cancer. Ann Surg Oncol 2008; 15:1805-6. [DOI: 10.1245/s10434-008-9908-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 03/12/2008] [Indexed: 01/22/2023]
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