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Wang ZL, Li YL, Tang L, Li XT, Bu ZD, Sun YS. Utility of the gastric window in computed tomography for differentiation of early gastric cancer (T1 stage) from muscularis involvement (T2 stage). Abdom Radiol (NY) 2021; 46:1478-1486. [PMID: 33000287 DOI: 10.1007/s00261-020-02785-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyze the diagnostic value of using the gastric window in computed tomography for differentiation of early gastric cancer (T1 stage) from muscularis involvement (T2 stage). MATERIALS AND METHODS All patients with pathologically confirmed T1 stage and T2 stage gastric cancer and who underwent endoscopic resection or gastrectomy at our institution from January 2011 to November 2018 were examined. Each patient received an enhanced CT scan of the abdomen before the operation. T staging of tumors based on the CT scans was performed independently by two radiologists using the gastric window (width 150-200 HU, level 80-100 HU) and the abdominal window (width 350-400 HU, level 50 HU). RESULTS Use of the gastric window to diagnose stage T1 EGC led to an accuracy of 88.9% for observer1 and 91.5% for observer2; use of the abdominal window led to an accuracy of 53.6% for observer1 and 51.6% (38/106) for observer2. Use of the gastric window to diagnose stage T2 led to an accuracy of 85.6% for observer1 and 82.4% for observer2; use of the abdominal window led to an accuracy of 52.3% for both observer1 and observer2. For observer1, use of the gastric window had a diagnostic accuracy of 69.2% for stage T1a and 62.5% for stage T1b; for observer2, the diagnostic accuracy was 65.1% for stage T1a and 67.0% for stage T1b. A Kappa test indicated moderate and substantial inter-observer agreement for T staging with gastric window (κ = 0.598, P < 0.001) and abdominal window (κ = 0.745, P < 0.001). CONCLUSION Use of the gastric window in computed tomography provided more accurate staging for T1 and T2 stages of gastric cancer than the conventional abdominal window.
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Affiliation(s)
- Zhi-Long Wang
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yan-Ling Li
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Lei Tang
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Xiao-Ting Li
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhao-De Bu
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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Multidisciplinary Approach in Improving Survival Outcome of Early-Stage Gastric Cancer. J Surg Res 2020; 255:285-296. [PMID: 32574755 DOI: 10.1016/j.jss.2020.05.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/06/2020] [Accepted: 05/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The necessity of extensive lymph node (LN) dissection/examination and adjuvant therapy for patients with early gastric cancer (EGC, Tis-T1, any N) remains controversial. We aim to refine treatment recommendations for patients with EGC through a reflective analysis for the survival gap between Eastern and Western countries. METHODS EGC patients diagnosed between 2004 and 2014 were identified from the National Cancer Database (NCDB) and a large medical center in China. Adequate LN yield was defined as ≥25 LNs examined. RESULTS In the US cohort, 14.4% of (1104/7641) patients with EGC had ≥25 LNs examined. The 5-y overall survival (OS) was significantly better than those with <25 LNs (78.9% versus 68.5%, P < 0.001). Examination of ≥25 LNs was an independent predictor of better OS after adjusting all known prognostic factors. Patients with ≥25 LNs examined had significantly higher chance of having LN-positive disease compared to patients with <25 LNs (14.9% versus 10.7%, P < 0.001). A similar stage migration phenomenon was observed in Chinese cohort (LN positive: 25.2% versus 18.4% in ≥25 LNs and <25 LNs examined group, respectively, P = 0.02). In the US cohort, adjuvant therapy was associated with a significant survival benefit for LN-positive patients (5-y OS: 71.0% versus 43.0% for with/without adjuvant therapy, respectively, P < 0.001) but not in LN-negative patients (5-y OS: 71.2% versus 71.5%, P = 0.90). CONCLUSIONS Adequate lymphadenectomy and LN examination are critical components of EGC management. Adjuvant therapy should be strongly encouraged for all EGC patients with LN-positive disease in the United States.
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Mogal H, Fields R, Maithel SK, Votanopoulos K. In Patients with Localized and Resectable Gastric Cancer, What is the Optimal Extent of Lymph Node Dissection-D1 Versus D2 Versus D3? Ann Surg Oncol 2019; 26:2912-2932. [PMID: 31076930 DOI: 10.1245/s10434-019-07417-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite advances in the treatment of patients with gastric cancer, the debate over the optimal extent of lymphadenectomy continues. METHOD A review of the classification, rationale for, and boundaries of lymphadenectomy is presented. A review of the available literature comparing D1 versus D2 versus D3 lymphadenectomy was performed and included randomized controlled trials, and prospective and retrospective comparative and non-comparative studies. RESULTS Earlier studies demonstrated increased morbidity with D2 compared with D1 lymphadenectomy, with no significant survival benefit. More recent studies have demonstrated survival benefit of a pancreas and spleen-sparing D2 lymphadenectomy in patients with advanced, node-positive tumors. Para-aortic/D3 dissections contribute to increased morbidity, with no survival benefit. CONCLUSIONS In patients with resectable gastric adenocarcinoma, a D2 lymph node dissection preserving the pancreas and spleen should be considered standard for optimal staging and treatment, provided it is performed by surgeons with sufficient expertise. Extended lymph node dissections beyond D2 should not be routinely performed as it has been shown to have increased morbidity, with no improvement in outcomes. While systemic chemotherapy should be considered standard in patients undergoing D2 lymphadenectomy, the role of adjuvant radiation continues to evolve.
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Affiliation(s)
- Harveshp Mogal
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Ryan Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Shishir K Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
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Zheng Z, Zhang Y, Zhang L, Li Z, Wu X, Liu Y, Bu Z, Ji J. A nomogram for predicting the likelihood of lymph node metastasis in early gastric patients. BMC Cancer 2016; 16:92. [PMID: 26873736 PMCID: PMC4751748 DOI: 10.1186/s12885-016-2132-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/07/2016] [Indexed: 12/17/2022] Open
Abstract
Background Early gastric cancer is defined as a lesion confined to the mucosa or submucosa, regardless of the size or lymph node metastasis. Treatment methods include endoscopic mucosal resection or endoscopic submucosal dissection, wedge resection, laparoscopically assisted gastrectomy and open gastrectomy. Lymph node metastasis is strong related with survival and recurrence. Therefore, the likelihood of lymph node metastasis is one of the most important factors when determining the most appropriate treatment. Methods We retrospectively analyzed 597 patients who underwent D2 gastrectomy for early gastric cancer. The relationship between lymph node metastasis and clinicopathological features was analyzed. Using multivariate logistic regression analyses, we created a nomogram to predict the lymph node metastasis probability for early gastric cancer. Receiver operating characteristic analyses was performed to assess the predictive value of the model. Results In the present study, 58 (9.7 %) early gastric cancer patients were histologically shown to have lymph node metastasis. The multivariate logistic regression analysis demonstrated that the age at diagnosis, differentiation status, the presence of ulcers, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in early gastric cancer. Additionally, the tumor macroscopic type, size and histology type significantly correlated with these important independent factors. We constructed a predictive nomogram with these factors for lymph node metastasis in early gastric cancer patients, and the discrimination was good with the AUC of 0.860 (95 % CI: 0.809–0.912). Conclusions We developed an effective nomogram to predict the incidence of lymph node metastasis for early gastric cancer patients.
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Affiliation(s)
- Zhixue Zheng
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Yinan Zhang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Lianhai Zhang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Ziyu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Xiaojiang Wu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Yiqiang Liu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
| | - Zhaode Bu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
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Zheng Z, Zhang Y, Zhang L, Li Z, Wu A, Wu X, Liu Y, Bu Z, Ji J. Nomogram for predicting lymph node metastasis rate of submucosal gastric cancer by analyzing clinicopathological characteristics associated with lymph node metastasis. Chin J Cancer Res 2016; 27:572-9. [PMID: 26752931 DOI: 10.3978/j.issn.1000-9604.2015.12.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To combine clinicopathological characteristics associated with lymph node metastasis for submucosal gastric cancer into a nomogram. METHODS We retrospectively analyzed 262 patients with submucosal gastric cancer who underwent D2 gastrectomy between 1996 and 2012. The relationship between lymph node metastasis and clinicopathological features was statistically analyzed. With multivariate logistic regression analysis, we made a nomogram to predict the possibility of lymph node metastasis. Receiver operating characteristic (ROC) analysis was also performed to assess the predictive value of the model. Discrimination and calibration were performed using internal validation. RESULTS A total number of 48 (18.3%) patients with submucosal gastric cancer have pathologically lymph node metastasis. For submucosal gastric carcinoma, lymph node metastasis was associated with age, tumor location, macroscopic type, size, differentiation, histology, the existence of ulcer and lymphovascular invasion in univariate analysis (all P<0.05). The multivariate logistic regression analysis identified that age ≤50 years old, macroscopic type III or mixed, undifferentiated type, and presence of lymphovascular invasion were independent risk factors of lymph node metastasis in submucosal gastric cancer (all P<0.05). We constructed a predicting nomogram with all these factors for lymph node metastasis in submucosal gastric cancer with good discrimination [area under the curve (AUC) =0.844]. Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability. CONCLUSIONS We developed a nomogram to predict the rate of lymph node metastasis for submucosal gastric cancer. With good discrimination and internal validation, the nomogram improved individualized predictions for assisting clinicians to make appropriated treatment decision for submucosal gastric cancer patients.
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Affiliation(s)
- Zhixue Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yinan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lianhai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Aiwen Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiaojiang Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yiqiang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaode Bu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Giuliani A, Miccini M, Basso L. Extent of lymphadenectomy and perioperative therapies: Two open issues in gastric cancer. World J Gastroenterol 2014; 20:3889-3904. [PMID: 24744579 PMCID: PMC3983445 DOI: 10.3748/wjg.v20.i14.3889] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/23/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is one of the leading causes of death for cancer worldwide, although geographical variations in incidence exist. Over the last decades, its incidence and mortality have gradually decreased in Western countries, while these have increased, or remained stable, in the other world regions. Gastric cancer is often diagnosed at an advanced stage, with the only notable exception of Japan, where nationwide screening programs are enforced, due to local high incidence. Curative- intent surgery (i.e., gastrectomy, total or partial, and lymphadenectomy) remains the cornerstone of treatment of gastric cancer. Much has been debated about the extent of lymph node dissection and, although it is a valuable contribution to staging and cure, operative treatment only represents one aspect of overall effective management, as the risk of both locoregional and distant recurrences are high, and bear a poor prognosis. As a matter of fact, surgery, as a single modality treatment, has probably achieved its maximum efficacy for local control and survival, while other accompanying nonsurgical treatment modalities have to be taken into account, although their role is still the subject of considerable debate. The authors in this review present an update on the outcome of treatment of gastric cancer in relation to the extent of lymphadenectomy and of various nonsurgical preoperative, intraoperative, and postoperative strategies.
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Milhomem LM, Cardoso DMM, Mota ED, Fraga-Júnior AC, Martins E, Mota OMD. Frequency and predictive factors related to lymphatic metastasis in early gastric cancer. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:235-9. [PMID: 23411921 DOI: 10.1590/s0102-67202012000400005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 09/10/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The standard treatment of gastric cancer still has high morbidity and mortality in western populations. Groups of patients with negligible risk of lymph node metastasis may benefit from less invasive treatments. Data regarding the frequency and predictive factors related to lymphatic metastasis in early gastric cancer are rare. AIM To perform the analysis of frequency and predictive factors related to lymphatic metastasis in patients with early gastric cancer treated in a tertiary center in Brazil. METHODS Nine hundred and twenty three patients underwent gastrectomy for gastric adenocarcinoma at the hospital. Of these, 126 had early tumors and were included in the analysis. Clinical and pathological related findings and lymphatic metastasis were evaluated. RESULTS Lymph node metastases were observed in 7.8% of patients with mucosal tumors and 22.6% of submucosal tumors. The presence of ulceration, Lauren histologic type, tumors larger than 50 mm, submucosal invasion, and presence of lymphatic or vascular invasion were significant factors in univariate analysis. The presence of ulceration, lesions larger than 50 mm, infiltration of the submucosal layer and lymphatic invasion were factors independently related to lymphatic metastasis in multivariate analysis. CONCLUSION Ulceration, lesions larger than 50 mm, infiltration of the submucosal layer and lymphatic invasion are independent risk factors related to lymphatic metastasis in early gastric cancer.
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Lee HH, Yoo HM, Song KY, Jeon HM, Park CH. Risk of limited lymph node dissection in patients with clinically early gastric cancer: indications of extended lymph node dissection for early gastric cancer. Ann Surg Oncol 2013; 20:3534-40. [PMID: 23846783 DOI: 10.1245/s10434-013-3124-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic gastrectomy is usually indicated in T1 N0-1 early gastric cancer (EGC). Limited lymph node dissection, such as D1+, is applied in these cases. However, preoperative staging is not always correct, and the risk of undertreatment thus exists. METHODS Patients with clinically early gastric cancer (cEGC) who underwent gastrectomy with lymph node dissection of D2 and over were selected from 4,021 patients with gastric cancer. The station numbers of all metastatic lymph nodes (MLNs) were identified, and MLNs were classified into groups 1 and 2 (including lymph nodes of second tier and over) on the basis of the system of the Japanese Gastric Cancer Association, irrespective of the number of MLNs. Clinicopathological data were compared according to the existence of lymph node metastasis and the classification of MLNs. RESULTS Of 1,308 patients with cEGC who fulfilled the inclusion criteria, 1,184 (90.5 %) were diagnosed pathologically with EGC. Among 126 patients with cEGC who were diagnosed with lymph node metastasis, 93 patients had only group 1 MLNs and 33 patients had group 2 MLNs. Tumor location in the proximal third of the stomach (odds ratio 5.450) and ulceration (odds ratio 11.928) were significant factors for group 2 metastasis. CONCLUSIONS Extended lymph node dissection is recommended in cEGC with ulceration or disease located in the proximal third of the stomach.
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Affiliation(s)
- Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Feng JF, Huang Y, Liu J, Liu H, Sheng HY, Wei WT, Lu WS, Chen DF, Chen WY, Zhou XM. Risk factors for No. 12p and No. 12b lymph node metastases in advanced gastric cancer in China. Ups J Med Sci 2013; 118:9-15. [PMID: 23039019 PMCID: PMC3572676 DOI: 10.3109/03009734.2012.729103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The risk factors for No. 12p and No. 12b lymph node (LN) metastases in advanced gastric cancer (GC) remain controversial. The aim of this study was to investigate the risk factors for No. 12p and No. 12b LN metastases in advanced GC. METHODS From January 1999 to December 2005, a retrospective analysis of 163 patients with advanced GC who underwent D2 lymphadenectomy in addition to No. 12p and No. 12b LN dissections was conducted. Potential clinicopathological factors that could influence No. 12p and No. 12b LN metastases were statistically analyzed. RESULTS There were 15 cases (9.2%) with No. 12p LN metastases and 5 cases (3.1%) with synchronous No. 12b LN metastases. A logistic regression analysis revealed that the Borrmann type (III/IV versus I/II, P = 0.029), localization (lesser/circular versus greater, P = 0.025), and depth of invasion (pT4 versus pT2/pT3, P = 0.009) were associated with 11.1-, 3.8-, and 5.6-fold increases, respectively, for risk of No. 12p and No. 12b LN metastases. A logistic regression analysis also showed that No. 5 (P = 0.006) and No. 12a (P = 0.004) LN metastases were associated with 6.9- and 11.3-fold increases, respectively, for risk of No. 12p and No. 12b LN metastases. In addition, significant differences in 5-year survival of patients with and without No. 12p and No. 12b LN metastases were observed (13.3% versus 35.1%, P = 0.022). CONCLUSION We conclude that Borrmann type, localization, and depth of invasion are significant variables for identifying patients with No. 12p and No. 12b LN metastases. Individuals with No. 5 or No. 12a LN metastases should be on high alert for the possibility of additional metastases to the No. 12p and No. 12b LNs.
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Affiliation(s)
- Ji- Feng Feng
- Department of Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Ying Huang
- Nursing Department, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Jing Liu
- Department of General Surgery, Southeast Hospital Affiliated to Xiamen University, Zhangzhou, People's Republic of China
| | - Huang Liu
- Department of Clinical Medicine, Medical College of Xiamen University, Xiamen, People's Republic of China
| | - Hua-Ying Sheng
- Nursing Department, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Wei-Tian Wei
- Department of Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Wei-Shan Lu
- Department of Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Da-Feng Chen
- Department of General Surgery, Southeast Hospital Affiliated to Xiamen University, Zhangzhou, People's Republic of China
| | - Wen-You Chen
- Department of General Surgery, Southeast Hospital Affiliated to Xiamen University, Zhangzhou, People's Republic of China
| | - Xing-Ming Zhou
- Department of Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
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Lee MH, Choi D, Park MJ, Lee MW. Gastric cancer: imaging and staging with MDCT based on the 7th AJCC guidelines. ACTA ACUST UNITED AC 2013; 37:531-40. [PMID: 21789552 DOI: 10.1007/s00261-011-9780-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastric cancer is a common deadly cancer worldwide. The tumor-node-metastasis (TNM) staging system is one of the most commonly used staging systems, and is accepted and maintained by the International Union against Cancer (UICC) and the American Joint Committee on Cancer (AJCC). The TNM system is well known to effectively predict the prognosis of gastric cancer patients. The latest revision of TNM staging was presented in the 7th edition of the AJCC in 2009. Multi-detector row CT (MDCT) is a powerful test for non-invasive evaluation and can assess metastatic and locoregional staging simultaneously. Current MDCT with isotropic imaging and 3D images has increased the accuracy of T and N staging in patients with gastric cancer. Multi-planar reformatted images permit the radiologist to select the optimal imaging plane to accurately evaluate tumor invasion depth of the gastric wall and perigastric infiltration to identify a fat plane between a tumor and adjacent organs, to avoid partial volume averaging effects, and to differentiate lymph nodes from small perigastric vessels. Thus, MDCT provides a useful all-in-one diagnostic method for the pre-operative evaluation of patients with known, or strongly suspected, gastric cancer according to the 7th AJCC TNM staging system.
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Affiliation(s)
- Mi Hee Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Ku, Seoul, Republic of Korea
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Bravo Neto GP, Dos Santos EG, Loja CADS, Victer FC, Neves MS, Pinto MF, Carvalho CEDS. Minor gastric resections with modified lymphadenectomy in early gastric cancer with negative sentinel node. Rev Col Bras Cir 2012. [PMID: 22836565 DOI: 10.1590/s0100-69912012000300004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To study the sentinel lymph node in early gastric cancer as a diagnostic method of unsuspected lymph node metastasis, which may allow the performance, in those with negative lymph nodes, of smaller gastric resections with limited lymphadenectomy. METHODS We studied seven patients with early gastric cancer treated at the Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, from September 2008 to May 2011, who underwent sentinel lymph node exams, performed by intraoperative peritumoral endoscopic injection of patent blue dye. RESULTS We found an average of three sentinel nodes per patient. The frozen biopsy of lymph nodes was negative for metastases, which allowed the realization of atypical gastric resection in three cases and antrectomy with BI reconstruction in four. The performed lymphadenectomy was modified D1. There was no operative mortality. The duration of postoperative follow-up ranged from five to 37 months, without evidence of recurrence. One patient developed a second early tumor 13 months after the initial surgery and underwent total gastrectomy. CONCLUSION The sentinel lymph node in early gastric cancer proved to be an effective method for the evaluation of nodal metastases in seven patients and allowed for smaller gastric resections and limited lymphadenectomies. These minor procedures reduce the risk of postoperative complications, maintaining, on the other hand, the oncological radicality that is required in the treatment of gastric cancer.
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Abstract
OBJECTIVES To conduct a meta-analysis of randomized controlled trials evaluating the efficacy and drawbacks of limited (D1) versus extended lymphadenectomy (D2) for proven gastric adenocarcinoma. METHODS A search of Cochrane, Medline, PubMed, Embase, Science Citation Index and Current Contents electronic databases identified randomized controlled trials published in the English language between 1980 and 2008 comparing the outcomes of D1 versus D2 gastrectomy for gastric adenocarcinoma. The meta-analysis was prepared in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses statement. The 6 outcome variables analyzed included length of hospital stay; overall complication rate; anastomotic leak rate; reoperation rate; 30-day mortality rate and 5-year survival rate. Random effects meta-analyses were performed using odds ratios (OR) and weighted mean differences (WMD). RESULTS Six trials totaling 1876 patients (D1 = 946, D2 = 930) were analyzed. In 5 of the 6 outcomes the summary point estimates favored D1 over D2 group with a statistically significant reduction of (i) 6.37 days reduction in hospital stay (WMD -6.37, confidence interval [CI] -10.66, -2.08, P = 0.0036); (ii) 58% reduction in relative odds of developing postoperative complications (OR 0.42, CI 0.27, 0.66, P = 0.0002); (iii) 60% reduction in anastomotic breakdown (OR 0.40, CI 0.25, 0.63, P = 0.0001); (iv) 67% reduction in reoperation rate (OR 0.33, CI 0.15, 0.72, P = 0.006); and (v) 41% reduction in 30-day mortality rate (OR 0.59, CI 0.40, 0.85, P = 0.0054). Lastly there was no significant difference in the 5-year survival (OR 0.97, CI 0.78, 1.20, P = 0.7662) between D1 and D2 gastrectomy patients. CONCLUSIONS On the basis of this meta-analysis we conclude that D1 gastrectomy is associated with significant fewer anastomotic leaks, postoperative complication rate, reoperation rate, decreased length of hospital stay and 30-day mortality rate. Finally, the 5-year survival in D1 gastrectomy patients was similar to the D2 cohort.
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Shen Y, Kang HK, Jeong YY, Heo SH, Han SM, Chen K, Liu Y. Evaluation of early gastric cancer at multidetector CT with multiplanar reformation and virtual endoscopy. Radiographics 2011; 31:189-99. [PMID: 21257941 DOI: 10.1148/rg.311105502] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Early gastric cancer (EGC) is defined as a carcinoma in which invasion is limited to the mucosa and submucosa, regardless of lymph node status and distant metastasis. Recent advances in multidetector computed tomography (CT) with multiplanar reformation (MPR) provide a powerful tool for identifying gastric wall invasion and the perigastric extent of gastric cancer. In addition, MPR images confer advantages in the assessment of both intra- and extraluminal processes of the gastric wall and the evaluation of more distant regions, such as the paraaortic lymph nodes and other abdominal organs. Virtual endoscopy performed after air distention of the stomach can aid in the evaluation of gastric endoluminal morphologic features and the extent of EGC. Moreover, virtual endoscopy helps in detecting subtle mucosal changes and differentiating them from submucosal lesions in the same way as conventional endoscopy. Virtual endoscopy can depict abnormal endoluminal lesions within a wider field of view than can conventional endoscopy, and there are no "blind spots" because retrospective image reformation is available, which provides useful information for preoperative mapping. Multidetector CT with MPR and virtual endoscopy is a powerful, noninvasive tool for the early detection and accurate preoperative staging of EGC.
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Affiliation(s)
- Yulan Shen
- Department of Diagnostic Radiology, Shanghai Jiao Tong University Medical School, Rui Jin Hospital, China
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Impact on survival of the number of lymph nodes removed in patients with node-negative gastric cancer submitted to extended lymph node dissection. Eur J Surg Oncol 2011; 37:305-11. [DOI: 10.1016/j.ejso.2011.01.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/02/2011] [Accepted: 01/10/2011] [Indexed: 12/23/2022] Open
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Park KJ, Lee MW, Koo JH, Park Y, Kim H, Choi D, Lee SJ. Detection of early gastric cancer using hydro-stomach CT: Blinded vs unblinded analysis. World J Gastroenterol 2011; 17:1051-7. [PMID: 21448358 PMCID: PMC3057149 DOI: 10.3748/wjg.v17.i8.1051] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 11/26/2010] [Accepted: 12/03/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the difference in diagnostic performance of hydro-stomach computed tomography (CT) to detect early gastric cancer (EGC) between blinded and unblinded analysis and to assess independent factors affecting visibility of cancer foci.
METHODS: Two radiologists initially blinded and then unblinded to gastroscopic and surgical-histological findings independently reviewed hydro-stomach CT images of 110 patients with single EGC. They graded the visibility of cancer foci for each of three gastric segments (upper, middle and lower thirds) using a 4-point scale (1: definitely absent, 2: probably absent, 3: probably present, and 4: definitely present). The sensitivity and specificity for detecting an EGC were calculated. Intraobserver and interobserver agreements were analyzed. The visibility of an EGC was evaluated with regard to tumor size, invasion depth, gastric segments, histological type and gross morphology using univariate and multivariate analysis.
RESULTS: The respective sensitivities and specificities [reviewer 1: blinded, 20% (22/110) and 98% (215/220); unblinded, 27% (30/110) and 100% (219/220)/reviewer 2: blinded, 19% (21/110) and 98% (216/220); unblinded, 25% (27/110) and 98% (215/220)] were not significantly different. Although intraobserver agreements were good (weighted κ = 0.677 and 0.666), interobserver agreements were fair (blinded, 0.371) or moderate (unblinded, 0.558). For both univariate and multivariate analyses, the tumor size and invasion depth were statistically significant factors affecting visibility.
CONCLUSION: The diagnostic performance of hydro-stomach CT to detect an EGC was not significantly different between blinded and unblinded analysis. The tumor size and invasion depth were independent factors for visibility.
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The long-term results of distal gastrectomy by mini-laparotomy in early gastric cancer patients. J Gastrointest Surg 2010; 14:1917-22. [PMID: 20589443 DOI: 10.1007/s11605-010-1278-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 06/15/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Radical distal gastrectomy by mini-laparotomy is an alternative surgical treatment modality with technical feasibility in early gastric cancer (EGC) patients. The aim of this study is to assess the oncologic feasibility of distal gastrectomy by mini-laparotomy in EGC patients through a long-term survival analysis based on the prospectively collected data. PATIENTS AND METHODS From January 2003 to November 2003, a total of 53 EGC patients who received distal gastrectomy by laparotomy were enrolled in this study. These patients were divided into two groups, that is, the mini-laparotomy group (ML, n = 22) and the conventional laparotomy group (CL, n = 31). A comparative long-term survival analysis was performed. RESULTS The hospital stay was significantly shorter in mini-laparotomy group (P = 0.002). However, there were no significant differences in the pathologic results such as the resection margin and the number of harvested lymph nodes. In long-term survival results, there were no significant differences in disease-free and overall survival rate of the patients according to the method of laparotomy. CONCLUSIONS Radical distal gastrectomy by mini-laparotomy in EGC patients would be also one of the minimally invasive surgical modality in oncologic aspect.
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Kim HJ, Lee DH, Ko YT. Comparison between blinded and partially blinded detection of gastric cancer with multidetector CT using surgery and endoscopic submucosal dissection as reference standards. Br J Radiol 2010; 83:674-82. [PMID: 20551252 DOI: 10.1259/bjr/88793106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study is to compare blinded with partially blinded detection of gastric cancer with multidetector (MD) CT by using surgery and endoscopic submucosal dissection (ESD) as reference standards. 44 patients with gastric cancer underwent MDCT with air as an oral contrast agent. Surgery was performed on 37 patients, ESD on six and surgery after ESD on one. To provide comparison cases of blinded evaluation, 38 MDCT examinations were added for cases where no focal gastric lesion was seen on endoscopy. Two radiologists, blinded to the presence, number and location of the tumours, evaluated axial and axial plus multiplanar reformation (MPR) images of 82 MDCT examinations with or without gastric cancer. For partially blinded evaluation, the same radiologists, blinded to the location and number of tumours, evaluated axial and axial plus MPR images of 44 MDCT examinations of gastric cancer. Differences in assessment were resolved by consensus. 45 gastric cancers were found in surgical and ESD specimens. Detection rates of gastric cancer from axial and axial plus MPR images during blinded evaluation and from axial and axial plus MPR images during partially blinded evaluation were 62% (28/45), 64% (29/45), 64% (29/45) and 71% (32/45), respectively. There was no statistical significance for the comparison between blinded and partially blinded detection rates of gastric cancer. The detection rate of gastric cancer with MDCT during blinded evaluation showed no specific difference compared with the detection rate of gastric cancer with MDCT during partially blinded evaluation.
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Affiliation(s)
- H J Kim
- Department of Radiology, Kyung Hee University Medical Center, 1, Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea.
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Xie HL, Li ZY, Gan RL, Li XJ, Zhang QL, Hui M, Zhou XT. Differential gene and protein expression in primary gastric carcinomas and their lymph node metastases as revealed by combined cDNA microarray and tissue microarray analysis. J Dig Dis 2010; 11:167-75. [PMID: 20579220 DOI: 10.1111/j.1751-2980.2010.00432.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To gain insight into the molecular events of lymph node metastasis of human gastric carcinoma. METHODS The gene expression profile of five matched primary gastric carcinomas and their lymph node metastases was analyzed by complementary DNA (cDNA) microarray. Differential genes were identified in the metastatic and corresponding primary tumor pairs. Among the differentially expressed genes, carbonic anhydrase II (CAII) and insulin-like growth factor binding protein 4 (IGFBP 4) genes were detected by RT-PCR. CTTN protein expression was examined by tissue microarray. RESULTS There was a high expression (over twofold) of 44 genes and a low expression (under twofold) of 32 genes in lymph node metastasis compared with primary gastric carcinoma, respectively. CAII mRNA was downregulated and IGFBP 4 mRNA was upregulated in paired lymph node metastases of gastric carcinomas. The overexpression of CTTN protein was related to the lymph node metastasis and the clinical stage of gastric carcinomas. CONCLUSION This study showed that there is a low expression of genes relative to growth signal and immune response in lymph node metastases, and a high expression of genes relative to growth factor, cell cycle, cell motility and adhesion in lymph node metastases compared with primary gastric carcinomas. The expression of CTTN was related to the invasion and metastasis of gastric cancer.
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Affiliation(s)
- Hai Long Xie
- Cancer Research Institute, Medical College of University of South China, Hengyang, Hunan Province, China
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Clinicopathological features associated with lymph node metastasis in early gastric cancer: analysis of a single-institution experience in China. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:353-6. [PMID: 19440566 DOI: 10.1155/2009/462678] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND An accurate assessment of potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the number of invasive procedures used in cancer therapy is critical for improving the patient's quality of life. OBJECTIVE To evaluate the clinicopathological features associated with lymph node metastasis of early gastric cancer in patients from a single institution in China. METHODS A retrospective review of data from 410 patients surgically treated for early gastric cancer at the First Affiliated Hospital (Nanjing, China) between 1998 and 2007, was conducted. The clinicopathological variables associated with lymph node metastasis were evaluated. RESULTS Lymph node metastasis was observed in 12.20% of patients. The macroscopic type, tumour size, location in the stomach, depth of gastric carcinoma infiltration, and presence of vascular or lymphatic invasion showed a positive correlation with the incidence of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For intramucosal cancer, tumour size was the unique risk factor for lymph node metastasis. For submucosal cancer, histological classification and tumour size were independent risk factors for lymph node metastasis. CONCLUSIONS Histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in patients with early gastric cancer in China. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible for highly selected cancers.
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Yakoub D, Athanasiou T, Tekkis P, Hanna GB. Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach? Surg Oncol 2008; 18:322-33. [PMID: 18922689 DOI: 10.1016/j.suronc.2008.08.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 07/20/2008] [Accepted: 08/21/2008] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aims to compare short term outcomes and oncological value of laparoscopy assisted (LADG) and open distal gastrectomy (ODG) in the treatment of early gastric cancer. METHODS Meta-analysis of 12 studies, including three randomized controlled trials, published between 2000 and 2007, comparing laparoscopy assisted and open distal gastrectomy in 951 patients with early gastric cancer, was done. Outcomes of interest were operative data, lymph node clearance, postoperative recovery complications. RESULTS Overall morbidity rate was significantly less with LADG (10.5% versus 20.1%, P=0.003, OR 0.52, CI 0.34-0.8). A mean of 4.61 less number of lymph nodes dissected than ODG (CI -5.96, -3.26 P<0.001) when all studies are included. There was no difference between the two groups in number of lymph nodes dissected when less than D2 lymphadenectomy was done (2.44 nodes less in LADG group, CI -5.52, 0.63; P=0.12). LADG patients had less operative blood loss (mean of 151ml, P<0.001), less time to walking, oral intake and flatus. LADG patients had less length of hospital stay (5.7days, P<0.001), postoperative fever and pain. ODG group showed significantly less operative time. There was no significant difference between the two groups in the incidence of anastomotic complications and wound infection. CONCLUSION LADG is a safe technical alternative to ODG for early gastric cancer with a lower overall complication rate and enhanced postoperative recovery. Endorsing LADG as a better alternative to ODG requires data on long term survival, quality of life and cost effectiveness.
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Affiliation(s)
- Danny Yakoub
- Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK
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Recent advances in conventional and molecular prognostic factors for gastric carcinoma. Surg Oncol Clin N Am 2008; 17:467-83, vii. [PMID: 18486878 DOI: 10.1016/j.soc.2008.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite radical surgery, the prognosis of patients who have gastric carcinoma remains unsatisfactory because of the intrinsic but unpredictable aggressiveness of this malignancy. During the past decade an ever-growing list of molecular prognostic factors has been proposed based on the discovery of the mechanisms underlying gastric cancer aggressiveness. Studies performed in larger and more homogeneous series of patients and adequate statistical analysis are warranted before any of the candidate biomarkers can be implemented in the routine clinical setting for the identification of patients at higher risk and thus for the selection of candidates for adjuvant or more aggressive therapies.
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Xu YY, Huang BJ, Sun Z, Lu C, Liu YP. Risk factors for lymph node metastasis and evaluation of reasonable surgery for early gastric cancer. World J Gastroenterol 2007; 13:5133-8. [PMID: 17876881 PMCID: PMC4434645 DOI: 10.3748/wjg.v13.i38.5133] [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: 03/15/2007] [Revised: 08/11/2007] [Accepted: 08/26/2007] [Indexed: 02/06/2023] Open
Abstract
AIM To give the evidence for rationalizing surgical therapy for early gastric cancer with different lymph node status. METHODS A series of 322 early gastric cancer patients who underwent gastrectomy with more than 15 lymph nodes retrieved were reviewed in this study. The rate of lymph node metastasis was calculated. Univariate and multivariate analyses were performed to evaluate the independent factors for predicting lymph node metastasis. RESULTS No metastasis was detected in No.5, 6 lymph nodes (LN) during proximal gastric cancer total gastrectomy, and in No.10, 11p, 11d during for combined resection of spleen and splenic artery and in No.15 LN during combined resection of transverse colon mesentery. No.11p, 12a, 14v LN were proved negative for metastasis. The global metastastic rate was 14.6% for LN, 5.9% for mucosa, and 22.4% for submucosa carcinoma, respectively. The metastasis in group II was almost limited in No.7, 8a LN. Multivariate analysis identified that the depth of invasion, histological type and lymphatic invasion were independent risk factors for LN metastasis. No metastasis from distal cancer (3.0 cm in diameter. CONCLUSION Segmental/subtotal gastrectomy plus D1/D1+No.7 should be performed for carcinoma (3.0 cm in diameter). Total gastrectomy should not be performed in proximal, so does combined resection or D2+/D3 lymphadenectomy.
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Affiliation(s)
- Ying-Ying Xu
- Department of Medical Oncology, First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Shin KS, Kim SH, Han JK, Lee JM, Lee HJ, Yang HK, Choi BI. Three-dimensional MDCT Gastrography Compared With Axial CT for the Detection of Early Gastric Cancer. J Comput Assist Tomogr 2007; 31:741-9. [PMID: 17895786 DOI: 10.1097/rct.0b013e318033de8e] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the diagnostic performance of multidetector-row computed tomography (CT) 3-dimensional CT gastrography (3-D CTG) to detect early gastric cancer (EGC) compared with axial CT images alone. METHODS Contrast-enhanced multidetector-row CT scanning was performed on 39 patients with histopathologically proven EGC. By using volume-rendering technique, CTG images were created and interval reviews of both the axial images without and with 3-D CTG images were performed independently by 2 radiologists retrospectively. The stomach was divided into 4 segments (ie, the cardia or fundus, body, angle, and antrum). For 156 gastric segments, the radiologists determined the presence of the lesion using a 5-point confidence level. The radiologists' performance for the lesion detection was evaluated by means of receiver operating characteristic analysis. Interobserver agreement was also analyzed. The ability of CTG to reveal the extent and the morphological features of the lesions was also evaluated and compared with the results of conventional studies. RESULTS Histopathologically, 41 EGCs were identified in 39 patients: 1 lesion was located in the fundus, 16 in the body, 9 in the angle, and 15 in the antrum. When 3-D CTG images were used, the receiver operating characteristic curve (AZ) analysis revealed a significant improvement in the diagnostic performance of both reviewers (AZ using axial CT images only, 0.608 and 0.602 for reviewers 1 and 2, respectively; AZ using CTG images, 0.821 and 0.822 for reviewers 1 and 2, respectively) (P < 0.05). The 3-D CTG also improved the sensitivity from 27% to 73% for reviewer 1 and from 29% to 76% for reviewer 2 (P < 0.05), as compared with the sensitivity when using axial CT images only. In addition, almost perfect agreement was achieved for CTG (weighted kappa, 0.836), whereas there was only moderate agreement for the axial CT images (weighted kappa, 0.445). The CTG provided information similar to that obtained by barium study and endoscopy in 51.6% and 59.5%, respectively, of the cases. CONCLUSIONS The combined interpretation of axial and 3-D CTG was significantly better for detecting EGC, with a diagnostic confidence higher than that using axial CT imaging alone.
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Affiliation(s)
- Kyung Sook Shin
- Department of Radiology, Chungnam National University College of Medicine, South Korea
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Yan QH, Liu J, Shi LK, Wang FA, Cai JH, Ikeguchi M. Clinical significance of micrometastasis in lymph nodes of mucosal gastric cancer. Shijie Huaren Xiaohua Zazhi 2006; 14:2026. [DOI: 10.11569/wcjd.v14.i20.2026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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