Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2025; 31(8): 102347
Published online Feb 28, 2025. doi: 10.3748/wjg.v31.i8.102347
Lymph node metastatic patterns of gastric carcinoma with a combination of adenocarcinoma and neuroendocrine carcinoma components
Kai Zhou, Zhong-Wu Li, Yan Wu, Zhi-Jie Wang, Ling-Qian Wang, Li-Xin Zhou, Ling Jia, Ke Ji, Xue-Song Yang, Ji Zhang, Xiao-Jiang Wu, An-Qiang Wang, Zhao-De Bu
Kai Zhou, Zhi-Jie Wang, Ling-Qian Wang, Ke Ji, Xue-Song Yang, Ji Zhang, Xiao-Jiang Wu, An-Qiang Wang, Zhao-De Bu, Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, China
Zhong-Wu Li, Yan Wu, Li-Xin Zhou, Ling Jia, Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
Co-first authors: Kai Zhou and Zhong-Wu Li.
Co-corresponding authors: An-Qiang Wang and Zhao-De Bu.
Author contributions: Wang AQ and Bu ZD contributed to conceptualization, funding acquisition, project administration; Zhou K, Wu Y, Li ZW, Wang ZJ, Wang LQ, Zhou LX, Jia L, Ji K, Yang XS contributed to data curation; Zhou K contributed to formal analysis, software and writing original draft; Zhou K, Wu Y, Li ZW contributed to validation, visualization and investigation; Zhou K, Wang AQ contributed to methodology; Bu ZD, Li ZW , Zhang J, Wu XJ contributed to resources; Wang AQ, Bu ZD, Li ZW contributed to supervision; Wang AQ, Wu Y, Bu ZD contributed to writing, review and editing.
Supported by the National Key Research and Development Program of China, No. 2023YFF1204702; the National Natural Science Foundation of China, No. 82173151; Capital’s Funds for Health Improvement and Research, No. CFH 2022-4-1025; Beijing Hospitals Authority Clinical Medicine Development of Special Funding, No. XMLX202119; and Science Foundation of Peking University Cancer Hospital, No. PY202329.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Beijing Cancer Hospital, Institutional Review Board (Approval No. 2022KT04).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at buzhaode@cjcrcn.org.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao-De Bu, PhD, Professor, Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. buzhaode@cjcrcn.org
Received: October 16, 2024
Revised: December 14, 2024
Accepted: January 7, 2025
Published online: February 28, 2025
Processing time: 98 Days and 20.7 Hours
Abstract
BACKGROUND

Gastric mixed-adenoneuroendocrine carcinoma (G-MANEC) is a subtype of gastric cancer. Building upon prior research findings, we propose that tumours containing both neuroendocrine carcinoma (NEC) and adenocarcinoma (AC) components, with each component ranging from 1% to 99% of the tumour, be classified as a distinct entity. We hereby term this adenoneuroendocrine mixed gastric cancer (G-ANEC). Research on lymph node (LN) involvement in G-MANEC has focused mainly on metastasis status, with limited studies on metastatic composition.

AIM

To investigate the LN metastasis patterns of G-ANEC, the clinicopathological features associated with these metastasis patterns, and to explore adjuvant chemotherapy regimens for G-ANEC.

METHODS

We analyzed 68 G-ANEC cases treated with radical surgery and confirmed LN metastasis at Peking University Cancer Hospital between August 2012 and June 2022. Utilizing χ2 tests in IBM statistical product and service solutions statistics and R software.

RESULTS

We identified three distinct LN metastasis patterns in G-ANEC that were significantly associated with the NEC proportion, tumour invasion depth, Lauren classification, and tumour location (P values: 0.008, 0.015, 0.01, and 0.004, respectively). When the SOX/XELOX regimen was applied for adjuvant chemotherapy, patients with LN metastasis comprising only AC exhibited better overall survival (OS) (94.25 ± 11.07 months vs 54.36 ± 11.36 months) than did those with NEC. When LN metastasis components contained NEC, there was a trend towards improved OS (64 ± 10.77 months vs 54.35 ± 11.36 months) and disease-free survival (71.28 ± 9.92 months vs 66.28 ± 11.93 months) in patients treated with the etoposide and cisplatin compared to those receiving the SOX/XELOX regimen.

CONCLUSION

We found a significant correlation between the NEC percentage, tumour invasion depth, Lauren classification, and tumour location and LN metastasis patterns in G-ANEC. For G-ANEC, a lower proportion of NEC or AC in the primary lesion does not preclude the possibility of these components metastasizing to the LNs. Different adjuvant chemotherapy regimens should be administered on the basis of the varying components of LN metastasis in patients with G-ANEC.

Keywords: Gastric mixed-adenoneuroendocrine carcinoma; Lymph node metastatic patteren; Clinicopathological features; Adjuvant chemotherapy regimens; Prognosis

Core Tip: Rare individual studies on the lymph node metastasis components and treatment issues of adenoneuroendocrine mixed gastric cancer (G-ANEC). For G-ANEC, even if the neuroendocrine carcinoma (NEC) or adenocarcinoma (AC) component is relatively small in the primary lesion, it may still metastasize to the lymph nodes (LNs). If the metastasis in the LNs consists only of AC components, treatment of G-ANEC should primarily be based on fluoropyrimidine drugs. If the metastasis in the LNs includes NEC components, treatment should primarily be based on the etoposide and cisplatin/irinotecan and cisplatin regimen.