Prognostic implication of isolated tumor cells and micrometastases in regional lymph nodes of gastric cancer

Table 1 Pathologic findings according to the size and pattern of lymph node metastasis after cytokeratin staining in pN0 cases on initial examination

	Negative	ITCs				Micro meta-stases	Macro meta-stases	P
		Single cell	Multiple cells	Single cluster	Multiple clusters
WHO (%)								0.019
1W/D, M/D	112 (50.5)	6 (50.0)	0 (0)	1 (20)	6 (42.9)	8 (42.1)	0 (0)
2P/D	54 (24.3)	4 (33.3)	7 (100)	2 (40)	5 (35.7)	8 (42.1)	1 (100)
Mucinous	9 (4.0)	0 (0)	0 (0)	1 (20)	0 (0)	2 (10.5)	0 (0)
3SRC	47 (21.2)	2 (16.7)	0 (0)	1 (20)	3 (21.4)	1 (5.3)	0 (0)
Depth (%)								<0.001
Mucosa	97 (43.7)	4 (33.3)	0 (0)	2 (40)	1 (7.1)	3 (15.8)	0 (0)
4SM	72 (32.4)	2 (16.7)	1 (14.4)	1 (20)	4 (28.7)	5 (26.3)	1 (100)
5PM	21 (9.5)	1 (8.3)	0 (0)	0 (0)	1 (7.1)	2 (10.5)	0 (0)
Subserosa	28 (12.6)	5 (41.7)	3 (42.8)	2 (40)	7 (50)	4 (21.1)	0 (0)
Serosa	4 (1.8)	0 (0)	3 (42.8)	0 (0)	1 (7.1)	5 (26.3)	0 (0)
Total (%)	222 (100)	12 (100)	7 (100)	5 (100)	14 (100)	19 (100)	1 (100)

¹Well and moderately differentiated tubular adenocarcinoma,

²Poorly differentiated tubular adenocarcinoma,

³Signet-ring cell carcinoma,

⁴Submucosa,

⁵Proper muscle.

Table 2 Clinicopathologic findings in seven cases with ITC with multiple scattered single cell pattern

Case	1F/U	1F/U months	Sex	Age	Tumor size (cm)	WHO	Depth	Stage	Number of positive nodes	Number of tumor cells in a lymph node
202	Alive	14	2M	67	2	4P/D	5SM	Ia	4	2
409	Alive	69	M	40	4.5	P/D	6SS	Ib	1	4
437	Died	20	3F	35	6	P/D	SS	Ib	19	>50
726	Died	33	F	40	14	P/D	7SE	II	3	>30
737	Died	28	F	30	3	P/D	SE	IV	9	>20
829	Died	28	M	46	6	P/D	SE	IV	2	45
850	Alive	63	M	49	5	P/D	SS	Ib	1	8

¹Follow-up,

²male,

³female,

⁴poorly differentiated tubular adenocarcinoma,

⁵submucosa,

⁶subserosa,

⁷serosa.

Table 3 Multivariate analysis of predictive factors for survival in pN0 using Cox regression model

Prognostic factor	Hazard ratio (95%CI)	P
Pattern of ITCs		0.018
Multiple individual cells vsothers	4.09 (1.28-13.10)
PT stage		<0.001
II-IV vs I	8.77 (2.89-26.32)
Lauren's classification		0.276
Diffuse vs intestinal	1.73 (0.65-4.61)