Life prognosis of sentinel node navigation surgery for early-stage gastric cancer: Outcome of lymphatic basin dissection

doi:10.3748/wjg.v27.i46.8010

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World Journal of Gastroenterology

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Retrospective Cohort Study

World J Gastroenterol. Dec 14, 2021; 27(46): 8010-8030
Published online Dec 14, 2021. doi: 10.3748/wjg.v27.i46.8010

Table 1 Patient characteristics

	n	SNNS n = 239	Control n = 423	P value
Age	Median (range)	64 (28-85)	67 (27-85)	0.004
Sex	Male:Female	157:82	289:134	0.491
Location	U:M:L	35:130:74	78:195:150	0.116
Circumference	Less:Ant:Gre:Post	107:37:48:47	201:78:72:72	0.492
Macroscopic type	Elevated:Depressed	62:177	108:315	0.926
Clinical T status (cT)	1a:1b:2	100:111:28	171:192:60	0.678
Clinical N status (cN)	0:1:2-3	239:0:0	423:0:0	1.000
Pathological diagnosis	DF:UDF	130:109	289:134	< 0.001
Sentinel node mapping	BD:RI:CM:ICG:None	39:6:135:59:0	2:1:13:21:386	< 0.001
Surgical procedure	TG:DG:PG:PPG; SG:MDG:MPG:LR	3:41:24:10; 84:33:6:38	23:263:51:62; 8:4:1:11	< 0.001
Nodal dissection	D0:D1(1 +):D2	174:42:23	45:191:187	< 0.001
Long axis (mm)	Median (range)	22 (2-65)	25 (4-87)	0.265
Pathological T (pT)	1a:1b:2:3-4	129:92:10:8	218:145:39:21	0.065
Pathological N (pN)	0:1:2-3	214:13:12	379:34:10	0.072
Recurrent cases		1	8

SNNS: Sentinel node navigation surgery group; DF: Differentiated type; UDF: Undifferentiated type; BD: Blue dye mapping; RI: Radioisotope colloid mapping; CM: Dye and RI combination mapping; ICG: Indocyanine green fluorescence mapping; TG: Total gastrectomy; DG: Distal gastrectomy; PG: Proximal gastrectomy; PPG: Pylorus-preserving gastrectomy; SG: Segmental gastrectomy; MDG: Mini-distal gastrectomy; MPG: Mini-proximal gastrectomy; LR: Local resection.

Table 2 List of 25 patients of lymph node metastasis in the sentinel node navigation surgery group

No.	LOC	MAC	LA	cT	cN	sN	MP	LB	INDSN	OP	D	PD	pT	MS	NS	MLB	MOB	NNS	MRSC	PROG¹
1	M	0 IIa + IIc	20	1b	0	0	ICG	l-GA	TP	DG	2	tub2	sm2	#3 #7	4	#7	-	1	82.3	Alive
2	M	0 IIc	25	1b	0	0	CM	l-GA	TP	DG	2	por1	sm2	#3	1	-	-	0	71.4	Alive
3	U	0 IIc	25	1b	0	0	ICG	l-GA	TP	PG	1 +	tub2	mp	#1 #3	2	#1	-	1	56.1	Trauma
4	M	0 IIa + IIc	40	2	0	0	ICG	l-GA	TP	DG	2	tub2	ss	#3	1	-	-	0	63.7	Alive
5	M	0 IIc + IIb	40	1b	0	0	ICG	l-GA	TP	DG	2	tub2	mp	#3	1	-	-	0	80.4	Alive
6	U	0 IIc	45	1b	0	0	CM	l-GA	TP	PG	1 +	sig	m	#1 #7	2	-	-	0	69.2	Alive
7	L	0 IIc + IIb	45	2	0	1	CM	l-GA	TP	DG	2	por2	ss	#3	2	#3	-	1	67.7	Alive
8	L	0 IIc + III	40	2	0	2	ICG	r-GEA	TP	DG	2	tub2	mp	#4d	2	#4d #6	#7	5	72.1	Alive
9	L	0 IIa	55	2	0	1	ICG	l-GA, r-GA	TP	DG	1 +	tub1	sm1	#5	1	-	-	0	67.7	Alive
10	L	0 IIa + IIc	20	1b	0	0	ICG	l-GA, r-GEA	TP	DG	2	tub2	sm2	#3 #4d #6	4	#6	-	1	62.0	Alive
11	M	0 IIc + III	25	2	0	0	BD	l-GA, r-GEA	TP	DG	2	por2	ss	#4d	2	-	-	0	120.0	Alive
12	M	0 IIa + IIc	25	1b	0	0	ICG	l-GA, r-GEA	TP	DG	1 +	tub2	sm2	#3 #7 #4d	4	-	-	0	59.5	CVD
13	M	0 I	32	1b	0	0	CM	l-GA, r-GEA	TP	TG	2	tub2	sm2	#3 #4d	5	-	-	0	64.7	Alive
14	M	0 IIc + IIb	37	1b	0	0	CM	l-GA, r-GEA	TP	DG	2	por2	m	#3	3	-	-	0	61.9	Alive
15	M	0 I	55	1a	0	0	ICG	l-GA, r-GEA	TP	DG	2	por2	mp	#4d	1	#3 #4d	-	4	69.8	Alive
16	M	0 IIc + III	30	2	0	1	BD	l-GA, r-GEA	TP	DG	2	por2	se	#1 #3 #4d	3	#4d	-	2	53.2	LNR
17	U	0 IIa + IIc	11	1a	0	0	CM	l-GA, l-GEA, p-GA	TP	PG	1 +	por1	sm2	#11d	1	#7	-	1	84.3	Alive
18	U	0 IIc	33	1b	0	0	CM	l-GA, l-GEA, p-GA	TP	PG	1 +	tub2	mp	#1	1	-	-	0	62.9	Alive
19	U	0 IIc	55	2	0	0	CM	l-GA, r-GEA, r-GEA	TP	TG	2	por2	sm2	#1 #3 #4d #10	4	#1	-	1	65.2	Alive
20	M	0 IIc	40	2	0	0	ICG	l-GA, r-GA, r-GEA	TP	DG	1+	tub2	sm1	#3	1	-	-	0	89.6	Alive
21	L	0 IIa + IIc	24	1b	0	2	CM	l-GA, r-GA, r-GEA	TP	DG	2	por1	sm2	#8a	1	#3	-	1	72.6	Alive
22	M	0 IIc	20	1b	0	0	ICG	l-GA, r-GEA	FN (FD)	SG	0	por2	sm2	(#4d)	1	#4d	-	1	61.2	Alive
23	M	0 IIc + III	23	2	0	0	CM	l-GA, r-GEA	FN (FD)	SG	0	tub2	mp	(#3)	1	#3	-	2	75.8	PK
24	L	0 IIc	45	1b	0	0	RI	l-GA, r-GA, r-GEA	FN (FD)	DG	2	por2	m	(#5)	1	-	-	0	66.8	Alive
25	L	0 I	25	1b	0	1	CM	l-GA, r-GA, r-GEA	FN (LM)	DG	2	tub2	sm2	-	0	#4d	-	1	63.6	Alive

¹“PROG” column indicates whether the patients are alive at the time of recent survival confirmation, recurrent status of gastric cancer, or the cause of death.

SNNS: Sentinel node navigation surgery; LOC: Location; MAC: Macroscopic type; LA: Size of long axis (mm); cT: Clinical T status; cN: Clinical N status; sN: Surgical N status; MP; Mapping procedures; ICG: Indocyanine green fluorescence mapping; CM: Combination mapping; BD: Blue dye mapping; RI: Radioactive colloid mapping; LB: Distributions of lymphatic basins; l-GA: Left gastric artery basin; r-GA: Right gastric artery basin; r-GEA: Right gastroepiploic artery basin; l-GEA: Left gastroepiploic artery basin; p-GA: Posterior gastric artery basin; INDSN: Intraoperative nodal diagnosis by sentinel node biopsy; TP: True positive diagnosis for nodal metastasis; FN (FD): False-negative diagnosis because of frozen section diagnosis; FN (LM): False negative because of obvious macroscopic nodal metastasis; OP: Surgical procedures; DG: Distal gastrectomy; PG: Proximal gastrectomy; TG: Total gastrectomy; SG: Segmental gastrectomy; D: Degree of nodal dissection; PD: Dominant pathological diagnosis; pT: Pathological T status; MS: Metastastic stations of sentinel nodes; NS: Numerical numbers of metastatic sentinel nodes; MLB: Metastatic stations of not sentinel nodes inside the lymphatic basins; MOB: Metastatic stations of not sentinel nodes outside the basins; NNS: Numerical numbers of metastatic nodes of not sentinel nodes; MRSC: Months to recent survival confirmation; PROG: Prognosis, recurrent status or cause of death; CVD: Cerebrovascular disease; LNR: Lymph nodal recurrence; PK: Pancreas cancer.

Table 3 Profiles of metachronous multiple remnant gastric cancer patients

No.	Group	ISP	Treatment	MTMC	Curability¹	MRSC	PROG²
1	SNNS	SG	DG	50.5	Curative	75.6	Pneumonia
2	SNNS	SG	ESD	60.2	Curative	114.9	Alive
3	SNNS	SG	ESD	22.9	Curative	79.9	Alive
4	SNNS	MPG	ESD	13.6	Curative	76.3	Alive
5	SNNS	LR	ESD	30.7	Curative	73.1	Alive
6	SNNS	DG	TG	43.6	Curative	62.9	Alive
7	Control	DG	TG	19.5	Curative	63.6	Alive
8	Control	DG	TG	17.2	Curative	97.4	Alive
9	Control	DG	ESD	44.3	Curative	55.5	AID
10	Control	DG	ESD	220.4	Curative	240.0	Alive
11	Control	DG	ESD	40.6	Curative	120.0	Alive
12	Control	PG	UR	74.3	UR	120.0	Alive
13	Control	PG	TG	76.8	Curative	120.0	Alive
14	Control	PG	ESD	18.5	Curative	120.0	Alive
15	Control	PG	ESD	28.2	Curative	120.0	Alive
16	Control	PPG	TG	50.8	Curative	120.0	Alive
17	Control	PPG	DG	85.0	Curative	116.2	Alive
18	Control	PPG	ESD	77.1	Curative	118.5	Alive
19	Control	PPG	ESD	22.0	Curative	98.2	Alive
20	Control	LR	DG	7.6	Cure	42.8	CVD
21	Control	LR	ESD	64.2	Cure	85.7	Alive

¹“Curability” column indicates whether treatment for metachronous multiple remnant gastric cancers was curative or not. All but one unresectable patient could be resected radically, and there were no recurrences of metachronous gastric cancer. One unresectable patient was alive with metachronous cancer 10 years after the initial surgery.

²“PROG” column indicates whether the patients are alive at the time of recent survival confirmation, or the cause of death.

ISP: Initial surgical procedure; SG: Segmental gastrectomy; MPG: Mini-proximal gastrectomy; LR: Local resection; DG: Distal gastrectomy; PG: Proximal gastrectomy; PPG: Pylorus-preserving gastrectomy; ESD: Endoscopic submucosal dissection; TG: Total gastrectomy; UR: Unresectable; MTMC: Months to treat metachronous gastric cancer; MRSC: Months to recent survival confirmation; PROG: Prognosis or cause of death; AID: Autoimmune disease; CVD: Cerebrovascular disease; SNNS: Sentinel node navigation surgery.

Table 4 Univariate and multivariate analysis for the factors affected to the overall survival

Factors	vs	Univariate¹ (Log-rank P)	Multivariate²
Factors	vs	Univariate¹ (Log-rank P)	Hazard ratio	95%CI	P value
Age		< 0.0001	1.092	1.064-1.120	< 0.0001
Sex	Male:Female	0.0009	1.815	1.099-2.998	0.0199
Location		0.0978
Circumference		0.301
Macroscopic type	Elevated:Depressed	< 0.0001	1.678	1.131-2.490	0.0101
Clinical T status		0.632
Pathological type	Diff.:Undiff.	0.0001
Long axis (mm)		< 00001	0.9815	0.965-0.998	0.0287
Pathological N status		0.0033	1.785	1.288-2.473	0.0005
SNNS	SNNS:Control	0.0014	0.4892	0.298-0.802	0.0046

¹The log-rank test was used for the univariate analysis of overall survival.

²The Cox proportional hazards regression model was used for multivariate analysis of overall survival.

SNNS: Sentinel node navigation surgery; diff.: Differentiated; Undiff.: Undifferentiated; CI: Confidential interval.

Table 5 Multivariate analysis for the factors affected to the cumulative incidence of causes of death or recurrences

Factors	Non-cancer deaths			Other cancers			Gastric cancer recurrence
Factors	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value
Age	1.101	1.064-1.140	< 0.0001	1.064	1.026-1.103	0.0008	0.992	0.894-1.101	0.88
Sex	1.533	0.823-2.855	0.18	2.126	0.863-5.239	0.1	3.213	0.592-17.43	0.18
Location	1.259	0.890-1.782	0.19	0.9636	0.637-1.457	0.86	1.472	0.482-4.502	0.5
Circumference	1.037	0.798-1.349	0.78	1.184	0.875-1.602	0.27	1.943	0.732-5.158	0.18
Macroscopic type	1.303	0.752-2.256	0.35	2.322	1.241-4.346	0.0084	1.083	0.136-8.636	0.94
Clinical T status	0.9053	0.584-1.403	0.66	0.8587	0.481-1.535	0.61	1.542	0.662-3.595	0.32
Pathological type	1.509	0.762-2.990	0.24	0.5908	0.211-1.657	0.32	1.27	0.165-9.786	0.82
Long axis	0.9802	0.958-1.003	0.086	0.9874	0.958-1.017	0.4	0.9468	0.867-1.034	0.22
Pathological N status	1.263	0.683-2.337	0.46	1.353	0.751-2.440	0.31	5.252	2.043-13.50	0.00058
SNNS	0.4438	0.230-0.855	0.015	0.7224	0.338-1.542	0.4	0.1859	0.030-1.166	0.072

SNNS: Sentinel node navigation surgery; HR: Hazard ratio; CI: Confidence interval.

Table 6 Patient characteristics after propensity score matching

	n	m-SNNS n = 231	m-control n = 231	P value
Age	Median (range)	64 (29-85)	64 (27-85)	0.473
Sex	Male:Female	152:79	147:84	0.697
Location	U:M:L	34:125:72	37:119:75	0.843
Circumference	Less:Ant:Gre:Post	106:37:45:43	103:40:46:42	0.980
Macroscopic type	Elevated:Depressed	57:174	57:174	1.000
Clinical T status (cT)	1a:1b:2	98:105:28	88:108:35	0.528
Clinical N status (cN)	0:1:2-3	231:0:0	231:0:0	1.000
Pathological diagnosis	DF:UDF	130:101	126:105	0.779
Long axis (mm)	Median (range)	23 (2-65)	25 (4-87)	0.547
Sentinel node mapping	BD:RI:CM:ICG:None	38:5:132:56:0	1:1:8:15:206	< 0.001
Surgical procedure	TG:DG:PG:PPG; SG:MDG:MPG:LR	3:40:23:10; 80:31:6:37	14:147:25:32; 4:4:0:5	< 0.001
Nodal dissection	D0:D1(1+):D2	169:39:23	23:97:111	< 0.001
Pathological T (pT)	1a:1b:2:3-4	125:89:10:7	126:72:20:13	0.075
Pathological N (pN)	0:1:2-3	206:13:12	213:13:5	0.251
Recurrent cases		1	3

m-SNNS: Matched sentinel node navigation surgery group; m-control: Matched control group; DF: Differentiated type; UDF: Undifferentiated type; BD: Blue dye mapping; RI: Radioisotope colloid mapping; CM: Dye and RI combination mapping; ICG: Indocyanine green fluorescence mapping; TG: Total gastrectomy; DG: Distal gastrectomy; PG: Proximal gastrectomy; PPG: Pylorus-preserving gastrectomy; SG: Segmental gastrectomy; MDG: Mini-distal gastrectomy; MPG: Mini-proximal gastrectomy; LR: Local resection.

Citation: Kinami S, Nakamura N, Miyashita T, Kitakata H, Fushida S, Fujimura T, Iida Y, Inaki N, Ito T, Takamura H. Life prognosis of sentinel node navigation surgery for early-stage gastric cancer: Outcome of lymphatic basin dissection. World J Gastroenterol 2021; 27(46): 8010-8030
URL: https://www.wjgnet.com/1007-9327/full/v27/i46/8010.htm
DOI: https://dx.doi.org/10.3748/wjg.v27.i46.8010