• D2 lymphadenectomy
• Gastric cancer
• Lymph node metastasis
• Lymph node station
• Survival

• Lymph node excision
• Lymphatic metastasis
• Nomograms
• Prognosis
• Stomach neoplasms

• Eunpyeong St. Mary's Hospital, The Catholic University of Korea

• Gastric cancer
• Loco-regional recurrence
• Lymph node dissection
• R0 resection
• Radical gastrectomy

Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer (GC). In addition, lymph node dissection is a key factor in determining the appropriate treatment for GC. However, the association between the number of positive lymph nodes and area of lymph node metastasis in GC remains unclear.

To investigate the clinical value of regional lymph node sorting after radical gastrectomy for GC.

This study included 661 patients with GC who underwent radical gastrectomy at Tianjin Medical University General Hospital between January 2012 and June 2020. The patients were divided into regional sorting and non-sorting groups. Clinicopathological data were collected and retrospectively reviewed to determine the differences in the total number of lymph nodes and number of positive lymph nodes between the groups. Independent sample t-tests were used for intergroup comparisons. Continuous variables that did not conform to a normal distribution were expressed as median (interquartile range), and the Mann-Whitney U test was used for inter-group comparisons.

There were no significant differences between the groups in terms of the surgical method, tumor site, immersion depth, and degree of differentiation. The total number of lymph nodes was significantly higher in the regional sorting group (n = 324) than in the non-sorting group (n = 337) (32.5 vs 21.2, P < 0.001). There was no significant difference in the number of positive lymph nodes between the two groups. A total of 212 patients with GC had lymph node metastasis in the lymph node regional sorting group, including 89 (41.98%) cases in the first dissection station and 123 (58.02 %) cases in the second dissection station. Binary and multivariate logistic regression results showed that the number of positive lymph nodes (P < 0.001) was an independent risk factor for lymph node metastases at the second dissection station.

Regional sorting of lymph nodes after radical gastrectomy may increase the number of detected lymph nodes, thereby improving the reliability and accuracy of lymph node staging in clinical practice.

• Radical gastrectomy
• Regional lymph node sorting
• Lymph node dissection
• Lymph node staging
• Metastasis
• Gastric cancer

The signature and prediction of perigastric lymph node metastasis (pLNM) is clinically important, but evidence is still lacking. Here, we aimed to identify an informative signature for the prediction of pLNMs in gastric cancer patients after total gastrectomy, and reassess the current indications for proximal gastrectomy and pylorus-preserving gastrectomy (PPG). We found that proximal gastrectomy may be expanded to patients with stage T1–T2 GC and/or tumor diameter < 4 cm in the upper-third stomach, while PPG may be expanded to include T1–T2/N0 and/or tumors < 4 cm in the middle-third stomach. Furthermore, we developed a new predictive factor, the shortest distance from the pylorus ring to the distal edge of the tumor, which showed good predictive performance for pLNMs.

Background: A growing number of studies suggest that the current indications for partial gastrectomy, including proximal gastrectomy and pylorus-preserving gastrectomy (PPG), may be expanded, but evidence is still lacking. Methods: We retrospectively analyzed 300 patients with gastric cancer (GC) who underwent total gastrectomy. We analyzed the incidence of pLNMs in relation to tumor location, tumor size and T stage. We further identified predictive factors for perigastric lymph node metastasis (pLNM) in stations 1, 2, 3, 4sa, 4sb, 4d, 5, and 6. Results: No patients with upper-third T1–T2 stage GC had pLNMs in stations 4sa, 4sb, 4d, 5, or 6, but 3.8% of patients with stage T3 had 4d pLNM. No patients with upper-third GC < 4 cm in diameter had pLNMs in 2, 4sa, 4d, 5, or 6, and 2.3% of patients had pLNMs in 4sb. For middle-third GCs, 2.9% of patients with T1 stage had pLNMs in 4sa and 5, but no patients with T2 stage or tumors < 4 cm had pLNMs in 2, 4sa, or 5. The shortest distance from pylorus ring to distal edge of tumor (sDPD) was a new predictive factor for pLNMs in 2, 4d, 5, and 6. Conclusions: Proximal gastrectomy may be expanded to patients with stage T1–T2 GC and/or tumor diameter < 4 cm in the upper-third stomach, whereas PPG may be expanded to include T1–T2/N0 and/or tumors < 4 cm in the middle-third stomach. A new predictive factor, sDPD, showed good predictive performance for pLNMs, especially in stations 4d, 5, and 6.

The number of positive lymph nodes, which was defined as “N stage”, is mostly used to predict the survival of D2-resected gastric cancer patients, not the location. A “central lymph node” (CnLN) was defined by Ikoma et al., included common hepatic, celiac and proximal splenic artery LNs. CnLNs located in the extraperigastric area are included in the D2 LN station for gastric cancer. We speculate that CnLNs can be regarded as a predictor of survival.

Eligible advanced gastric cancer patients who underwent curative resection and D2 lymph node dissection between 2004 and 2012 at our institution were identified. The frequency of CnLN metastases and risk factors affecting DFS were examined. Survival differences were assessed by log-rank tests and Kaplan–Meier curves.

The study identified 1178 patients who underwent curative surgery or D2 or more extensive lymphadenectomy. A total of 342 patients had been proven to have CnLN metastasis. Larger tumor size (P < 0.001), more frequent lymphatic vessel invasion (P < 0.001), signet ring cell histology (P = 0.014), and more advanced pathological T stage (P = 0.013) were significantly related to CnLNs metastasis. The patients with CnLN metastasis had a poor prognosis (HR for DFS of 1.366, 95%CI = 1.138–1.640, P = 0.001). For the pN2/3 patients, CnLN metastasis was associated with shorter 5-year DFS (for pN2 patients: 25.9% vs 39.3%, P = 0.017; for pN3 patients: 11.5% vs 23.4%, P = 0.005).

Gastric cancer patients with CnLN metastasis who underwent D2 resection had a poor prognosis. With the same N stage, the patients with positive CnLNs had shorter survival. CnLNs metastasis could be a supplement to N stage and a predictor of survival in gastric cancer patients. Large sample, multicenter, randomized clinical trials are still needed in the future.

• D2 lymphadenectomy
• Gastric cancer
• Lymph node metastasis
• Survival

Evidence suggests that the anatomic extent of metastatic lymph nodes (MLNs) affects prognosis, as proposed by alternative staging systems. The aim of this study was to establish a new staging system based on the number of perigastric (PMLN) and extra-perigastric (EMLN) MLNs.

Data from a Chinese cohort of 1090 patients who had undergone curative gastrectomy with D2 or D2 plus lymphadenectomy for gastric cancer were retrospectively analysed. A Japanese validation cohort (n = 826) was included. Based on the Cox proportional hazards model, the regression coefficients of PMLN and EMLN were used to calculate modified MLN (MMLN). Prognostic performance of the staging systems was evaluated.

PMLN and EMLN were independent prognostic factors in multivariate analysis (coefficients: 0.044, 0.115; all P < 0.001). MMLN was calculated as follows: MMLN = PMLN + 2.6 × EMLN. The MMLN staging system showed superior prognostic performance (C-index: 0.751 in the Chinese cohort; 0.748 in the Japanese cohort) compared with the five published LN staging systems when MMLN numbers were grouped as follows: MMLN0 (0), MMLN1 (1–4), MMLN2 (5–8), MMLN3 (9–20), and MMLN4 (>20).

The MMLN staging system is suitable for assessing overall survival among patients undergoing curative gastrectomy with D2 or D2 plus lymphadenectomy.

• Anatomical extent
• Gastric cancer
• Metastatic lymph nodes
• Prognosis
• Propensity score matching

• Lymph node dissection
• Prognosis
• Spleen preservation
• Splenectomy
• Stomach neoplasms

• Investigator Sponsored Research Program

A hybrid topographic and numeric lymph node (LN) staging system for gastric cancer, which was recently proposed by Japanese experts as a simple method with a prognostic predictive power comparable to the N staging of the American Joint Committee on Cancer (AJCC) Tumor-node-metastasis classification, has not yet been validated in other Asian countries. This study aimed to examine the prognostic predictability of the hybrid staging system with the current AJCC staging system in gastric cancer.

Overall, 400 patients with gastric cancer who underwent surgery at Changhua Christian Hospital from January 2007 to December 2017 were included in the study. Univariate and multivariate analyses were performed to identify prognostic factors for gastric cancer-related death. Homogeneity and discrimination abilities of the two staging systems were compared using likelihood ratio chi-square test, linear trend chi-square test, Harrell’s c-index, and bootstrap analysis.

One-third of the LN-positive patients were reclassified into the new N and Stage system. The concordance rates of the two staging systems and the N staging between the two staging systems were 0.810 and 0.729, respectively. Harrell’s c-indices for the stage and N staging were higher in the 7^th AJCC staging system than the hybrid staging system (c-index for stage, 0.771 vs 0.764; c-index for nodal stage, 0.713 vs 0.705). Stratification of the patients according to the histological grade revealed that Harrell’s c-indices for the stage and N stage of the hybrid staging system were comparable with those of the 7^th AJCC staging system (c-index for AJCC stage vs hybrid stage, 0.800 vs 0.791; c-index for AJCC N stage vs hybrid N stage, 0.746 vs 0.734) among patients with histologically lower grade gastric cancer. The performance of the new nodal staging system was better than that of the 7^th AJCC staging system by likelihood ratio and linear trend tests and bootstrap analysis in the low-grade group.

The hybrid anatomical location-based classification may have better prognostic predictive ability than the 7^th AJCC staging system for LN metastasis of low-grade gastric cancer. Further studies involving different ethnic populations are necessary for the validation of the new staging system.

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Staging
• Retrospective Studies
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Taiwan/epidemiology

• Changhua Christian Hospital

• drug resistance gene
• gastric cancer
• microRNA 185
• multidrug resistance
• zinc finger protein 139

• ATP Binding Cassette Transporter, Subfamily B/genetics
• Antineoplastic Agents/pharmacology
• Cell Line, Tumor
• Drug Resistance, Multiple/genetics
• Drug Resistance, Neoplasm/genetics
• Fluorouracil/pharmacology
• Gene Expression Regulation, Neoplastic/drug effects
• Humans
• Kruppel-Like Transcription Factors/genetics
• MicroRNAs/genetics
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/genetics
• Stomach Neoplasms/pathology
• Transfection

• Gastric cancer
• JGCA
• UICC
• lymph node metastasis
• lymph node staging

• Advanced gastric cancer
• Elderly patients
• Lymph node metastasis
• Pathological characteristics
• Tumor size

It has been reported that LMO1 gene was associated with progression, metastasis and apoptosis of leukemia, colorectal cancer and lung cancer. However, the association of LMO1 and gastric cancer remains unclear. The aim of this study is to analyze the relation between LMO1 expression and apoptosis of gastric cancer cells and explore the clinical implications of LMO1 in gastric cancer tissues. The results demonstrated that expression levels of LMO1 and Bcl-2 proteins in gastric cancer tissues were higher than those in adjacent tissues, whereas the opposite was detected for Bax expression (P<0.05). LMO1 protein was associated with TNM staging and lymph node metastasis in gastric cancer (P<0.05). The survival rate of the patients with positive LMO1 gastric carcinoma was lower than that with negative LOM1 expression, and LMO1 was as an independent prognostic factor in COX survival analysis (P<0.05). LMO1-siRNA transfected MKN45 cells had a significant decrease in LMO1 expression and the cell viability, despite of an increase in the apoptotic rate (P<0.05). Following LMO1-siRNA transfection, Bcl-2 expression decreased, while the expression of Bax increased (P<0.05). It's concluded that overexpressed LMO1 in gastric cancer could be as one of new markers of poor prognosis.

• LMO1 gene
• RNA interference
• apoptosis
• clinicopathological features
• gastric cancer

• Gastric cancer
• Prognosis
• Skip metastasis

• Gastric cancer
• locally advanced cancer
• multimodality
• radiotherapy (RT)

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Gastric Stump/pathology
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging/methods
• Prognosis
• Stomach Neoplasms/pathology

• Gastrointestinal lymphomas
• MALT lymphoma
• NK/T-cell enteropathy
• radiotherapy (RT)