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Kim JW, Hong H, Park SH, Choi JH, Suh YS, Kong SH, Park DJ, Lee HJ, Lee HS, Kwak Y, Kim WH, Sano T, Yang HK. Lymph node metastasis prediction model for each lymph node station in gastric cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025:109590. [PMID: 39894713 DOI: 10.1016/j.ejso.2025.109590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 01/07/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND Lymph node metastasis (LNM) prediction for each LN station is required for tailored surgery for patient safety or improving quality of life in gastric cancer. This retrospective review was performed to develop a prediction program for calculating the probability of LNM according to LN stations in patients with gastric cancer. METHOD Among patients who underwent gastrectomy for primary gastric cancer between 2003 and 2017 at Seoul National University Hospital, 4660 patients up to 2013 were used as the development set, and 2564 patients after 2013 were used as the validation set. Not only the center of tumor but also all locations of stomach by tumor were included in the analysis. A multiple logistic regression analysis was used to develop an LNM prediction program for each LN station in development set. The program was validated using C-statistics and a calibration plot of the validation set. RESULTS Multivariate analysis identified tumor depth, gross type, and involved locations as covariates associated with LNM. However, the significant factors differed slightly according to the LN station. The prediction equations were developed for each LN station. In the validation set, the prediction equation exhibited good discriminant C-statistics of over 0.8 for all stations. The calibration plot of the prediction equation predicted the LNM rate, which corresponded closely to the actual rate. CONCLUSIONS A program was developed to predict LNM at LN stations. Predictive power was confirmed via internal validation. Predicting the LN metastatic rate for each LN station could help in planning more customized surgery.
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Affiliation(s)
- Jong Won Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin-Hoo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Surgery, Uijeongbu Eulji Medical Centre, Eulji University College of Medicine, Republic of Korea
| | - Jong-Ho Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Surgery, Nowon Eulji University Hospital, Eulji University School of Medicine, Republic of Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Takeshi Sano
- Department of Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Republic of Korea.
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Deng H, He Y, Huang G, Huang Y, Wu J, Qin X. Predictive value of prognostic nutritional index in patients undergoing gastrectomy for gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e39917. [PMID: 39465872 PMCID: PMC11479530 DOI: 10.1097/md.0000000000039917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 09/13/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND The value of prognostic nutritional index (PNI) in gastrectomy remains controversial. This meta-analysis aimed to evaluate the predictive value of PNI in patients undergoing gastrectomy for malignancy. METHODS We retrieved studies from medical literature databases to analyze the endpoints of overall survival, cancer-specific survival, recurrence-free survival, and clinicopathologic features. The hazard ratio (HR) and 95% confidence interval (CI) were used to access the survival prognostic value of PNI in patients after gastrectomy. Odds ratio and mean difference were used to evaluate the relationship between the low PNI and clinicopathologic features. RESULTS In total, we included 38 articles (39 trial comparisons) which contained 23,756 gastrectomy patients. The results showed that low PNI was associated with shorter overall survival (HR: 1.82, 95% CI 1.62-2.03), shorter cancer-specific survival (HR: 1.44, 95% CI 1.24-1.67), and shorter recurrence-free survival (HR: 2.52, 95% CI 1.41-4.47). Besides, patients with low PNI had a higher risk of postoperative complications compared with high PNI (HR: 1.65, 95% CI 1.30-2.09). And low PNI group was found to be related to older, lower BMI, larger tumor size, deeper tumor invasion, poorer differentiation, more advanced tumor stage, total gastrectomy, and the presence of lymph node metastasis, lymphatic invasion, and vessel invasion. CONCLUSION PNI was significantly associated with survival and postoperative complications of gastric cancer patients undergoing gastrectomy. Therefore PNI has the potential to be a prognostic predictor for gastrectomy.
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Affiliation(s)
- Huachu Deng
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yiqiang He
- Department of Hepatobiliary and Gastrointestinal Surgery, Affiliated Nationalities Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Gaofei Huang
- Department of Emergency Medicine, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
| | - Yuetong Huang
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiaheng Wu
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xingan Qin
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
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Zhang Z, Zhao Q, Fan L, Wang D, Zhao X, Tan B, Liu Y, Liu Q, Li Z, Yang P, Ding P, Wang Z, Yang L, Wang S, Li Y. Safety, tolerability, and pharmacokinetics of mitoxantrone hydrochloride injection for tracing in patients with gastric cancer: a single-blind, single-center, phase I clinical trial. Am J Cancer Res 2024; 14:1675-1684. [PMID: 38726280 PMCID: PMC11076265 DOI: 10.62347/lsdv5580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/22/2024] [Indexed: 05/12/2024] Open
Abstract
Mitoxantrone Hydrochloride Injection for Tracing (MHI), a modified new drug marketed in China, has been approved by the National Medical Products Administration for lymph node tracing in thyroid cancer and sentinel lymph node biopsy in breast cancer. This single-center, single-blind, dose-escalation phase I clinical trial aimed to investigate the safety of MHI on lymph node tracing in gastric cancer. In this study, four dose groups (1.0 mL, 1.5 mL, 2.0 mL, and 3.0 mL) with 3 gastric cancer patients in each group were set. The safety, tolerability, pharmacokinetics and preliminary efficacy of different doses were investigated. Results showed that none of the patients experienced dose-limiting toxicity or developed serious adverse events or adverse drug reactions. Pharmacokinetic analyses revealed minimal absorption of the tracer, resulting in low and transient blood drug concentrations across all participants. The mean time to peak concentration was (0.561 ± 0.3728) h (with mean peak concentration (Cmax) of 10.300 ng/mL), (0.500 ± 0.0167) h (mean Cmax of 13.687 ng/mL), (0.494 ± 0.0096) h (mean Cmax of 30.933 ng/mL), and (0.661 ± 0.2791) h (mean Cmax of 21.067 ng/mL) in the 1.0 mL, 1.5 mL, 2.0 mL, and 3.0 mL dose groups, respectively. The mean lymph node staining rates were 21.0%, 24.7%, 32.5%, and 44.5%, and the mean metastatic lymph node staining rates were 20.6%, 36.1%, 42.4%, and 21.0% in each group. This study confirmed that MHI was safe, well-tolerated, and had low systemic effects when used for lymphatic tracing of gastric cancer, and the tracing effect was better in the 3 mL dose group. This trail was registered on the website of Centre for Drug Evaluation State Drug and Food Administration (http://www.chinadrugtrials.org.cn/index.html) with the name of clinical study of lymphatic tracer in lymph node tracing of gastric cancer, the code was CTR20201906.
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Affiliation(s)
- Zhidong Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Qun Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Liqiao Fan
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Dong Wang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Xuefeng Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Bibo Tan
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Yu Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Qingwei Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Zhaoxing Li
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Peigang Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Ping’an Ding
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Zhixin Wang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Li Yang
- Department of CT/MRI, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Shujun Wang
- College of Pharmacy, Shenyang Pharmaceutical UniversityShenyang 110000, Liaoning, China
| | - Yong Li
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
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Sadeghi R, Taheri R, Jangjoo A, Pakdel A, Arjmand MH, Motiei MR, Memar B, Aliakbarian M. Evaluation of the diagnostic value of Sentinel Lymph Node in patients with gastric adenocarcinoma. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2024; 12:21-26. [PMID: 38164234 PMCID: PMC10757058 DOI: 10.22038/aojnmb.2023.70461.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 01/03/2024]
Abstract
Objectives Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA). Methods This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated. Results In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively. Conclusion Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result.
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Affiliation(s)
- Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Taheri
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akbar Pakdel
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Hassan Arjmand
- Transplant Research Center, Clinical research institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Motiei
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahram Memar
- Department of Pathology, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Transplant Research Center, Clinical research institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Dinescu VC, Gheorman V, Georgescu EF, Paitici Ș, Bică M, Pătrașcu Ș, Bunescu MG, Popa R, Berceanu MC, Pătrașcu AM, Gheorman LM, Dinescu SN, Udriștoiu I, Gheorman V, Forțofoiu MC, Cojan TȘȚ. Uncovering the Impact of Lymphadenectomy in Advanced Gastric Cancer: A Comprehensive Review. Life (Basel) 2023; 13:1769. [PMID: 37629625 PMCID: PMC10455758 DOI: 10.3390/life13081769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Gastric cancer is a significant health concern worldwide, and lymphadenectomy plays a crucial role in its treatment. However, there is ongoing debate regarding the optimal approach-D1 or D2 lymphadenectomy. This paper aims to synthesize the available evidence by conducting a comprehensive literature review and comparing the advantages and disadvantages of both techniques. The analysis includes studies, clinical trials, and systematic reviews that assess survival outcomes, morbidity, and quality of life. The selected studies revealed different outcomes associated with D1 and D2 lymphadenectomy, including lymph node harvest, disease control, recurrence rates, and overall survival. Postoperative complications also varied between the two techniques. These findings highlight the complex considerations involved in selecting the most suitable lymphadenectomy approach for individual patients. Therefore, the decision requires an individualized assessment that considers the potential benefits and risks of D1 and D2 techniques. A collaborative approach involving interdisciplinary teams is crucial for developing personalized treatment plans that optimize both oncological outcomes and postoperative quality of life.
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Affiliation(s)
- Venera-Cristina Dinescu
- Department of Health Promotion and Occupational Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Veronica Gheorman
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Eugen Florin Georgescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania; (E.F.G.); (M.B.); (Ș.P.)
| | - Ștefan Paitici
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania; (E.F.G.); (M.B.); (Ș.P.)
| | - Marius Bică
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania; (E.F.G.); (M.B.); (Ș.P.)
| | - Ștefan Pătrașcu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania; (E.F.G.); (M.B.); (Ș.P.)
| | - Marius Gabriel Bunescu
- Occupational Medicine Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Romeo Popa
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihaela Corina Berceanu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ana Maria Pătrașcu
- Hematology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Lavinia Maria Gheorman
- Department of Diabetology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Sorin Nicolae Dinescu
- Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ion Udriștoiu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.U.); (V.G.)
| | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.U.); (V.G.)
| | - Mircea Cătălin Forțofoiu
- Internal Medicine Department, University of Medicine and Pharmacy of Craiova, Filantropia Hospital of Craiova, 200143 Craiova, Romania;
| | - Tiberiu-Ștefăniță Țenea Cojan
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania; (E.F.G.); (M.B.); (Ș.P.)
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Xiao F, Ouyang B, Zou J, Yang Y, Yi L, Yan H. Trim14 promotes autophagy and chemotherapy resistance of gastric cancer cells by regulating AMPK/mTOR pathway. Drug Dev Res 2020; 81:544-550. [PMID: 32096264 DOI: 10.1002/ddr.21650] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the relationship between TRIM14 expression and chemotherapy resistance of gastric cancer (GC) cells. METHODS The expression of TRIM14 in 5-fluorouracil (5-FU)- and oxaliplation (L-OHP)-resistant GC tissues and cells were determined by qRT-PCR and western blotting. PcDNA3.1-TRIM14 and shRNA-TRIM14 vector were transfected to 5-FU-resistant GC cells (SGC7901/5-FU), and the proliferation and apoptosis of cells were measured. Animal experiments on 5-FU-resistant GC mice were performed to study the effect of TRIM14 expression on tumor size and weight, GC cell migration, and proliferation. pcDNA3.1-MK-3903 plasmid was transfected to SGC7901/5-FU cells with TRIM14 silence. The cell proliferation and apoptosis were determined. The protein expressions of Trim14, LC3, and BECLIN1 were measured by western blotting. RESULTS TRIM14 was significantly upregulated in 5-FU- and L-OHP-resistant GC tissues and cells. The overexpression of TRIM14 promoted the proliferation and autophagy of SGC7901/5-FU cells, and inhibited the apoptosis. Moreover, in vivo experiment verified that the silence of TRIM14 reduced the tumor size and weight, and inhibited the migration and proliferation of GC cells in 5-FU-resistant GC mice. The overexpression of MK-3903 reversed the inhibiting role of TRIM14 knockout on the proliferation and autophagy of SGC7901/5-FU cells. CONCLUSION TRIM14 promoted chemotherapy resistance of GC cells by regulating AMPK/mTOR pathway, and may be a new biomarker for treating GC.
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Affiliation(s)
- Feng Xiao
- Department of Pathology, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
| | - Binshen Ouyang
- Department of Pathology, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jue Zou
- Department of Pathology, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
| | - Yelin Yang
- Department of Pathology, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
| | - Lina Yi
- Department of Pathology, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
| | - Hongzhu Yan
- Department of Pathology, Seventh People's Hospital of Shanghai University of TCM, Shanghai, China
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Matsuoka T, Yashiro M. Precision medicine for gastrointestinal cancer: Recent progress and future perspective. World J Gastrointest Oncol 2020; 12:1-20. [PMID: 31966910 PMCID: PMC6960076 DOI: 10.4251/wjgo.v12.i1.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/12/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal (GI) cancer has a high tumor incidence and mortality rate worldwide. Despite significant improvements in radiotherapy, chemotherapy, and targeted therapy for GI cancer over the last decade, GI cancer is characterized by high recurrence rates and a dismal prognosis. There is an urgent need for new diagnostic and therapeutic approaches. Recent technological advances and the accumulation of clinical data are moving toward the use of precision medicine in GI cancer. Here we review the application and status of precision medicine in GI cancer. Analyses of liquid biopsy specimens provide comprehensive real-time data of the tumor-associated changes in an individual GI cancer patient with malignancy. With the introduction of gene panels including next-generation sequencing, it has become possible to identify a variety of mutations and genetic biomarkers in GI cancer. Although the genomic aberration of GI cancer is apparently less actionable compared to other solid tumors, novel informative analyses derived from comprehensive gene profiling may lead to the discovery of precise molecular targeted drugs. These progressions will make it feasible to incorporate clinical, genome-based, and phenotype-based diagnostic and therapeutic approaches and apply them to individual GI cancer patients for precision medicine.
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Affiliation(s)
- Tasuku Matsuoka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka 5458585, Japan
| | - Masakazu Yashiro
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka 5458585, Japan
- Oncology Institute of Geriatrics and Medical Science, Osaka City University Graduate School of Medicine, Osaka 5458585, Japan
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Isozaki H, Matsumoto S, Murakami S. Survival outcomes after sentinel node navigation surgery for early gastric cancer. Ann Gastroenterol Surg 2019; 3:552-560. [PMID: 31549015 PMCID: PMC6749950 DOI: 10.1002/ags3.12280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/06/2019] [Accepted: 07/10/2019] [Indexed: 12/11/2022] Open
Abstract
AIM This study evaluated the prognosis after sentinel node navigation surgery (SNNS) for early gastric cancer. METHODS For 100 patients who underwent SNNS (between August 13, 2003 and December 17, 2018) at our hospital, the survival outcomes were investigated. RESULTS (a) SN were detected with a diagnostic accuracy of 0.98. (b) Of seven patients who had positive SN metastasis, three underwent standard gastrectomy with D2 lymph node dissection. Among them, one patient died of recurrence (bone) and the other two patients were alive 4.5 and 14.7 years after surgery. The remaining four patients with positive SN who underwent diminished gastrectomy with lymphatic basin dissection at their request are alive 2.8, 6.0, 6.9 and 10.8 years after surgery without recurrence. (c) No patients who underwent diminished gastrectomy died of gastric cancer after surgery. (d) In the period following diminished gastrectomy, one patient underwent total gastrectomy and five patients underwent endoscopic submucosal dissection, and they survived for longer than 5 years. (e) As a result of SNNS, the gastric cancer-specific cumulative 5-year survival rate was 98.5%. CONCLUSIONS Diminished gastrectomy during SNNS resulted in a satisfactory prognosis. However, regular follow-up after surgery is needed to detect secondary cancer of the remaining stomach.
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Kim SM, Lee H, Min BH, Kim JJ, An JY, Choi MG, Bae JM, Kim S, Sohn TS, Lee JH. A prediction model for lymph node metastasis in early-stage gastric cancer: Toward tailored lymphadenectomy. J Surg Oncol 2019; 120:670-675. [PMID: 31301150 DOI: 10.1002/jso.25628] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to develop a prediction model for the presence and location of lymph node metastasis (LNM) in early gastric cancer. METHOD We reviewed medical records of 4 929 patients who underwent radical gastrectomy for early gastric cancer. Variables of age, sex, lymphatic invasion, depth of invasion, location, gross type, differentiation, and tumor size were analyzed. Logistic regression analysis was used to determine independent predictors of LNM at each LN station. RESULT Overall incidence of LNM was 9.1% (448/4 929 patients). For the presence of LNM, risk factors of age, sex, lymphatic invasion, depth of invasion, anatomical part, gross ulceration, size, and tumor differentiation were significantly associated with LNM. The area under the curve (AUC) for predicting LNM after validation was 0.834 for the test set. For the location of LNM, age, sex, lymphatic invasion, depth of invasion, anatomical part, circumferential portion, gross type, differentiation, and tumor size were significantly associated with LNM. The AUC of each LN station was favorable with the test set. CONCLUSION Predicting the location of metastatic LNs appeared to be possible in patients with early gastric cancer.
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Affiliation(s)
- Su Mi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Bara T, Gurzu S, Jung I, Borz C, Banias L, Bara T. Sentinel node biospy using intravital blue dye: An useful technique for identification of skip metastases in gastric cancer. Medicine (Baltimore) 2019; 98:e14951. [PMID: 30896665 PMCID: PMC6709175 DOI: 10.1097/md.0000000000014951] [Citation(s) in RCA: 3] [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] [Received: 08/05/2018] [Revised: 01/22/2019] [Accepted: 02/27/2019] [Indexed: 02/05/2023] Open
Abstract
As the lymph node status remains the main prognostic factor of gastric cancer (GC), several lymph node-based staging systems have been recently proposed for an appropriate postoperative therapy. The identification of sentinel lymph nodes (SLNs) might improve the postoperative protocols. The aim of this study was to present our experience in detecting SLNs in GC using methylene blue dye.We have performed an observational study and retrospectively analyzed all of the consecutive cases of GC operated by the same surgical team and managed by the same pathologists during 2013 to 2015. In all of the cases SLN status was determined using the methylene blue that was intraoperatively administered in the peritumoral subserosal tissue. All blue colored nodes were histopathologically examined. In the node negative cases immunohistochemical stains using AE1/AE3 keratin were performed.The blue SLNs were identified in 48 out of the 50 cases included in the study, with a 96% sensitivity and 87.50% specificity. From the 48 cases, 34 (70.83%) presented positive SLNs; in the other 14 cases the SLNs were negative (29.17%). False negativity was observed in 6 of the 14 cases. In 2 of the cases the false negativity of the group 20 was induced by the anthracotic pigment. In other 2 false negative cases, although no regional metastases were founded, sentinel skip metastases in the group 8 and 15, respectively, were identified.Mapping of the SLNs is a simple and cheap method that might improve the accuracy of LN-based staging of patients with GC and favor identification of skip metastases.
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Affiliation(s)
| | - Simona Gurzu
- Department of Pathology
- Advanced Medical and Pharmaceutical Research Center (CCAMF), University of Medicine, Pharmacy, Sciences and Technology, Tîrgu Mureş, Romania
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Shen M, Zhong XW. Clinical significance of expression of SERPINE1 gene in gastric cancer. Shijie Huaren Xiaohua Zazhi 2018; 26:1818-1824. [DOI: 10.11569/wcjd.v26.i31.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To detect the expression of the SERPINE1 gene and analyze its clinical significance in gastric cancer (GC).
METHODS The patients with GC were selected from the TCGA database. K-M survival curve, COX proportional hazards model, χ2 test and logistic regression were used to analyze the patients' data.
RESULTS COX proportional risk model analysis showed that SERPINE1 expression, age, T stage, N stage, M stage, and TNM stage were prognostic factors for overall survival. Among them, SERPINE1 expression, age and M stage were independent risk factors affecting tumor prognosis. Chi-square test and logistic regression were used to analyze the risk factors affecting the expression of the SERPINE1 gene. The results showed that the age, sex, tumor differentiation and tumor stage in GC patients did not affect the expression of the SERPINE1 gene, while the expression in the gastric antrum was lower than that in other sites. SERPINE1 expression was significantly higher in GC tissues than in adjacent normal tissues.
CONCLUSION The expression of the SERPINE1 gene in GC increases, which is associated with a poor prognosis of GC. SERPINE1 may become a target for GC screening and treatment.
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Affiliation(s)
- Miao Shen
- Department of Pathology, Deqing County People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Xing-Wei Zhong
- Department of Gastroenterology, Deqing County People's Hospital, Huzhou 313200, Zhejiang Province, China
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Gao P, Jie ZG, Li ZR, Cao Y, Zhang GY, Xiong JB, Xiao W, Liu Y. Efficacy of Complex Banmao Capsules combined with chemotherapy in treatment of patients with advanced gastric carcinoma. Shijie Huaren Xiaohua Zazhi 2018; 26:655-660. [DOI: 10.11569/wcjd.v26.i11.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy of Compound Banmao Capsules combined with chemotherapy in the treatment of patients with advanced gastric carcinoma.
METHODS Eighty patients with advanced gastric carcinoma treated from January 2014 to December 2014 at our department were randomly divided into either a study group or a control group. All of the patients had undergone radical gastrectomy with D2 lymphadenectomy. According to the UICC/AJCC TNM staging system for gastric cancer (seventh edition), all of the patients were confirmed to have stage Ⅱb-Ⅲc disease. The patients in the control group were treated with XELOX chemotherapy only, and the patients in the study group were treated with XELOX chemotherapy plus Compound Banmao Capsules. After treatment, clinical efficacy, quality of life, and adverse reactions were compared between the two groups.
RESULTS The Karnofsky performance score was significantly better and the incidence of adverse reactions was significantly lower in the study group than in the control group (P < 0.05). There was no significant difference in the 3-year survival rate between the two groups (P > 0.05). However, the survival of patients in the study group showed an increasing tendency compared with the control group.
CONCLUSION Compound Banmao Capsules may reduce the adverse effects of chemotherapy and improve the quality of life and compliance of patients with gastric cancer .
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Affiliation(s)
- Pan Gao
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Zhi-Gang Jie
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Zheng-Rong Li
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Yi Cao
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Guo-Yang Zhang
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Jian-Bo Xiong
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Wei Xiao
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Yi Liu
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, China
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Youn GJ, Chung WC. [Micrometastasis in Gastric Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 69:270-277. [PMID: 28539031 DOI: 10.4166/kjg.2017.69.5.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the incidence and mortality rate of gastric cancer have been steadily declining, gastric cancer is still the fourth most common cancer in the world and more than 50% of cases occur in Eastern Asia. In Korea, gastric cancer is the second most common cancer and third cause of cancer related death. The standard surgical procedure for resectable advanced gastric cancer is D2 lymphadenectomy with radical gastrectomy. Even though R0 resection was completed, recurrence is relatively common, and contributes to the limited survival of the patients in gastric cancer. As a clinically relevant factor for detection of the recurrence, the presence of isolating tumor cells has been introduced and it is so called as 'micrometastasis'. Numerous immunohistochemistry and molecular studies have shown that micrometastasis can be demonstrated not only in lymph nodes but also in such body compartments as the bone marrow, peritoneal cavity and blood. Herein, we review the current knowledge and evidence of the prognostic significance of micrometastasis in peritoneal, lymph node, bone marrow. Also, we discuss the current state of research on the circulating tumor cell in peripheral blood.
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Affiliation(s)
- Gun Jung Youn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Chul Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Moncayo VM, Alazraki AL, Alazraki NP, Aarsvold JN. Sentinel Lymph Node Biopsy Procedures. Semin Nucl Med 2017; 47:595-617. [DOI: 10.1053/j.semnuclmed.2017.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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The Prevalence of Overall and Initial Lymph Node Metastases in Clinical T1N0 Thoracic Esophageal Cancer: From the Results of JCOG0502, a Prospective Multicenter Study. Ann Surg 2017; 264:1009-1015. [PMID: 27420375 DOI: 10.1097/sla.0000000000001557] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the sites and frequencies of overall and initial lymph node (LN) metastases (LNMs) of clinical T1N0 esophageal cancer. BACKGROUND The sites and frequencies of initial LNMs and sentinel LNs (SLNs) of esophageal cancer remain unclear. METHODS The Japan Clinical Oncology Group JCOG0502 trial was a 4-arm prospective study that compared esophagectomy with chemoradiotherapy for clinical T1N0 esophageal cancer in both randomized and patient-preference arms. The preoperative diagnostic accuracy was evaluated for patients assigned to the surgery arm. Patients who withdrew consent and who were not treated were excluded. All patients underwent esophagectomy with D2 or greater LN dissection. From the pathologic findings, sites and frequencies of LNMs and SLNs were assessed and the frequency of skip LNMs was calculated. RESULTS In total, 211 patients underwent LNM and SLN analysis. Regarding N-factor accuracy, 57 (27.0%) of 211 clinical N0 cases had pathologic LNMs. The upper mediastinal and mediastinal/abdominal regions were frequent sites of LNMs in upper and lower thoracic cases, respectively. However, in middle thoracic cases, LNMs were observed in the neck, mediastinal, and abdominal regions, and pathologic SLN spread to all 3 fields. The frequency of skip LNMs was 36.7%. CONCLUSIONS A clinical diagnosis of T1N0 is not sufficiently accurate, and therefore, it is unacceptable to omit LN dissection or minimize the prophylactic radiation field. SLNs, which are not location restricted, should be surveyed in all 3 fields.
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Feasibility and diagnostic performance of dual-tracer-guided sentinel lymph node biopsy in cT1-2N0M0 gastric cancer: a systematic review and meta-analysis of diagnostic studies. World J Surg Oncol 2017; 15:103. [PMID: 28511723 PMCID: PMC5434631 DOI: 10.1186/s12957-017-1159-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/23/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dual-tracer-guided sentinel lymph node (SLN) biopsy may provide a promising diagnostic tool to assess accurately the status of lymph node metastasis in the surgical operation and assure the oncologic safety of the function or stomach preserving surgery. The diagnostic performance of this technology in recent studies varied. Thus, we conducted this meta-analysis. METHODS This systematic review and meta-analysis was registered at the PROSPERO. Eligible studies were searched in the PubMed, EMBASE, Web of Knowledge, and Cochrane Library databases. A random-effect model was used to pool the data. Summary receiver operator characteristic curves, analysis for publication bias, meta-regression, and subgroup analysis were also performed. RESULTS The pooled SLN identification rate and sensitivity were 0.97 and 0.89. 99mTc-human serum albumin with indocyanine green (ICG), 99mTc-antimony sulfur colloid with ICG, performing SLN biopsy ≥15 min after dye injection, an SLN ≥5, the basin dissection, laparoscopic surgery, in studies conducted in Japan and studies published after 2012, were associated with higher sensitivity. CT1 stage, performing SLN biopsy ≥15 min after dye injection, in studies conducted in Japan and studies published after 2012, were related with a higher identification rate. CONCLUSIONS Dual tracer is promising in SLN biopsy in gastric cancer, and the clinical application of SLN biopsy should be limited to the patients of cT1N0M0 gastric cancer. The combination of 99mTc-human serum albumin and ICG as well as the combination of 99mTc-antimony sulfur colloid and ICG may be the optimal tracer combination. However, it seems not justified to put this technique into routine clinical application recently. Some factors that might enhance diagnostic value are identified.
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Lianos GD, Hasemaki N, Vaggelis G, Karampa A, Anastasiadi Z, Lianou A, Papanikolaou S, Floras G, Bali CD, Lekkas E, Katsios C, Mitsis M. Sentinel node navigation in gastric cancer: new horizons for personalized minimally invasive surgical oncology? Transl Gastroenterol Hepatol 2016; 1:91. [PMID: 28138656 PMCID: PMC5244601 DOI: 10.21037/tgh.2016.12.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/24/2016] [Indexed: 12/23/2022] Open
Abstract
Complete (R0) resection and regional lymph nodes (LNs) dissection represent undoubtedly the basic surgical tools for patients with gastric cancer. It is reported that the LN metastasis rate in patients with early gastric cancer (EGC) is approximately 15-20%. Therefore, the innovative clinical application of sentinel node navigation surgery (SNNS) for EGC might be able to prevent unnecessary LN dissection as well as to reduce significantly the volume of gastric resection. Recent evidence suggests that double tracer methods appear superior compared to single tracer techniques. However, the researchers' interest is now focused on the identification of new LN detection methods utilizing sophisticated technology such as infrared ray endoscopy, fluorescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin-eosin is still considered the mainstay staining for assessing the metastatic status of LNs. In this review, we summarize the current evidences and we provide the latest scientific information assessing safety, efficacy and potential limitations of the innovative sentinel node (SN) navigation technique for gastric cancer. We try also to provide a "view" towards a future potential application of personalized minimally invasive surgery in gastric cancer field.
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Affiliation(s)
- Georgios D. Lianos
- Department of Surgery, Ioannina University Hospital & University of Ioannina, Ioannina, Greece
- Department of Surgery, General Hospital of Preveza, Preveza, Greece
| | - Natasha Hasemaki
- Department of Surgery, General Hospital of Preveza, Preveza, Greece
| | | | | | - Zoi Anastasiadi
- Department of Surgery, Ioannina University Hospital & University of Ioannina, Ioannina, Greece
| | - Aikaterini Lianou
- Department of Surgery, Ioannina University Hospital & University of Ioannina, Ioannina, Greece
| | | | - Grigorios Floras
- Department of Surgery, General Hospital of Preveza, Preveza, Greece
| | - Christina D. Bali
- Department of Surgery, Ioannina University Hospital & University of Ioannina, Ioannina, Greece
| | | | - Christos Katsios
- Department of Surgery, Ioannina University Hospital & University of Ioannina, Ioannina, Greece
| | - Michail Mitsis
- Department of Surgery, Ioannina University Hospital & University of Ioannina, Ioannina, Greece
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Bara T, Bara T, Neagoe R, Sala D, Gurzu S, Jung I, Borz C. Sentinel Lymph Node Mapping In Gastric Cancer Surgery: Current Status. ACTA MEDICA MARISIENSIS 2016. [DOI: 10.1515/amma-2016-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Lymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion. The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.
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Affiliation(s)
- Tivadar Bara
- Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
| | - Tivadar Bara
- Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
| | - Radu Neagoe
- Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
| | - Daniela Sala
- Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
| | - Simona Gurzu
- Department of Pathology, University of Medicine and Pharmacy of Tirgu Mures, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine and Pharmacy of Tirgu Mures, Romania
| | - Cristian Borz
- Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
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Polom W, Markuszewski M, Cytawa W, Czapiewski P, Lass P, Matuszewski M. Fluorescent Versus Radioguided Lymph Node Mapping in Bladder Cancer. Clin Genitourin Cancer 2016; 15:e405-e409. [PMID: 28007368 DOI: 10.1016/j.clgc.2016.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/30/2016] [Accepted: 11/20/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The aim of the study was to compare 2 methods of the sentinel lymph node biopsy (SLNB) procedure in bladder cancer: we applied technetium radiocolloid (RadCol) detected by a gamma ray detection probe, and indocyanine green (ICG) detected by a near-infrared fluorescent (NIRF) camera. MATERIAL AND METHODS The SLNB was performed on 50 patients using the RadCol and the ICG, followed by a lymphadenectomy and a pathologic examination. RESULTS In the analyzed group of 47 patients (3 patients were excluded owing to the lack of lymphatic drainage from the tumor), the SLNB was performed using the 2 methods. The ICG with a NIRF-guided camera detected all sentinel lymph nodes (SLNs) in 46 cases, whereas RadCol detected them in 45 cases. In 12 (25.6%) of 47 patients, the ICG-fluorescent method revealed more SLNs than the RadCol method. In 8 (17%) patients, the SLNs revealed in the ICG fluorescence were metastatic. In 3 (6.4%) patients, we found SLNs outside the standard lymphadenectomy template, but a histopathologic examination showed they were negative for cancer. In 3 (6.4%) patients, the SLNs detected by both methods were negative for cancer, but other resected lymph nodes revealed metastases. CONCLUSION Our study shows that SLNB procedure with the RadCol or the ICG method is useful for the evaluation of lymph nodes in bladder cancer. The new ICG fluorescent technique with a NIRF camera system is safe, enables live view of the results of the procedure, and does not create additional costs. However, it highlights more lymph nodes than the radioactive method.
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Affiliation(s)
- Wojciech Polom
- Urology Department, Medical University of Gdańsk, Gdańsk, Poland.
| | | | - Wojciech Cytawa
- Nuclear Medicine Department, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Czapiewski
- Pathomorphology Department, Medical University of Gdańsk, Gdańsk, Poland; Pathology Department, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Piotr Lass
- Nuclear Medicine Department, Medical University of Gdańsk, Gdańsk, Poland
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Santos FAV, Drummond-Lage AP, Rodrigues MA, Cabral MA, Pedrosa MS, Braga H, Wainstein AJA. Sentinel node biopsy using blue dye and technetium99 in advanced gastric cancer: anatomical drainage and clinical application. ACTA ACUST UNITED AC 2016; 49:S0100-879X2016000800701. [PMID: 27409337 PMCID: PMC4954739 DOI: 10.1590/1414-431x20165341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/28/2016] [Indexed: 12/11/2022]
Abstract
Lymph node metastases are an independent prognosis factor in gastric carcinoma (GC) patients. Radical lymphadenectomy can improve survival but it can also increase surgical morbidity. As a principle, sentinel node (SN) navigation surgery can avoid unnecessary lymphadenectomy without compromising prognosis. In this pilot study, 24 patients with untreated GC were initially screened for SN navigation surgery, of which 12 were eligible. Five patients had T2 tumors, 5 had T3 tumors and 2 had T1 tumors. In 33% of cases, tumor diameter was greater than 5.0 cm. Three hundred and eighty-seven lymph nodes were excised with a median of 32.3 per patient. The SN navigation surgery was feasible in all patients, with a median of 4.5 SNs per patient. The detection success rate was 100%. All the SNs were located in N1 and N2 nodal level. In 70.9% of cases, the SNs were located at lymphatic chains 6 and 7. The SN sensitivity for nodal staging was 91.6%, with 8.3% of false negative. In 4 patients who were initially staged as N0, the SNs were submitted to multisection analyses and immunohistochemistry, confirming the N0 stage, without micrometastases. In one case initially staged as negative for nodal metastases based on SN analyses, metastases in lymph nodes other than SN were found, resulting in a 20% skip metastases incidence. This surgery is a reproducible procedure with 100% detection rate of SN. Tumor size, GC location and obesity were factors that imposed some limitations regarding SN identification. Results from nodal multisection histology and immunohistochemistry analysis did not change initial nodal staging.
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Affiliation(s)
- F A V Santos
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - A P Drummond-Lage
- Instituto de Pós Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil
| | - M A Rodrigues
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - M A Cabral
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - M S Pedrosa
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - H Braga
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - A J A Wainstein
- Instituto de Pós Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil
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Bravo Neto GP, Dos Santos EG, Victer FC, Neves MS, Pinto MF, Carvalho CEDS. Sentinel Lymph Node Navigation Surgery for Early Gastric Cancer: Is It a Safe Procedure in Countries with Non-Endemic Gastric Cancer Levels? A Preliminary Experience. J Gastric Cancer 2016; 16:14-20. [PMID: 27104022 PMCID: PMC4834616 DOI: 10.5230/jgc.2016.16.1.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 02/06/2023] Open
Abstract
Purpose Early diagnosis of gastric cancer is still the exception in Western countries. In the East, as in Japan and Korea, this disease is an endemic disorder. More conservative surgical procedures are frequently performed in early gastric cancer cases in these countries where sentinel lymph node navigation surgery is becoming a safe option for some patients. This study aims to evaluate preliminary outcomes of patients with early gastric cancer who underwent sentinel node navigation surgeries in Brazil, a country with non-endemic gastric cancer levels. Materials and Methods From September 2008 to March 2014, 14 out of 205 gastric cancer patients underwent sentinel lymph node navigation surgeries, which were performed using intraoperative, endoscopic, and peritumoral injection of patent blue dye. Results Antrectomies with Billroth I gastroduodenostomies were performed in seven patients with distal tumors. The other seven patients underwent wedge resections. Sentinel basin resections were performed in four patients, and lymphadenectomies were extended to stations 7, 8, and 9 in the other 10. Two patients received false-negative results from sentinel node biopsies, and one of those patients had micrometastasis. There was one postoperative death from liver failure in a cirrhotic patient. Another cirrhotic patient died after two years without recurrence of gastric cancer, also from liver failure. All other patients were followed-up for 13 to 79 months with no evidence of recurrence. Conclusions Sentinel lymph node navigation surgery appears to be a safe procedure in a country with non-endemic levels of gastric cancer.
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Affiliation(s)
- Guilherme Pinto Bravo Neto
- Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Elizabeth Gomes Dos Santos
- Division of Esophageal and Gastric Surgery, General Surgery Service of the Clementino Fraga Filho University Hospital (HUCFF-UFRJ), Rio de Janeiro, Brazil
| | - Felipe Carvalho Victer
- Division of Esophageal and Gastric Surgery, General Surgery Service of the Clementino Fraga Filho University Hospital (HUCFF-UFRJ), Rio de Janeiro, Brazil
| | - Marcelo Soares Neves
- Gastroenterology Service of the Clementino Fraga Filho University Hospital (HUCFF-UFRJ), Rio de Janeiro, Brazil
| | - Márcia Ferreira Pinto
- Gastroenterology Service of the Clementino Fraga Filho University Hospital (HUCFF-UFRJ), Rio de Janeiro, Brazil
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Tóth D, Plósz J, Török M. Clinical significance of lymphadenectomy in patients with gastric cancer. World J Gastrointest Oncol 2016; 8:136-146. [PMID: 26909128 PMCID: PMC4753164 DOI: 10.4251/wjgo.v8.i2.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/13/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
Approximately thirty percent of patients with gastric cancer undergo an avoidable lymph node dissection with a higher rate of postoperative complication. Comparing the D1 and D2 dissections, it was found that there is a significant difference in morbidity, favoured D1 dissection without any difference in overall survival. Subgroup analysis of patients with T3 tumor shows a survival difference favoring D2 lymphadenectomy, and there is a better gastric cancer-related death and non-statistically significant improvement of survival for node-positive disease in patients with D2 dissection. However, the extended lymphadenectomy could improve stage-specific survival owing to the stage migration phenomenon. The deployment of centralization and application of national guidelines could improve the surgical outcomes. The Japanese and European guidelines enclose the D2 lymphadenectomy as the gold standard in R0 resection. In the individualized, stage-adapted gastric cancer surgery the Maruyama computer program (MCP) can estimate lymph node involvement preoperatively with high accuracy and in addition the Maruyama Index less than 5 has a better impact on survival, than D-level guided surgery. For these reasons, the preoperative application of MCP is recommended routinely, with an aim to perform “low Maruyama Index surgery”. The sentinel lymph node biopsy (SNB) may decrease the number of redundant lymphadenectomy intraoperatively with a high detection rate (93.7%) and an accuracy of 92%. More accurate stage-adapted surgery could be performed using the MCP and SNB in parallel fashion in gastric cancer.
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Coccolini F, Montori G, Ceresoli M, Cima S, Valli MC, Nita GE, Heyer A, Catena F, Ansaloni L. Advanced gastric cancer: What we know and what we still have to learn. World J Gastroenterol 2016; 22:1139-1159. [PMID: 26811653 PMCID: PMC4716026 DOI: 10.3748/wjg.v22.i3.1139] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/25/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is a common neoplastic disease and, more precisely, is the third leading cause of cancer death in the world, with differences amongst geographic areas. The definition of advanced gastric cancer is still debated. Different stadiating systems lead to slightly different stadiation of the disease, thus leading to variations between the single countries in the treatment and outcomes. In the present review all the possibilities of treatment for advanced gastric cancer have been analyzed. Surgery, the cornerstone of treatment for advanced gastric cancer, is analyzed first, followed by an investigation of the different forms and drugs of chemotherapy and radiotherapy. New frontiers in treatment suggest the growing consideration for intraperitoneal administration of chemotherapeutics and combination of traditional drugs with new ones. Moreover, the necessity to prevent the relapse of the disease leads to the consideration of administering intraperitoneal chemotherapy earlier in the therapeutical algorithm.
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Mocellin S, McCulloch P, Kazi H, Gama‐Rodrigues JJ, Yuan Y, Nitti D. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database Syst Rev 2015; 2015:CD001964. [PMID: 26267122 PMCID: PMC7263417 DOI: 10.1002/14651858.cd001964.pub4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of lymphadenectomy extent on the survival of patients with primary resectable gastric carcinoma is debated. OBJECTIVES We aimed to systematically review and meta-analyze the evidence on the impact of the three main types of progressively more extended lymph node dissection (that is, D1, D2 and D3 lymphadenectomy) on the clinical outcome of patients with primary resectable carcinoma of the stomach. The primary objective was to assess the impact of lymphadenectomy extent on survival (overall survival [OS], disease specific survival [DSS] and disease free survival [DFS]). The secondary aim was to assess the impact of lymphadenectomy on post-operative mortality. SEARCH METHODS We searched CENTRAL, MEDLINE and EMBASE until 2001, including references from relevant articles and conference proceedings. We also contacted known researchers in the field. For the updated review, CENTRAL, MEDLINE and EMBASE were searched from 2001 to February 2015. SELECTION CRITERIA We considered randomized controlled trials (RCTs) comparing the three main types of lymph node dissection (i.e., D1, D2 and D3 lymphadenectomy) in patients with primary non-metastatic resectable carcinoma of the stomach. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from the included studies. Hazard ratios (HR) and relative risks (RR) along with their 95% confidence intervals (CI) were used to measure differences in survival and mortality rates between trial arms, respectively. Potential sources of between-study heterogeneity were investigated by means of subgroup and sensitivity analyses. The same two authors independently assessed the risk of bias of eligible studies according to the standards of the Cochrane Collaboration and the quality of the overall evidence based on the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria. MAIN RESULTS Eight RCTs (enrolling 2515 patients) met the inclusion criteria. Three RCTs (all performed in Asian countries) compared D3 with D2 lymphadenectomy: data suggested no significant difference in OS between these two types of lymph node dissection (HR 0.99, 95% CI 0.81 to 1.21), with no significant difference in postoperative mortality (RR 1.67, 95% CI 0.41 to 6.73). Data for DFS were available only from one trial and for no trial were DSS data available. Five RCTs (n = 3 European; n = 2 Asian) compared D2 to D1 lymphadenectomy: OS (n = 5; HR 0.91, 95% CI 0.71 to 1.17) and DFS (n=3; HR 0.95, 95% CI 0.84 to 1.07) findings suggested no significant difference between these two types of lymph node dissection. In contrast, D2 lymphadenectomy was associated with a significantly better DSS compared to D1 lymphadenectomy (HR 0.81, 95% CI 0.71 to 0.92), the quality of the body of evidence being moderate; however, D2 lymphadenectomy was also associated with a higher postoperative mortality rate (RR 2.02, 95% CI 1.34 to 3.04). AUTHORS' CONCLUSIONS D2 lymphadenectomy can improve DSS in patients with resectable carcinoma of the stomach, although the increased incidence of postoperative mortality reduces its therapeutic benefit.
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Affiliation(s)
- Simone Mocellin
- University of PadovaMeta‐Analysis Unit, Department of Surgery, Oncology and GastroenterologyVia Giustiniani 2PadovaVenetoItaly35128
| | - Peter McCulloch
- John Radcliffe HospitalNuffield Department of Surgery6th floorHeadingtonOxfordUKOX3 9DU
| | - Hussain Kazi
- University of LiverpoolAcademic DepartmentLiverpoolUK
| | - Joaquin J Gama‐Rodrigues
- Hospital de ClinicasDepartment of Digestive SurgeryRua Manuel da Nobrega, 1564Sao PauloSao PauloBrazil04001005
| | - Yuhong Yuan
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1280 Main Street WestRoom HSC 4N50HamiltonONCanadaL8S 4K1
| | - Donato Nitti
- University of PadovaClinica Chirurgica IIVia Giustiniani 2PadovaItaly35128
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