Zhu YL, Sun YK, Xue XM, Yue JY, Yang L, Xue LY. Unnecessity of lymph node regression evaluation for predicting gastric adenocarcinoma outcome after neoadjuvant chemotherapy. World J Gastrointest Oncol 2019; 11(1): 48-58 [PMID: 30984350 DOI: 10.4251/wjgo.v11.i1.48]
Corresponding Author of This Article
Li-Yan Xue, MD, Professor, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanJiaYuanNanLi, Chaoyang District, Beijing 100021, China. xuely@cicams.ac.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yue-Lu Zhu, Xue-Min Xue, Jiang-Ying Yue, Li-Yan Xue, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yong-Kun Sun, Lin Yang, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Jiang-Ying Yue, Department of Pathology, Esophageal Carcinoma Hospital of Linzhou, Anyang 456592, Henan Province, China
Author contributions: Xue LY and Yang L designed this study; Sun YK and Zhu YL enrolled the patients and collected the clinical data; Zhu YL, Yue JY and Xue LY evaluated the pathological sections; Xue LY, Xue XM and Zhu YL conducted the statistical analyses; the manuscript was drafted by Zhu YL, Sun YK, and Yue JY and reviewed for content by Xue LY and Xue XM; All authors read and approved the final manuscript.
Supported byCAMS Innovation Fund for Medical Sciences, No. 2016-I2M-3-005; and the Beijing Hope Run Special Fund, No. LC2015A03 and No. LC2013B34.
Institutional review board statement: This study was conducted after obtaining approval from the Independent Ethics Committee at the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. NCC2013RE-049.
Informed consent statement: Consent was not required from each patient because this was a retrospective study.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Li-Yan Xue, MD, Professor, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanJiaYuanNanLi, Chaoyang District, Beijing 100021, China. xuely@cicams.ac.cn
Telephone: +86-10-87787514 Fax: +86-10-67702630
Received: September 28, 2018 Peer-review started: September 28, 2018 First decision: October 15, 2018 Revised: November 26, 2018 Accepted: December 24, 2018 Article in press: December 24, 2018 Published online: January 15, 2019 Processing time: 109 Days and 22.4 Hours
ARTICLE HIGHLIGHTS
Research background
Neoadjuvant chemotherapy has been applied to improve the long-term survival of patients with gastric adenocarcinoma (GAC). Although the regression change of primary tumors may affect the prognosis of GAC patients, it is controversial whether evaluation of lymph node (LN) regression change would help predict the outcomes of GAC patients.
Research motivation
Our previous study revealed that the grading of primary tumor regression was valuable for predicting the prognosis of GAC patients. However, the role of regression change in LNs for prognosis remains questionable.
Research objectives
We analyzed the prognostic effect of LN regression change in GAC patients after neoadjuvant chemotherapy, and tried to explore the necessity of LN regression evaluation.
Research methods
We evaluated the histological regression of resected LNs from 192 GAC patients, and classified regression change and residual tumor in LNs into four groups: (A) true negative LNs with no evidence of a preoperative therapy effect, (B) no residual metastasis but the presence of regression change in LNs, (C) residual metastasis with regression change in LNs, and (D) metastasis with minimal or no regression change in LNs. The effects of regression change and residual tumor groups in LNs on overall survival and progression-free survival were evaluated by Cox regression analysis.
Research results
The patients who had no residual tumor in LNs (Groups A+B) had a significantly better outcome than the patients who had residual tumors in LNs (Groups C+D) (P < 0.01), no matter whether they had LN regression change or not. No significant differences in survival were found between Groups A and B, or between Groups C and D.
Research conclusions
Our study revealed that patients who had residual tumors in LNs had significantly worse outcomes than patients who had no residual tumors in LNs, independent of whether LN regression change existed or not. Therefore, it may not be necessary to evaluate LN regression change in GAC patients.
Research perspectives
This was a single center retrospective study, and the preoperative therapeutic strategies were not uniform. Prospective studies are needed for further investigation.
