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Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer.

Zhao BW, Chen YM, Jiang SS, Chen YB, Zhou ZW, Li YF - PLoS ONE (2015)

Bottom Line: Clinicopathological characteristics were assessed to identify effective predictive factors for LNM and overall survival.Because LNM independently predicts the prognosis of EGC, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and laparoscopic partial gastrectomy should be cautiously used in high-risk EGC patients.A pre-operative assessment of LNM status based on clinicopathological factors may be useful for therapy planning.

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.

ABSTRACT

Background: Lymph node metastasis (LNM) has been shown to be related to the prognosis of early gastric cancer (EGC). The choice of optimal treatment depends on an accurate pre-operative assessment of LNM status in EGC patients. However, in China, where EGC cases account for only a small part of gastric cancer (GC) cases, there are not enough data to make an accurate assessment. Therefore, this study, which involved a relatively large number of EGC patients, aimed to explore the relationship between clinicopathological characteristics and LNM in EGC.

Methods: Clinicopathological data from 205 EGC patients who underwent surgical resection at Sun Yat-Sen University Cancer Center from January 2000 to December 2011 were retrospectively analyzed. Clinicopathological characteristics were assessed to identify effective predictive factors for LNM and overall survival.

Results: LNM occurred in 52 (25.37%) EGC cases; of these cases, 18 occurred in intra-mucosal cancers (13 N1, 4 N2 and 1 N3), and 34 occurred in sub-mucosal cancers (22 N1, 7 N2 and 5 N3). Logistic regression analysis demonstrated that tumor differentiation (P=0.002), depth of tumor infiltration (P=0.004), vessel invasion (P=0.012), tumor size (P=0.020) and gender (P=0.022) were risk factors associated with LNM in EGC, listed in order of priority. The overall survival rate was 90.2%. Kaplan-Meier survival analysis showed that overall survival of EGC patients was significantly correlated with LNM (P=0.001), N staging (P<0.001) and invasion of lymphatic or blood vessels (P=0.010), but it was not correlated with tumor size, depth of tumor infiltration or tumor cell differentiation. Moreover, a multiple Cox regression analysis demonstrated that only N staging (P=0.001) could serve as an independent prognostic predictor in EGC patients.

Conclusions: Because LNM independently predicts the prognosis of EGC, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and laparoscopic partial gastrectomy should be cautiously used in high-risk EGC patients. A pre-operative assessment of LNM status based on clinicopathological factors may be useful for therapy planning.

No MeSH data available.


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LNM occurred in an intra-mucosal gastric cancer patient shown in the H-E staining graph.
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pone.0129531.g001: LNM occurred in an intra-mucosal gastric cancer patient shown in the H-E staining graph.

Mentions: Early gastric cancer (EGC) is a gastric cancer in which the lesion is confined to the mucosa and submucosa, regardless of the tumor size or the status of lymph node metastasis (LNM) [1]. Compared with advanced gastric cancer (AGC), EGC patients have a better post-operation prognosis, with an overall survival rate as high as 90%[1]. EGC treatment consists of endoscopic mucosal resection (EMR) or endoscopic sub-mucosal dissection (ESD) and gastrectomy plus D1 or D2 lymphadenectomy through laparoscopic or open operation [2–4]. As reported in previous studies, LNM rarely occurs in intramucosal gastric cancers (usually in less than 6% of such cases). However, when the tumor invades into the sub-mucosa layer of the stomach wall in which lymphatic vessels are abundant, the rate of LNM increases significantly to above 10% [5] and the prognosis is relatively poor (Figs 1 and 2). Moreover, in some large-scale studies performed in Japan and Korea, the overall survival rate of lymph node-positive EGC fell to 70%-80%, and the relapse rate rose to 8%[6–8]. The use of radical surgery depends on the status of LNM. Thus, it is essential to summarize the clinicopathological characteristics of EGC patients to find the risk factors for LNM and to indicate an effective treatment for EGC patients.


Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer.

Zhao BW, Chen YM, Jiang SS, Chen YB, Zhou ZW, Li YF - PLoS ONE (2015)

LNM occurred in an intra-mucosal gastric cancer patient shown in the H-E staining graph.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496056&req=5

pone.0129531.g001: LNM occurred in an intra-mucosal gastric cancer patient shown in the H-E staining graph.
Mentions: Early gastric cancer (EGC) is a gastric cancer in which the lesion is confined to the mucosa and submucosa, regardless of the tumor size or the status of lymph node metastasis (LNM) [1]. Compared with advanced gastric cancer (AGC), EGC patients have a better post-operation prognosis, with an overall survival rate as high as 90%[1]. EGC treatment consists of endoscopic mucosal resection (EMR) or endoscopic sub-mucosal dissection (ESD) and gastrectomy plus D1 or D2 lymphadenectomy through laparoscopic or open operation [2–4]. As reported in previous studies, LNM rarely occurs in intramucosal gastric cancers (usually in less than 6% of such cases). However, when the tumor invades into the sub-mucosa layer of the stomach wall in which lymphatic vessels are abundant, the rate of LNM increases significantly to above 10% [5] and the prognosis is relatively poor (Figs 1 and 2). Moreover, in some large-scale studies performed in Japan and Korea, the overall survival rate of lymph node-positive EGC fell to 70%-80%, and the relapse rate rose to 8%[6–8]. The use of radical surgery depends on the status of LNM. Thus, it is essential to summarize the clinicopathological characteristics of EGC patients to find the risk factors for LNM and to indicate an effective treatment for EGC patients.

Bottom Line: Clinicopathological characteristics were assessed to identify effective predictive factors for LNM and overall survival.Because LNM independently predicts the prognosis of EGC, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and laparoscopic partial gastrectomy should be cautiously used in high-risk EGC patients.A pre-operative assessment of LNM status based on clinicopathological factors may be useful for therapy planning.

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.

ABSTRACT

Background: Lymph node metastasis (LNM) has been shown to be related to the prognosis of early gastric cancer (EGC). The choice of optimal treatment depends on an accurate pre-operative assessment of LNM status in EGC patients. However, in China, where EGC cases account for only a small part of gastric cancer (GC) cases, there are not enough data to make an accurate assessment. Therefore, this study, which involved a relatively large number of EGC patients, aimed to explore the relationship between clinicopathological characteristics and LNM in EGC.

Methods: Clinicopathological data from 205 EGC patients who underwent surgical resection at Sun Yat-Sen University Cancer Center from January 2000 to December 2011 were retrospectively analyzed. Clinicopathological characteristics were assessed to identify effective predictive factors for LNM and overall survival.

Results: LNM occurred in 52 (25.37%) EGC cases; of these cases, 18 occurred in intra-mucosal cancers (13 N1, 4 N2 and 1 N3), and 34 occurred in sub-mucosal cancers (22 N1, 7 N2 and 5 N3). Logistic regression analysis demonstrated that tumor differentiation (P=0.002), depth of tumor infiltration (P=0.004), vessel invasion (P=0.012), tumor size (P=0.020) and gender (P=0.022) were risk factors associated with LNM in EGC, listed in order of priority. The overall survival rate was 90.2%. Kaplan-Meier survival analysis showed that overall survival of EGC patients was significantly correlated with LNM (P=0.001), N staging (P<0.001) and invasion of lymphatic or blood vessels (P=0.010), but it was not correlated with tumor size, depth of tumor infiltration or tumor cell differentiation. Moreover, a multiple Cox regression analysis demonstrated that only N staging (P=0.001) could serve as an independent prognostic predictor in EGC patients.

Conclusions: Because LNM independently predicts the prognosis of EGC, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and laparoscopic partial gastrectomy should be cautiously used in high-risk EGC patients. A pre-operative assessment of LNM status based on clinicopathological factors may be useful for therapy planning.

No MeSH data available.


Related in: MedlinePlus