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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.


Related in: MedlinePlus

Kaplan-Meier survival analysis showed that overall survival of EGC was significantly correlated with invasions of lymphatic or blood vessels (P = 0.010).
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pone.0129531.g005: Kaplan-Meier survival analysis showed that overall survival of EGC was significantly correlated with invasions of lymphatic or blood vessels (P = 0.010).

Mentions: The overall survival rate was 90.2%. Kaplan-Meier survival analysis showed that overall survival was significantly correlated with LNM (P = 0.001) or N staging (P<0.001) and invasions of lymphatic or blood vessels (P = 0.010), but it was not correlated with age, gender, tumor size, tumor location, depth of tumor infiltration, tumor cell differentiation or general shape. As with treatment, the overall survival of these patients showed no obvious relationship with the scope of gastric resection (P = 0.856), D1 or D2 operation (P = 0.353) or the number of lymphadenectomies (<15 or ≥15, P = 0.269). Moreover, multiple Cox regression analysis identified that only N staging (P = 0.001) could serve as an independent prognostic predictor in the EGC patients (Table 3). The overall survival rates of the LNM-negative and LNM-positive groups were 94.1% and 78.8%, respectively (P = 0.001, Log-rank test); the average overall survival time was 144.142 and 113.876 months, respectively. Kaplan-Meier plots are shown in Figs 3, 4, 5 and 6.


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)

Kaplan-Meier survival analysis showed that overall survival of EGC was significantly correlated with invasions of lymphatic or blood vessels (P = 0.010).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0129531.g005: Kaplan-Meier survival analysis showed that overall survival of EGC was significantly correlated with invasions of lymphatic or blood vessels (P = 0.010).
Mentions: The overall survival rate was 90.2%. Kaplan-Meier survival analysis showed that overall survival was significantly correlated with LNM (P = 0.001) or N staging (P<0.001) and invasions of lymphatic or blood vessels (P = 0.010), but it was not correlated with age, gender, tumor size, tumor location, depth of tumor infiltration, tumor cell differentiation or general shape. As with treatment, the overall survival of these patients showed no obvious relationship with the scope of gastric resection (P = 0.856), D1 or D2 operation (P = 0.353) or the number of lymphadenectomies (<15 or ≥15, P = 0.269). Moreover, multiple Cox regression analysis identified that only N staging (P = 0.001) could serve as an independent prognostic predictor in the EGC patients (Table 3). The overall survival rates of the LNM-negative and LNM-positive groups were 94.1% and 78.8%, respectively (P = 0.001, Log-rank test); the average overall survival time was 144.142 and 113.876 months, respectively. Kaplan-Meier plots are shown in Figs 3, 4, 5 and 6.

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