Lymph node micrometastasis of poorly differentiated node-negative gastric cancer risks a worse-than-expected survival outcome under standard management algorithm |
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| Institution: | 1. Department of Surgery, Chang Gung Memorial Hospital, Linkou & Chang Gung University, Taiwan;2. Department of Pathology, Chang Gung Memorial Hospital, Linkou & Chang Gung University, Taiwan;1. Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan;2. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Branch, Taiwan;3. Division of Thoracic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan;1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan;2. Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan;1. Department of Surgical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de l’Ouest, France;2. Department of Medical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de l’Ouest, France;1. Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, USA;2. Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, NY, USA;3. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA;1. The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK;2. Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK;3. The Institute of Cancer Research, Old Brompton Road, London, SW7 3RP, UK;4. Plastic Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK;5. Department of Finance and Costings, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK;6. Heamato-oncology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK;7. Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK |
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| Abstract: | BackgroundInvestigation of lymph node micrometastasis (mN) of gastric cancer has been focused on either T1 disease or T1-4N0 disease. Yet, it is unclear whether standard management algorithm toward poorly differentiated gastric cancer (PDGC) is more vulnerable to existence of mN, given its inherently biological aggressiveness, as compared with other histological types.Patients and methodsA surgical series (n = 3456) of gastric cancer categorized by histological differentiation was enrolled to analyze survival stratification. Of them, a cohort of T1-T4 N0 PDGC (n = 100) were subjected to cytokeratin immunohistochemistry, a surrogate of mN.ResultsCancer-specific survival by AJCC8 staging system could be nicely differentiated in both well-/moderately differentiated and signet ring cell types, while those between stage IA versus IB (p = 0.105), and stage IB versus IIA (p = 0.141) in PDGC could not. Thirteen (13%) out of 100 node-negative PDGC cases exhibited mN, with 5, 2, 5 and 1 cases occurring in T1, T2, T3, and T4 stage, respectively, without identifiable contributing factors. Prognostic performance of AJCC8 working upon PDGC became more discriminative by incorporating mN, as hazard ratio of stage IIIC referenced to stage IA increased from 43 to 78.ConclusionDefective discriminative survival of PDGC by standard staging algorithm prompted us to survey mN occurring in T1-T4N0 PDGC. The prognostic performance of AJCC8 working upon PDGC was enhanced by incorporating mN. As so, we recommend documentation of mN exclusively on node-negative PDGC that helps unveil stage migration phenomenon and switch to appropriate adjuvant therapy in need. |
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| Keywords: | Poorly differentiated gastric cancer Lymph node micrometastasis Cytokeratin Immuohistochemistry |
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