Prognostic significance of the number of metastatic lymph nodes in patients with gastric cancer

To confirm the prognostic significance of the number of the metastatic lymph nodes (MLN) in cases of gastric cancer, the results of surgical treatment of 668 patients with primary gastric cancer were analyzed retrospectively. Five-year survival rates were calculated with reference to the number of MLN, namely, none (89.2%), one to three (77.4%), four to six (55.8%), and seven or more (36.2%). Furthermore, even when the cancer had invaded the serosa, 5-year survival was significantly more frequent in patients with one to three MLN (71.7%) than in those with four to six (35.5%) or more than six (31.5%) (P less than 0.01), and the 5-year survival was close to that of patients with no MLN (70.5%). Not only qualitative but also quantitative evaluation of lymph node metastasis is essential for estimating the prognosis of patients with gastric cancer.     

Prognostic impact of positive lymph node ratio in gastric carcinoma

BACKGROUND AND OBJECTIVES: To evaluate the prognostic value of metastatic lymph node ratio in gastric carcinoma. METHODS: One hundred and sixty four patients who underwent D(2) dissection for gastric carcinoma at Ankara Oncology Hospital were reviewed retrospectively. The prognostic factors including Japanese classification, AJCC/UICC TNM classification and metastatic lymph node ratio (1-10% and >10%) were evaluated in univariate and multivariate Cox regression analysis. RESULTS: The multivariate analysis showed that Borrmann classification, pN-category of AJCC/UICC classification and metastatic lymph node ratio were the most significant prognostic factors and a higher hazard ratio was obtained for metastatic lymph node ratio than pN category of AJCC/UICC classification (4.5 vs. 11.4). When the metastatic ratio groups of 1-10% and >10% were subdivided into pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification, there was no statistical difference between survival curves. When pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification were subdivided into the ratio groups of 1-10% and >10%, the survival rate of ratio group 1-10% was better than ratio group >10%. CONCLUSION: With its simplicity and reproducibility, metastatic lymph node ratio can be used as a reliable prognostic indicator.     

Prognostic value of the number of metastatic lymph nodes in gastric cancer with radical surgery

To evaluate the effectiveness of extended lymph node dissection in gastric cancer, the relationship between the number of lymph nodes with metastasis and the long-term outcome was studied retrospectively in 761 patients who underwent curative resection with extensive lymph node dissection. The cumulative 5-year survival rate was 85.8% in patients without lymph node metastasis, 60.2% in those with 1–4 lymph nodes, 35.6% with 5–10 nodes, and 12.3% with 11 or more nodes involved. Concerning N₂ or N₃ patients in whom metastatic lymph nodes would have remained without extensive dissection, the 5-year survival rate was 70.5% in those with 1–4 lymph nodes involved and 44.0% with 5 or more lymph nodes involved when no serosal invasion was observed. It was 38.5% with 1–4 lymph nodes and 5% with 5 or more lymph nodes involved when serosal invasion was observed. These results suggest that extensive lymph node dissection is effective in gastric cancer patients without serosal invasion and, when only a few lymph nodes are involved, also in those with serosal invasion. However, it is not considered to be effective in patients with serosal invasion and metastasis to many lymph nodes. Combination therapies are thought to be required in such patients. © 1993 Wiley-Liss, Inc.     

淋巴结转移率在T3期胃癌预后中的临床意义（附347例）

目的:探讨T3期胃癌患者淋巴结转移率的影响因素及淋巴结转移率对于预后生存的临床意义。方法:回顾性分析2007年1月至2010年12月期间哈尔滨医科大学肿瘤医院347例接受手术治疗的T3期胃癌患者的临床病理资料,通过χ2检验分析淋巴结转移率与相关临床病理因素之间的关系;Logistic回归分析淋巴结转移率的影响因素;利用Kaplan-Meier法绘制生存曲线图以及Log-rank检验比较不同组间患者生存率的差异;采用Cox比例风险回归模型对患者预后进行分析。结果:与淋巴结转移率≤28.66%组相比,淋巴结转移率>28.66%组患者肿瘤病理分型较差［93.3%(127/136) vs 76.8%(162/211),P=0.000］,肿瘤位于全胃的比例较高［12.5%(17/136) vs 3.8%(8/211),P=0.002］,肿瘤直径较大［49.3%(67/136) vs 27.5%(58/211),P=0.000］,血清CEA浓度较高［33.1%(45/136) vs 22.7%(48/211),P=0.034］,远处器官发生转移的几率较大［11.0%(15/136) vs 2.4%(5/211),P=0.001］。Logistic回归分析表明:肿瘤位置(全胃)、肿瘤直径(>6.1 cm)、病理分化类型(分化较差)、血清CEA水平(>5 ng/ml)、血清白蛋白浓度(≤40 g/L)是导致淋巴结转移率较高的危险因素(均P<0.05)。随访期间内有233例(67.1%)患者因肿瘤进展死亡;术后5年生存率为33.1%。单因素分析表明:年龄≤60岁、根治性手术、肿瘤单发、淋巴结转移率≤28.66%、M0、肿瘤直径≤6.1 cm、血清CA19-9≤37 U/ml的T3期胃癌患者预后较好(均P<0.05),而淋巴结的清扫数目并不影响患者的预后生存(P=0.089);多因素分析显示:年龄［HR(95%CI):1.487(1.139~1.941),P=0.004］、手术［HR(95%CI):1.741(1.205~2.515),P=0.003］、淋巴结转移率［HR(95%CI):3.053(2.293~4.065),P=0.000］、是否发生远处转移［HR(95%CI):1.766(1.043~2.991),P=0.034］是T3期胃癌患者的预后独立危险因素。结论:淋巴结转移率是影响T3期胃癌患者预后的独立危险因素,而肿瘤位置、病理分化类型、肿瘤直径、血清CEA浓度、远处器官发生转移是淋巴结转移率的影响因素。因此,对于T3期的胃癌患者,术前可以通过相关血液、影像检查,对患者的淋巴结转移率及预后进行准确而有效的评估。     

腋窝淋巴结清扫总数在预测淋巴结阴性乳腺癌患者预后中的价值

目的探讨腋窝淋巴结清扫总数在预测淋巴结阴性乳腺癌患者预后中的价值。方法采用Kaplan-Meier法和多因素回归分析方法,对138例有完整随访资料的淋巴结阴性乳腺癌患者的生存情况及影响因素进行分析。结果本组患者随访时间为33-96月,中位随访时间89月。5年总生存率为93.5%,无瘤生存率为80.1%。单因素分析显示,腋窝淋巴结清扫总数影响淋巴结阴性乳腺癌患者的预后(χ2=6.24,P<0.05),多因素回归分析发现腋窝淋巴结清扫总数是影响淋巴结阴性乳腺癌患者预后的独立因素之一(P=0.025)。结论手术清扫腋窝淋巴结数目可反映区域淋巴结清扫的彻底性以及评价术后病理分期的准确性,是影响淋巴结阴性乳腺癌患者预后的独立预后因素之一。     

Prognostic role of lymph node metastasis in early gastric cancer

Objective： To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gaswic cancer （EGC） patients. Methods： We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results： Of all the EGC patients, 7.5% （17/226） were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions： The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.     

Prognostic role of p‐mTOR expression in cancer tissues and metastatic lymph nodes in pT2b gastric cancer

Despite the great interest in mammalian target of rapamycin (mTOR) as a potential anticancer therapy target, the prognostic role of mTOR in gastric cancer has not been elucidated. In this study, we investigated mTOR expression in gastric cancer tissues and in metastatic lymph nodes and examined its association with clinical outcome. A total of 290 patients with pT2b gastric cancer were enrolled in this study. Patients were divided into 3 groups according to metastatic lymph node status: Group 1 contained 96 patients without lymph node metastasis, Group 2 contained 102 patients with a few (1–2) metastatic lymph nodes and Group 3 contained 92 patients with extensive (>16) lymph node metastasis. Phosphorylated mTOR expression was determined immunohistochemically using tissue microarrays. p‐mTOR expression was observed in 36.5% of the gastric cancer tissues in Group 1, 39.2% in Group 2 and 60.9% in Group 3. A significant correlation was found between p‐mTOR expression in gastric cancer tissues and in metastatic lymph nodes. The Borrmann type in Group 1, perineural invasion and p‐mTOR expression in metastatic lymph nodes in Group 2 and p‐mTOR expression in metastatic lymph nodes in Group 3 were found to be independent prognostic factors of disease‐free survival. The 5‐year disease free survival rate of Group 2 patients was 84.4% in negative p‐mTOR and 66.1% in positive p‐mTOR expression in metastatic lymph nodes (p = 0.015). The 5‐year disease free survival rate of Group 3 patients was 37.3% in negative p‐mTOR and 14.9% in positive p‐mTOR expression in metastatic lymph nodes (p = 0.037). There was a linear correlation between the rate of tumor recurrence and mTOR expression scores in metastatic lymph nodes. In pT2b gastric cancer, p‐mTOR expression in gastric cancer is associated with the extent of lymph node metastasis, and p‐mTOR expression in metastatic lymph nodes is correlated with poor disease‐free survival. mTOR may harbor significant potential for a prognostic biomarker and therapeutic target for gastric cancer treatment.     

VEGF-C和VEGF-D在胃癌及相关淋巴结组织中表达和临床意义的研究

目的：比较血管内皮生长因子C（vascular endothelial growth factor C,VEGF-C）和血管内皮生长因子D（vascular endothelial growth factor D,VEGF-D）在胃癌和相关淋巴结的表达,并评价其预后意义.方法：采用原位杂交技术检测45例胃癌患者原发病灶和转移淋巴结中VEGF-C和VEGF-D mRNA的表达水平;并检测转移及非转移淋巴结中VEGF-C和VEGF-D mRNA表达差异.结果：71%和62.2%的胃癌原发病灶可见VEGF-C和VEGF-D mRNA表达,原发病灶阳性者,相应的淋巴结转移病灶都可见VEGF-C和VEGF-D mRNA表达,55.6%和51.1%的胃癌患者淋巴结转移病灶VEGF-C和VEGF-D mRNA表达水平高于原发病灶,原发病灶和转移病灶淋巴管生成表达水平的差异与胃癌的预后密切相关（P＜0.05）.结论：胃癌癌细胞转移至淋巴结后淋巴管生成因子表达可能进一步提高,以进一步增强转移能力.     

早期胃癌淋巴结转移及临床意义

淋巴结转移是影响早期胃癌手术方式选择和预后的重要因素,对其转移规律和特点的认识及检测方法的掌握对于合理开展缩小手术至关重要。运用免疫组化和逆转录聚合酶链反应技术对早期胃癌前哨淋巴结检测不仅可以了解淋巴结站的转移特点、规律,而且可以发现微转移,从而指导术中淋巴结清扫范围而选择合理术式,避免标准根治术淋巴结清扫和扩大的手术方式对机体造成不必要的损害,减少手术创伤和术后并发症的出现,提高患者术后生存质量。     

Prognostic significance of the metastatic lymph node ratio in T3 gastric cancer patients undergoing total gastrectomy

Aims and background: The International Union Against Cancer tumor node metastasis classification is routinely applied for evaluating the prognosis of patients with gastric cancer. However, results are still heterogeneous. This study was therefore carried out to evaluate the prognostic significance of the metastatic lymph node (LN) ratio in T3 gastric cancer patients undergoing gastrectomy. Methods: Clinical data of 109 LN-positive cases were retrospectively analyzed. Spearman correlation analysis was used to determine the correlation coefficiency. Survival time was determined by Kaplan-Meier and Log-rank test. Multivariate analysis was performed using the Cox model. ROC curves were used to compare the accuracy of the number of metastatic LN and metastatic LN ratio. Results: The metastatic LN ratio did not correlate with the number of LN when at least 15 nodes were dissected, whereas the number of metastatic LN did. Univariate analysis showed that the metastatic LN ratio influenced significantly the survival time, while multivariate analysis revelaed it to be a major independent prognostic factor. Conclusions: The metastatic LN ratio can be used as a major independent prognostic factor for the patients with T3 gastric cancer.     

Evaluation of the ratio of lymph node metastasis as a prognostic factor in patients with gastric cancer

Background. Lymph node metastasis in patients with gastric cancer is one of the important prognostic factors. However, there is no consensus concerning the best classification for lymph node metastasis as a prognostic factor. So, to evaluate the ratio of the number of metastatic lymph nodes to the total number of dissected lymph nodes (the ratio of LN meta) as a prognostic factor, we compared the ratio of LN meta with lymph node status according to the Japan Classification of Gastric Carcinoma and the total number of metastatic lymph nodes with multivariate analysis. Methods. Between 1991 and 1997, a total of 360 patients with primary gastric cancer who underwent gastrectomy with D2 or more extended lymph node dissection were included in this study. Ten kinds of prognostic factors and three types of different classifications for lymph node metastasis were analyzed by multivariate analysis using the Cox regression. Results. The average number of dissected lymph nodes and metastatic lymph nodes were 55.0 (range, 11–184) and 2.6 (range, 0–86), respectively. There were significant differences of the 5-year cumulative survival rates among each group of the ratio of LN meta (0%, 1%–9%, 10%–24%, and more than 25%). Age, tumor size, curability, and the ratio of LN meta were selected as independent prognostic factors by forward stepwise selection. The ratio of LN meta showed the highest hazard ratio by Cox regression. Conclusion. The ratio of LN meta appears to be an important prognostic factor and the best classification factor for lymph node metastasis. Received for publication on May 14, 1999; accepted on June 10, 1999     

Prognostic significance of the size of cancer nests in metastatic lymph nodes in human esophageal cancers

BACKGROUND: Postoperative survival of patients with esophageal cancers after curative surgery is strongly affected by the presence of lymph node metastasis. The number and location of lymph node metastases have been evaluated and graded, but the clinical significance of their size has not been well investigated. METHODS: Of 322 esophageal cancer patients who underwent curative operations with radical lymph node dissection, 170 (53%) had lymph node metastasis. A total of 784 metastatic lymph nodes were obtained, and the area of the cancer nests was measured microscopically in the cross section. The data from each patient included the area of the largest cancer nest in the positive nodes (Nmax), classified as Na (<4 mm2), Nb (4-25 mm2), Nc (25-100 mm2), or Nd (>100 mm2). RESULTS: The 170 patients were classified according to the Nmax value: Na, 31 (18.2%); Nb, 35 (20.5%); Nc, 49 (28.8%); and Nd, 55 (32.4%). The 5-year survival rate was 77.7% in patients without lymph node metastasis and 35.4% in those with lymph node metastasis. When classified by Nmax, the 5-year survival rate was 77.8% for Na, 63.9% for Nb, 18.8% for Nc, and 12.8% for Nd. There was no significant difference in the survival rate between Na patients and those without lymph node metastasis. Nmax showed significant correlation with the primary tumor size, depth of tumor invasion, and number and location of metastatic lymph nodes, but not with histologic type or primary tumor location. In multivariate analysis, the Nmax value, the number of lymph node metastases and depth of tumor invasion were independent prognostic factors, while the location of the lymph node metastases was not statistically significant. CONCLUSIONS: The area of the largest cancer nest in the lymph nodes was one of the most significant prognostic factors for esophageal cancers. This estimation is objective and reproducible and may be of great importance when deciding the therapeutic modality for patients with esophageal cancers.     

胃癌淋巴结转移与预后的关系

目的：探讨胃癌淋巴结转移与预后的关系,为胃癌的手术治疗提供依据。方法：回顾性分析2000年-2004年间住院并行手术治疗的胃癌患者361例,建立数据库用SPSS13．0统计软件分析。结果：Logistic多因素回归分析显示胃癌肿瘤大小、浸润深度与淋巴结转移有关（P〈0．01）;Kaplan—Meier生存分析显示淋巴结转移与胃癌预后相关（P〈0．05）;而在相同浸润深度时,淋巴结转移与胃癌预后无关（P〉0．05）。结论：对于浸润深度相同,而淋巴结转移程度不同的胃癌,积极手术治疗能取得同样的治疗效果。     

胃中部癌前哨淋巴结邻近、横向和跳跃性转移的临床分析

Objective: To investigate the distribution pathway of sentinel lymph nodes (SLN) in middle third gastric carci-noma, as the foundation for rational lymphadenectomy. Methods: 52 cases of middle third tumors with solitary lymph nodes from 1852 gastric carcinomas were selected. The locations and histological types of metastatic lymph nodes were analyzed retrospectively. Results: Of 52 solitary node metastases cases, 37 were limited to perigastric nodes (N1), while 15 with skipping metastasis. In the 35 cases with tumor of lesser curvature, there were 17 cases found lymph nodes of the lesser curvature side (No. 3), 5 cases involved lymph nodes of the greater curvature (No. 4), and 8 cases with lymph nodes of the left gastric artery (No. 7). In the 17 cases with tumor of greater curvature, 7 cases spread to No. 4, while 3 metastasized to lymph nodes of the spleen hilum (No. 10). The difference of the histological types in groups N1 and over N1, were not statistically significant (P > 0.05). Conclusion: Adjacent metastasis formed the primary distribution pattern of SLN in middle third gastric carcinoma, transversal and skipping metastases being also notable.     

Prognostic performance of different lymph node classification systems in young gastric cancer

BackgroundAccurate staging plays a pivotal role in cancer care. The lymph node (LN) ratio (LNR) and the log odds of positive LNs (LODDS) have been suggested as alternatives to the N staging since the TNM system has the risk of stage migration. The prognostic significance of LNR and LODDS in young patients with gastric cancer (GC) has not been reported. This study aims to investigate the correlations between LNR and LODDS and survival of young patients with GC, and compare the predictive performance of these LN staging methods.MethodsGC patients before the age of 40 from 2004 to 2016 in the Surveillance, Epidemiology and End Results database were enrolled. The prognostic evaluation of the N factor, LNR and LODDS was compared using the time-dependent receiver operating characteristic (ROC) analysis, area under the curve (AUC), C-index and Akaike information criterion (AIC).ResultsMultivariate survival analysis identified that the LNR and LODDS were significantly independent prognostic indicators for overall survival (OS) in young patients with GC and in the subgroups comprised of patients with ≤15 LNs examined. The time-dependent ROC curves of the LNR and LODDS were continuously superior to that of the N factor in predicting OS during the observation period. And the AUCs revealed that the predictive accuracy of the LNR and LODDS was remarkably superior to the N factor at 1 and 3 years (P<0.05). The model incorporating LNR or LODDS had higher C-index and lower AIC when comparing to the model incorporating the N factor.ConclusionsThe LNR and LODDS improve accuracy of survival risk prediction in young patients with GC when comparing to the N factor. These two novel LN classification methods should be considered as alternatives to the N staging for the prognostic prediction of young patients with GC.