Result of 11,946 gastric cancer treatment with immunochemosurgery

Although the therapeutic results of gastric cancer have markedly improved, it still remains the most common of cancer deaths in Korea. Annually more than 700, and all together 11,946, gastric cancer patients were surgically treated from 1970 to 1998 at Seoul National University Hospital. Stage III gastric cancer is already a systemic disease, Radical surgery alone cannot cure the patient, and about 35% recurred within 2-3 years. To improve the prognosis of advanced gastric cancer, systemic treatment such as immunotherapy and chemotherapy is required in the early postoperative period to kill the micrometastatic or remaining cancer cells after curative resection. We evaluated the survival rate and prognostic factors for 9,262 consecutive patients from 1981 to 1996. The clinicopathologic variables used for evaluating prognostic values were classified into patient, -tumor- and treatment-related factors. The prognostic significance of treatment modality was evaluated in stage III gastric cancer. The five-year survival rates were 55.9% for overall patients and 64.8% for patients who received curative resection. Radical lymph node dissection was found to produce survival gains in patients with stage II and IIIa. For postoperative adjuvant therapy, immunochemotherapy was most effective in patients with stage III. In multivariate analysis, curability of operation, depth of invasion, and ratio of involved-to-resected lymph nodes were the significant prognostic factors. Consequently, early detection and real curative resection with radical lymph node dissection, followed by immunochemotherapy (particularly in patients with stage III gastric cancer) should be recommended as a standard treatment principle for patients with 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     

Multivariate prognostic study on large gastric cancer

BACKGROUND: Although many authors investigate the prognostic factors of gastric cancer, there are few comprehensive studies on the prognosis of patients with large gastric cancer. The aim of this study was to clarify the prognostic factors of large gastric cancer using multivariate analysis. METHODS: The study included 95 patients who underwent gastrectomy for gastric cancer measuring 10 cm or more in diameter. We examined 24 clinicopathologic factors based on patient, operation, and tumor findings. Survival rates were analyzed by the Kaplan-Meier and Mantel-Cox method, and multivariate analysis was done using the Cox proportional hazards model. RESULTS: Overall 5-year survival rate was 22%, and median survival period was 15 months. The 5-year survival rate was influenced by the tumor size, gross type, serosal invasion, extragastric lymph node metastasis, liver metastasis, peritoneal dissemination, stage of disease (I, II vs. III, IV), resection margin, and operative curability (R0 vs. R1, R2). Of these, independent prognostic factors were three tumor findings: serosal invasion (absent vs. present, odds ratio 3.06, P < 0.01), extragastric lymph node metastasis (absent vs. present, odds ratio 2.13, P < 0.05), and liver metastasis (absent vs. present, odds ratio 3.77, P < 0.05). The survival was not significantly associated with any of the patient factors or operation factors including the extent of lymph node dissection. CONCLUSION: In patients with large gastric cancer, independent prognostic factors were serosal invasion, extragastric lymph node metastasis, and liver metastasis. Prognosis after gastectomy was determined by these tumor factors and was not associated with the patient or operation factors.     

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.     

Determining of metastatic lymph node ratio in patients who underwent D2 dissection for gastric cancer

The purpose of this study was to determine outcome of the ratio of metastatic lymph nodes to the total number of dissected lymph nodes (MLR) in patients with gastric cancer. We retrospectively analyzed 111 patients who underwent D₂ lymph node dissection. The prognostic factors including UICC/AJCC TNM classification and MLR were evaluated by univariate and multivariate analysis. The MLR was significantly higher in patients with a larger tumor, lymphatic vessel invasion, blood vessel invasion and perineural invasion, and advanced stage. Moreover, the MLR was significantly associated with the depth of invasion and the number of lymph node metastasis. The univariate analysis revealed for overall survival (OS) that stage of disease, lymphatic vessel invasion, blood vessel invasion, perineural invasion, lymph node metastasis (UICC/AJCC pN stage) and MLR were relevant prognostic indicators. Furthermore, both UICC/AJCC pN stage and MLR were detected as prognostic factor by multivariate analysis, as was perineural invasion. Our results indicated that MLR and UICC/AJCC pN staging system were important prognostic factors for OS of patients with D₂ lymph node dissection in gastric cancer in a multivariate analysis. MLR may be useful for evaluating the status of lymph node metastasis in gastric cancer.     

肝门淋巴结清扫术在原发性肝癌治疗中的价值

目的探讨原发性肝癌患者肝门淋巴结转移的相关因素、转移规律以及肝门淋巴结清扫对其预后的影响。方法对113例原发性肝癌患者在肝脏切除前常规进行肝门区域淋巴结清扫;对淋巴结转移的发生率、部位、术前术后诊断符合率以及对预后的影响进行分析。结果原发性肝癌113例中18例（15.93%）患者有淋巴结转移,其中肝细胞肝癌10例,胆管细胞癌7例,混合型肝癌1例。术中门静脉、胆总管及肝动脉周围的淋巴结均被清扫,清扫的淋巴结平均数为（3.8±1.6）个。有肝门淋巴结转移者中位生存时间为13个月,而无肝门淋巴结转移者中位生存时间为25个月,两者2年生存率分别为17.12%和49.83%,差异有统计学意义。结论淋巴结状态是肿瘤患者1个重要的预后因素,显著影响患者生存率。肝门淋巴结清扫是安全的,对没有慢性肝病的胆管细胞性肝癌患者应常规应用。     

Gastric cancer with extragastric lymph node metastasis: multivariate prognostic study

Background. Although many authors have investigated the prognostic factors of gastric cancer, there are few comprehensive studies on the prognosis of patients with extensive lymph node metastasis. The aim of this study was to clarify the prognostic factors of gastric cancer with extragastric lymph node metastasis, using multivariate analysis. Methods. The study population consisted of 121 patients who had undergone radical gastrectomy and extended lymph node dissection (D2, D3) for gastric cancer with extragastric lymph node metastasis. We examined 18 clinicopathologic factors, including the type of gastrectomy, tumor size, depth of wall invasion, status of lymph node metastasis, and stage of disease. Survival rates were analyzed by the Kaplan-Meier and Mantel-Cox methods, and multivariate analysis was done using the Cox proportional hazards model. Results. The overall 5-year survival rate was 32%, and the 5-year survival rate after curative gastrectomy was 37%. Overall survival rate was associated with the type of gastrectomy, stage of disease, operative curability, tumor size, depth of wall invasion, and anatomical distribution of positive nodes, whereas the survival rate after curative gastrectomy was correlated with the type of gastrectomy, stage of disease, tumor size, gross type, and depth of wall invasion. Independent prognostic factors were operative curability and depth of wall invasion, and survival after curative gastrectomy was influenced only by the depth of wall invasion (mucosa and submucosa [T1], muscularis and subserosa [T2] vs serosa [T3]). Conclusion. In patients with gastric cancer with extragastric lymph node metastasis, independent prognostic factors after gastrectomy were operative curability and depth of wall invasion. Long-term survival can be achieved when the patients have no serosal invasion (T1, T2) and are treated by curative gastrectomy. Received: August 7, 2000 / Accepted: December 19, 2000     

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.     

Prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in patients with advanced gastric cancer

BACKGROUND AND OBJECTIVES: To determine the prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in gastric cancer patients. METHODS: We retrospectively reviewed 777 advanced gastric cancer patients who had undergone curative gastrectomy at our hospital. RESULTS: The n ratio was significantly greater in cases with a large tumor, undifferentiated tumor, lymphatic vessel invasion, or blood vessel invasion. Furthermore, the n ratio was significantly correlated with the depth of invasion, level of lymph node metastasis, and number of lymph node metastases. The prognosis for gastric cancer patients correlated well with the n ratio. Multivariate analysis indicated that the n ratio, but not the number of lymph node metastases, was an independent prognostic indicator. Moreover, the n ratio was an independent prognostic factor in N1, N2, and N3 patients defined by the Japanese Classification of Gastric Cancer (JCGC). CONCLUSIONS: The n ratio is useful for evaluating the status of lymph node metastasis in gastric cancer. Therefore, the addition of the n ratio to the N (nodal) category defined by the JCGC may be a useful strategy in the N-staging classification of gastric cancer.     

Lymphadenectomy in gastric cancer: influence on prognosis of lymph node count

To better understand the role of the number of lymph nodes retrieved on long-term outcome of gastric cancer treatment, 154 patients who had undergone curative resection, with dissection of >15 nodes were retrospectively studied. Dissection of perigastric and extraperigastric lymph nodes, defined as 'extended' (>26 nodes dissected) in 39 cases and 'limited' (< or = 26 nodes dissected) in 115 cases, was performed. A total of 3479 lymph nodes (mean 22.6 per specimen), were dissected and of these 721 showed metastases. A mean of 8.1 lymph node metastases, per metastatic case, was found. Regression analysis showed no independent factor associated with the extent of lymphadenectomy. Depth of wall invasion (p=0.000) and histological growth pattern (p=0.044) were independently associated with the number of lymph nodes involved (pN0, pN1 1-7, pN2 >7). The cumulative 5-year survival rate was 47% in patients without lymph node metastases; 29% in those with 1-7 nodes involved and 17% in those with >8 nodes involved (p=0.002). Receiver operating characteristic (ROC) curve analysis, in 65 nodenegative cancer cases, demonstrated an area under the curve for vital status (alive or dead) of 0.602 (95% CI: 0.473 - 0.721). All node-negative cases with a number equivalent to or exceeding the cutoff point of 23 nodes were alive. ROC analysis showed 11 to be the cutoff number of metastasized lymph nodes in correlation with vital status. Almost all those patients in whom the number of positive nodes was equivalent to, or exceeded the cutoff point had died (area under the ROC curve 0.633; 95% CI: 0.524 - 0.733). ROC analysis showed that the cutoff lymph node ratio, in relation to vital status, was 0.33. The majority of patients at or above this cutoff point had died (area under ROC curve 0.682; 95% CI: 0.574 - 0.776). Multivariate survival analysis showed that lymph node ratio was the only independent prognostic factor (p=0.001). The present findings suggest that, in lymphadenectomy with at least 15 nodes, the number and status of regional nodes dissected, irrespective of the location, provide reliable prognostic information on curatively resected gastric carcinomas.     

Metastatic lymph node ratio as a prognostic factor in gastric cancer.

BACKGROUND: There is an association between the number of resected lymph node and the number of metastatic lymph nodes in gastric cancer, suggesting that pN category could be influenced by the extension of the lymphadenectomy. This study evaluates this association and proposes a comprehensive use of the ratio as prognostic factor. METHOD: Review of 183 consecutive patients with gastric adenocarcinoma. The association between the number of resected lymph nodes and the number of metastatic lymph nodes was analysed and evaluated with other prognostic factors. RESULTS: The number of lymph node metastases increased with the number of resected lymph nodes. The lymph node ratio was a better prognostic factor than the number of metastatic lymph nodes. CONCLUSIONS: The metastatic lymph node ratio seems to be a good prognostic factor, but needs further evaluation.     

Prognostic factors in stage IV gastric cancer: univariate and multivariate analyses

Background. The prognosis of stage IV gastric cancer is poor with the 5-year survival rate still being about 10%. Methods. We classified 130 patients with stage IV gastric cancer into four groups: peritoneal metastasis, liver metastasis, lymph node metastasis, and multiple factor groups, according to the factors that determined stage IV in each patient and compared survival in the four groups. We also performed univariate and multivariate analyses of various prognostic clinicopathological factors. The 5-year survival rate in the patients with stage IV gastric cancer was 7.4%. Results. No significant differences were observed in survival among the four groups. Univariate analysis showed significant differences in survival among the categories of lymphatic invasion ( P = 0.0045), venous invasion ( P = 0.0024), peritoneal metastasis ( P = 0.0019), postoperative chemotherapy ( P = 0.0385), curability ( P = 0.0001), and lymph node dissection ( P = 0.0001). In the curability B group, survival was prolonged in the postoperative chemotherapy group. Multivariate analysis revealed the highest relative hazard (RH) for lymph node dissection (RH, 2.261), followed, in descending order, by curability (RH, 1.905), peritoneal metastasis (RH, 1.896), lymphatic invasion (RH, 1.736), and venous invasion (RH, 1.481). Conclusion. As prognostic factors in stage IV gastric cancer, the tumor factors of peritoneal metastasis and vessel invasion, and the treatment factors of curability and lymph node dissection may be important, and active treatment appears to improve survival. Received: March 2, 2000 / Accepted: June 2, 2000     

Prognostic factors in patients with advanced gastric cancer with macroscopic invasion to adjacent organs treated with radical surgery

Background. The prognosis of patients with gastric cancer with invasion to adjacent organs is poor. The prognostic factors of patients with advanced gastric cancer with macroscopic invasion to adjacent organs (T4) who were treated with radical surgery was determined in the present study. Methods. A total of 86 consecutive patients with advanced gastric cancer who underwent radical (potentially curable) gastrectomy with combined resection of other organs for macroscopic invasion to adjacent organs during surgery, were investigated. The organs invaded macroscopically were the pancreas in 43 patients, mesocolon in 29, liver in 7, transverse colon in 5, adrenal gland in 3, spleen in 1, diaphragm in 1, and other organs in 5. The prognostic factors were evaluated by univariate and multivariate analysis. Results. The cumulative 5-year survival rate of the patients treated by radical surgery with the combined resection of invaded organs was 35.0%. Multivariate analysis demonstrated that location of the tumor, lymph node metastasis, histological depth of invasion, and extent of lymph node dissection were significant prognostic factors in advanced gastric cancer patients treated by radical surgery with combined resection of adjacent organs for macroscopic invasion. Conclusion. For patients with macroscopic T4 gastric cancer located in the middle- or lower-third of the stomach, aggressive resection of invaded adjacent organs with extended lymph node dissection should be performed to improve long-term outcome. Received: July 21, 2000 / Accepted: November 28, 2000     

Number and anatomical extent of lymph node metastases in gastric cancer: analysis using intra-lymph node injection of activated carbon particles (CH40)

BACKGROUND: The long-term survival of 200 patients with gastric cancer who underwent radical gastrectomy was analyzed with respect to the number and anatomical extent of lymph node metastasis. All of the patients received intra-lymph node injection of fine activated carbon particle solution (CH40) during surgery. METHODS: The average number of resected lymph nodes increased in line with the anatomical level of lymph node dissection; 32.5 per patient in D1, 42.3 in D2, 3 and 66.3 in D4. The percentage of blackened lymph nodes without metastasis (42.4%) was slightly higher than that of lymph nodes containing metastasis (37.2%), but the difference was not statistically significant. Of the 200 patients, 61 (30.5%) had microscopic evidence of metastatic lymph node involvement. Twenty-two patients had between one and three metastatic lymph nodes, 19 had between four and nine and 20 patients had more than nine. The 5-year survival rate was 93.1% in patients without lymph node metastasis, 71.9% in patients with 1-8 metastatic nodes, 36.1% in patients with 4-9 nodes and 19.2% in patients with > 9 nodes. RESULTS: The 5-year survival rate according to the anatomical extent of metastatic lymph nodes was 93.1% in n0, 63.1% in n1, 37.9% in n2, 27.8% in n3 and 0% in n4. The number of metastatic lymph nodes and also their anatomical extent were identified as independent prognostic factors for survival by multivariate analysis. CONCLUSION: The number and anatomical extent of metastatic lymph nodes have similar impacts on prognosis in gastric cancer.     

Analysis of risk factors for skip lymphatic metastasis and their prognostic value in operated N2 non-small-cell lung carcinoma.

BACKGROUND: The aim of this study is to report a series and to analyze risk factors for skip lymphatic metastasis an their prognostic value in operated N2 non-small-cell lung carcinoma. METHODS: From 1997 to 2002, 142 patients classified pN2 were included in the study. Tumours were classified according to the TNM classification. Skips metastases were defined by the cases of N2 disease without lobar and interlobar and hilar lymph node involvement. A skip (+) and a skip (-) group were defined. Characteristics of tumours, ganglionar involvement and survival were analysed in both groups. RESULTS: Forty-two patients fulfilled the criteria for skip metastasis. The average number of mediastinal lymph nodes resected by patient was similar in both groups, whereas more intrapulmonary nodes were dissected in the skip (-) group (4.7 +/- 3 vs 3 +/- 3; p < 0.002). The ratio of involved to resected lymph nodes was 0.47 +/- 0.27 in the skip (-) group vs 0.23 +/- 0.20 in the skip (+) group (p < 0.0001). In the skip (+) group, 85% of the patients presenting with a right upper lobe tumour had involvement of the superior mediastinal lymph nodes against 40% in the skip (-) group. The 5-year survival rate was 48% in the skip (-) group vs 37% in the skip (+) group (p = 0.49). In multivariate analysis, incomplete resection, tumour size, extended resection and pT were significant prognostic factors. CONCLUSIONS: Skip metastasis are frequent in non-small-cell lung cancer and complete dissection of hilar and mediastinal lymph nodes should remain the surgical standard procedure for this disease. However, skip metastasis are not an independent prognostic factor in survival.     

Prognostic value of stromal cell‐derived factor 1 expression in patients with gastric cancer after surgical resection

Aberrant chemokine stromal cell‐derived factor 1 (SDF‐1) expression has been shown to be involved in the development and progression of various malignancies. Our present study aims to investigate the clinical and prognostic value of SDF‐1 expression and improve risk stratification in patients with gastric cancer. Peritumoral and intratumoral SDF‐1 levels were assessed in 220 retrospectively enrolled gastric cancer patients, and their relations with clinicopathological features and clinical outcomes were evaluated. A predictive nomogram was created to refine risk stratification for overall survival of gastric cancer patients. Compared with peritumor tissues, tumor tissues showed decreased SDF‐1 expression levels according to TNM stage progression in gastric cancer specimens. Peritumoral SDF‐1 expression correlated positively with tumor invasion depth and lymph node metastasis, whereas intratumoral SDF‐1 expression associated negatively with tumor size, tumor differentiation, tumor invasion depth, lymph node metastasis, and clinical TNM stage. Moreover, both low peritumoral SDF‐1 expression and high intratumoral SDF‐1 expression indicated favorable overall survival, and SDF‐1 risk derived from the peritumoral/intratumoral SDF‐1 expression signature could stratify prognosis of patients with gastric cancer. After backward elimination, SDF‐1 risk was identified as an independent prognostic factor for survival. Finally, a predictive nomogram was generated with identified independent prognosticators to assess patient survival at 3 and 5 years following surgery. Conclusively, SDF‐1 risk, an identified independent prognostic factor, could be developed into a nomogram with tumor invasion depth, lymph node involvement, and distant metastasis to refine predictive accuracy for survival in patients with gastric cancer after surgical resection.     

Gastric carcinoma invading muscularis propria and macroscopic appearance.

From 1965 to 1983, 1362 patients with primary gastric cancer and no other evidence of a malignancy underwent gastric resection in the Second Department of Surgery, Kyushu University. Of these, 117 patients (8.6%) with gastric cancer invading the muscularis propria (pm) were studied clinicopathologically with special reference to the macroscopic appearance: Borrmann type cancer or advanced gastric cancer simulating early gastric cancer (AGC simulating EGC). The Borrmann type cancer comprised 62.4% (73/117) of cases and the AGC simulating EGC comprised 37.6% (44/117). The survival rate for patients with the Borrmann type cancer was lower than in cases of AGC simulating EGC (P less than 0.01). The 10-year survival rate was 82.6% for patients with AGC simulating EGC and 60.5% for those with Borrmann type cancer. A multivariate analysis showed that operative curability and lymph node metastasis are significant prognostic factors and these events differed between the Borrmann type cancer and AGC simulating EGC and the survival rate for patients with the Borrmann type cancer was less favorable. Our findings show that the lymph node dissection is important for the operative curability of pm gastric cancer with the Borrmann type. Postoperative chemotherapy is required in cases of a non-curative resection.     

Extracapsular lymph node spread

BACKGROUND:

Lymphatic spread is 1 of the most relevant prognostic factors for gastric carcinoma. The current International Union Against Cancer (UICC) pN staging system is based on the number of metastatic lymph nodes and does not take into consideration the characteristics of the metastatic lymph nodes itself. The aim of the current study was to examine the prognostic value of extracapsular lymph node involvement in gastric cancer and to find correlations with clinicopathological parameters.

METHODS:

Tissue samples were obtained from 159 gastric cancer patients who underwent gastrectomy with D2‐lymphadenectomy in 142 (89.3%) cases and subtotal gastrectomy with D2‐lymphadenectomy in 17 (10.7%) cases. The number of resected lymph nodes, number of metastatic lymph nodes, and number of metastatic lymph nodes with extracapsular lymph node involvement were determined. Extracapsular spread was defined as infiltration of cancer cells beyond the capsule of the metastatic lymph node.

RESULTS:

Ninety‐six (60.4%) patients had lymph node metastasis. In 57 (35.8%) cases, extracapsular lymph node involvement was also detected. Extracapsular lymph node involvement was significantly associated with higher pN‐category (P < .001), higher pM category (P = .048), and higher UICC stages (P = .001). According to the Kaplan‐Meier log‐rank statistical method, extracapsular lymph node involvement was significantly associated with poor survival (P = .001). In the multivariate analysis besides pT (P < .001) and R‐category (P = .009), extracapsular lymph node involvement also remained as an independent prognostic factor (P = .003), whereas the UICC pN‐category (P = .822) lost its prognostic value.

CONCLUSIONS:

Extracapsular lymph node involvement is associated with higher tumor stages and is an independent negative prognostic factor in gastric cancer. In future staging systems for gastric cancer, extracapsular lymph node involvement should be considered. Cancer 2010. © 2010 American Cancer Society.     

胸段食管癌转移淋巴结数量与生存率关系的研究

目的 探讨胸段食管癌转移淋巴结数最与食管癌预后的关系.方法 分析1995年7月至2005年7月在山西省肿瘤医院行胸段食管癌根治术的患者1140例的临床资料,并进行生存情况分析.结果 淋巴结转移数量与食管癌的生存率呈负相关(P=0.000);患者淋巴结切除数量≥8枚、<8枚时,淋巴结转移度差异有统计学意义(P=0.000).结论 食管癌淋巴结转移数量与患者预后呈显著相关性,能反映其预后,建议pTNM分期将淋巴结转移数考虑在N1内.     

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。