Lymphatic vascular invasion is an independent correlated factor for lymph node metastasis and the prognosis of resectable T2 gastric cancer patients. Tumour Biol. 2013;34:1005-1012. [PMID: 23292920 DOI: 10.1007/s13277-012-0637-3]

A meta-analysis of the association between adjuvant chemoradiotherapy and disease-free survival in gastric cancer according to the histology

BACKGROUND

There are biological distinctions between gastric cancers from Eastern and Western nations, and therapeutic strategies may differ regionally. Perioperative chemotherapy, adjuvant chemotherapy, and adjuvant chemoradiotherapy (CRT) have all been demonstrated to be effective in the treatment of gastric cancer. The goal of this study was to do a meta-analysis of published studies that were eligible to see if adjuvant chemoradiotherapy was helpful for gastric cancer based on the cancer's histology.

METHOD

From inception to May 4, 2022, manual searches were conducted to identify all eligible literature using the PubMed database for the published phase III clinical trial and a randomize-controlled trial testing the role of adjuvant chemoradiotherapy in operable gastric cancer.

RESULTS

Two trials with a total of 1004 patients were selected as a result. Adjuvant CRT was found to have no effect on disease-free survival (DFS) in gastric cancer patients treated with D2 surgery (HR: 0.70 (0.62-1.02), p: 0.07). However, patients with intestinal-type gastric cancers exhibited significantly longer DFS (HR: 0.58 (0.37-0.92), p = 0.02).

DISCUSSION

After D2 dissection, adjuvant CRT improved DFS in patients with intestinal-type gastric cancers but not in those with diffuse-type gastric cancers.

Nuclear medicine radiomics in digestive system tumors: Concept, applications, challenges, and future perspectives

Radiomics aims to develop novel biomarkers and provide relevant deeper subvisual information about pathology, immunophenotype, and tumor microenvironment. It uses automated or semiautomated quantitative analysis of high-dimensional images to improve characterization, diagnosis, and prognosis. Recent years have seen a rapid increase in radiomics applications in nuclear medicine, leading to some promising research results in digestive system oncology, which have been driven by big data analysis and the development of artificial intelligence. Although radiomics advances one step further toward the non-invasive precision medical analysis, it is still a step away from clinical application and faces many challenges. This review article summarizes the available literature on digestive system tumors regarding radiomics in nuclear medicine. First, we describe the workflow and steps involved in radiomics analysis. Subsequently, we discuss the progress in clinical application regarding the utilization of radiomics for distinguishing between various diseases and evaluating their prognosis, and demonstrate how radiomics advances this field. Finally, we offer our viewpoint on how the field can progress by addressing the challenges facing clinical implementation.

Risk factors of lymphovascular invasion in hypopharyngeal squamous cell carcinoma and its influence on prognosis

PURPOSE

Lymphatic vascular invasion (LVI) is a poor prognostic factor for hypopharyngeal squamous cell carcinoma (HPSCC), but the risk factors of LVI and its relationship with clinicopathological of HPSCC remain unclear. This study aims to explore these issues.

METHODS

We retrospectively analyzed the clinicopathological data of 170 patients with HPSCC from January 2011 to December 2015. The relationship between LVI and clinicopathologic was analyzed by Chi-square test or Fisher's exact test. The risk factors of LVI were examined using a logistic regression model, while risk factors of survival rate were carried out using the Cox regression model.

RESULTS

LVI occurred in 59 cases (34.7%). In multivariate analysis, T3-4 stage (HR = 2.877; 95% CI: 1.379-6.004; p = 0.005), N2-3 stage (HR = 2.325; 95% CI: 1.120-4.824; p = 0.024), and poor differentiation (HR = 2.983; 95% CI: 1.229-7.242; p = 0.016) were independent risk factors for LVI; positive LVI was an independent risk factor for local recurrence (HR = 2.488; 95% CI: 1.150-5.383; p = 0.021), poor 5-year OS (HR = 0.375; 95% CI: 0.232-0.606; p < 0.000), DSS (HR = 0.374; 95% CI: 0.235-0.595; p < 0.000), and DFS (HR = 0.454; 95% CI:0.254-0.813; p = 0.008).

CONCLUSION

T3-4 stage, N2-3 stage and poor differentiation are independent risk factors for LVI of HPSCC; LVI increases the local recurrence and regional recurrence rate, and decreases 5-year OS, DFS and DSS of HPSCC.

The Clinical Significance of Lymphovascular Invasion in Gastric Cancer

BACKGROUND/AIM

Lymphovascular invasion (LVI) is recognized as a prognostic predictor of recurrence in certain carcinomas. According to current Japanese guidelines, however, in gastric cancer, LVI is not clinically useful information, except for predicting the curability of endoscopic resection. We clarified the clinical significance of LVI in gastric cancer and its correlation with disease prognosis.

PATIENTS AND METHODS

A total of 2,090 cases of gastric cancer undergoing radical gastrectomy were enrolled. The correlation of LVI and other histopathological factors was evaluated with regards to patient prognosis.

RESULTS

LVI(+) was noted in 894 cases. A multivariate analysis showed that pT, pN, and LVI were independent risk factors for patient prognosis. In pT2-4 patients with nodal metastasis, a significant difference was revealed, and the 5-year overall survival rates in LVI(+) cases were lower than those in LVI(-) (60.9% vs. 76.7%, p=0.005).

CONCLUSION

LVI in gastric cancer is an independent prognostic factor, and tends to worsen prognosis, especially in advanced cancers with lymph node metastases.

miR-3196 acts as a Tumor Suppressor and Predicts Survival Outcomes in Patients With Gastric Cancer

BACKGROUND

Gastric cancer is one of the most common malignancies worldwide with high mortality. Therefore, identifying cancer-related biomarkers for predicting prognosis and progression of gastric cancer is essential. This study aimed to investigate the clinical value and functional role of microRNA-3196 in gastric cancer.

METHODS

The relative expression levels of microRNA-3196 in gastric cancer tissues and adjacent normal tissues were detected by quantitative reverse transcription-polymerase chain reaction. In this study, quantitative reverse transcription-polymerase chain reaction, cell proliferation assay, and Transwell migration and invasion assays were performed to explore microRNA-3196 expression level and its effects on cell proliferation, migration, and invasion in gastric cancer cells. The Kaplan-Meier method and multivariate Cox regression analyses were used to explore the prognostic significance of microRNA-3196 in gastric cancer. Dual-luciferase report assay was performed to validate the potential target gene regulated by microRNA-3196 in gastric cancer.

RESULTS

The expression of microRNA-3196 was downregulated in gastric cancer tissues and cell lines. Downregulation of microRNA-3196 was associated with lymph node metastasis and Tumor Node Metastasis (TNM) stage. The Kaplan-Meier curve analysis indicated that patients with low expression of microRNA-3196 had a poor prognosis, and the Cox regression analysis results showed microRNA-3196 expression was an independent prognostic factor of gastric cancer. Moreover, overexpression of microRNA-3196 inhibited cell proliferation, migration, and invasion, while knockdown of microRNA-3196 promoted these cellular behaviors in AGS and MKN45 cells. OTX1 may be a potential target gene regulated by microRNA-3196 in gastric cancer.

CONCLUSIONS

These results suggested that microRNA-3196 might not only a tumor suppressor in gastric cancer cells by modulating OTX1 but also might be an independent prognostic biomarker and therapeutic target of gastric cancer.

An Immune-Related Gene Panel for Preoperative Lymph Node Status Evaluation in Advanced Gastric Cancer

Background and Aim: Gastric cancer (GC) is the common leading cause of cancer-related death worldwide. Immune-related genes (IRGs) may potentially predict lymph node metastasis (LNM). We aimed to develop a preoperative model to predict LNM based on these IRGs. Methods: In this paper, we compared and evaluated three machine learning models to predict LNM based on publicly available gene expression data from TCGA-STAD. The Pearson correlation coefficient (PCC) method was utilized to feature selection according to its relationships with LN status. The performance of the model was assessed using the area under the curve (AUC) and F1 score. Results: The Naive Bayesian model showed better performance and was constructed based on 26 selected gene features, with AUCs of 0.741 in the training set and 0.688 in the test set. The F1 score in the training set and test set was 0.652 and 0.597, respectively. Furthermore, Naive Bayesian model based on 26 IRGs is the first diagnostic tool for the identification of LNM in advanced GC. Conclusion: These results indicate that our new methods have the value of auxiliary diagnosis with promising clinical potential.

Prognostic significance of Borrmann type combined with vessel invasion status in advanced gastric cancer

BACKGROUND

Borrmann classification (types I-IV) for the detection of advanced gastric cancer has been accepted worldwide, and lymphatic and/or blood vessel invasion (LBVI) status is related to the poor prognosis after gastric cancer.

AIM

To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer.

METHODS

We retrospectively studied the clinicopathological characteristics and long-term survival data of 2604 patients who were diagnosed with advanced gastric adenocarcinoma at Harbin Medical University Cancer Hospital from January 2009 to December 2013. Categorical variables were evaluated by the Pearson’s χ² test, the Kaplan-Meier method was used to identify differences in cumulative survival rates, and the Cox proportional hazards model was used for multivariate prognostic analysis.

RESULTS

A total of 2604 patients were included in this study. The presence of LVBI [LBVI (+)] and Borrmann type (P = 0.001), tumor location (P < 0.001), tumor size (P < 0.001), histological type (P < 0.001), tumor invasion depth (P < 0.001), number of metastatic lymph nodes (P < 0.001), and surgical method (P < 0.001) were significantly correlated with survival. When analyzing the combination of the Borrmann classification and LBVI status, we found that patients with Borrmann type III disease and LBVI (+) had a similar 5-year survival rate to those with Borrmann IV + LBVI (-) (16.4% vs 13.1%, P = 0.065) and those with Borrmann IV + LBVI (+) (16.4% vs 11.2%, P = 0.112). Subgroup analysis showed that the above results were true for any pT stage and any tumor location. Multivariate Cox regression analysis showed that Borrmann classification (P = 0.023), vascular infiltration (P < 0.001), tumor size (P = 0.012), pT stage (P < 0.001), pN stage (P < 0.001), and extent of radical surgery (P < 0.001) were independent prognostic factors for survival.

CONCLUSION

Since patients with Borrmann III disease and LBVI (+) have the same poor prognosis as those with Borrmann IV disease, more attention should be paid to patients with Borrmann III disease and LBVI (+) during diagnosis and treatment, regardless of the pT stage and tumor location, to obtain better survival results.

Impact of Lymphovascular Invasion on Survival Outcome in Patients With Gastric Cancer

OBJECTIVES

To evaluate the prognostic significance of lymphovascular invasion (LVI) for patients with gastric cancer (GC).

METHODS

A total of 1,720 consecutive patients who underwent curative gastrectomy were retrospectively identified. The association between LVI and clinicopathologic characteristics was determined and its impact on survival outcome was evaluated.

RESULTS

LVI was detected in 21.3% of GC patients, 5.9% of patients with early GC, 24.0% of patients with advanced GC, and 6.7% of node-negative patients using H&E staining. Tumor size (odds ratio [OR], 1.509; 95% confidence interval [CI], 1.159-1.965; P < .01), differentiated type (OR, 1.817; 95% CI, 1.377-2.398; P < .001), and the depth of tumor invasion (OR, 3.011; 95% CI, 2.174-4.171; P < .001) were independent predictive factors for LVI. LVI-positive patients have a poorer prognosis than LVI-negative patients, irrespective of tumor stage or lymph node metastasis. LVI was an independent prognostic factor for patients with GC (hazard ratio, 1.299; 95% CI, 1.112-1.518; P < .001).

CONCLUSIONS

LVI provided additional prognostic information for GC patients, and LVI-positive patients should be considered candidates for adjuvant chemotherapy.

Prognostic factors for survival in patients with gastric cancer: Single-centre experience

OBJECTIVE:

We aimed to investigate survival outcomes and survival-related prognostic factors in gastric cancer patients who were followed-up or received adjuvant therapy in our center.

METHODS:

Patients with gastric cancer treated between 2005 and 2016 were evaluated retrospectively. We included 345 non-metastatic (stage I-III) gastric cancer patients in the study. The clinical, demographic, histologic data of the patients and treatment characteristics were obtained from the patient’s files.

RESULTS:

While 50 patients were stage I, 94 patients were stage II, 201 patients were stage III. While 221 patients (64%) presenting with serosal or adjacent visceral organ invasion or with involved lymph nodes were treated with adjuvant chemoradiotherapy, 124 patients presenting with early-stage disease were followed after surgery. Median follow up time was 34 months (4–156 months). While the median overall survival (OS) was 51 months, median disease-free survival (DFS) was 35 months. Overall survival and disease-free survival rates for 1^st, 3^rd and 5^th years were 85%, 55%, 45% and 72%, 49%, 38%, respectively. According to univariate analysis, tumor size, T stage (p<0.001), N stage (p<0.001), TNM stage (p<0.001), grade (p<0.001) and presence of lymphovascular invasion (p=0.005) were determined as prognostic factors that affect overall survival significantly. According to the multivariate analysis, only T and N stage (p<0.001) were determined as independent prognostic factors for overall survival.

CONCLUSION:

Many different prognostic factors have been defined for gastric cancer. In concordance with the literature, we found T and N stages as prognostic factors in univariate and multivariate analysis.

Intramucosal-lymphatic invasion has a slight impact on lymph node metastasis in patients with early gastric cancer

PURPOSE

Lymphatic invasion (LI) is associated with lymph node metastasis (LNM) and a poor prognosis in patients with early gastric cancer (EGC). Although the impact of the LI volume on LNM has been described, no reports have assessed the impact of its depth on LNM.

METHODS

A total of 360 EGC patients with pathologically proven LI who underwent radical gastrectomy with lymphadenectomy between January 2005 and June 2018 at our institution were extracted from our database. Patients were divided into 2 groups: the mLI group, in which LI was limited to the muscularis mucosae (n = 34); and the smLI group, in which LI reached the submucosal region (n = 326). Clinicopathological features, including the LNM incidence, were compared between the groups.

RESULTS

LNM was recognized in 3 patients (9%) in the mLI group and 101 (31%) in the smLI group (P = 0.005). In the mLI group, LNM was not recorded in any patients who met the curative criteria of ESD other than mLI.

CONCLUSIONS

LI limited to the mucosal region does not seem to be a strong indicator for LNM. When pathological findings of an endoscopic submucosal dissection specimen show only mLI as a non-curative criterion, the probability of LNM may be very low.

Protein expression profiles and clinicopathologic characteristics associate with gastric cancer survival

BACKGROUND

Prognosis remains one of most crucial determinants of gastric cancer (GC) treatment, but current methods do not predict prognosis accurately. Identification of additional biomarkers is urgently required to identify patients at risk of poor prognoses.

METHODS

Tissue microarrays were used to measure expression of nine GC-associated proteins in GC tissue and normal gastric tissue samples. Hierarchical cluster analysis of microarray data and feature selection for factors associated with survival were performed. Based on these data, prognostic scoring models were established to predict clinical outcomes. Finally, ingenuity pathway analysis (IPA) was used to identify a biological GC network.

RESULTS

Eight proteins were upregulated in GC tissues versus normal gastric tissues. Hierarchical cluster analysis and feature selection showed that overall survival was worse in cyclin dependent kinase (CDK)2, Akt1, X-linked inhibitor of apoptosis protein (XIAP), Notch4, and phosphorylated (p)-protein kinase C (PKC) α/β2 immunopositive patients than in patients that were immunonegative for these proteins. Risk score models based on these five proteins and clinicopathological characteristics were established to determine prognoses of GC patients. These proteins were found to be involved in cancer related-signaling pathways and upstream regulators were identified.

CONCLUSION

This study identified proteins that can be used as clinical biomarkers and established a risk score model based on these proteins and clinicopathological characteristics to assess GC prognosis.

Radiomics Signature on Computed Tomography Imaging: Association With Lymph Node Metastasis in Patients With Gastric Cancer

Background: To evaluate whether radiomic feature-based computed tomography (CT) imaging signatures allow prediction of lymph node (LN) metastasis in gastric cancer (GC) and to develop a preoperative nomogram for predicting LN status.

Methods: We retrospectively analyzed radiomics features of CT images in 1,689 consecutive patients from three cancer centers. The prediction model was developed in the training cohort and validated in internal and external validation cohorts. Lasso regression model was utilized to select features and build radiomics signature. Multivariable logistic regression analysis was utilized to develop the model. We integrated the radiomics signature, clinical T and N stage, and other independent clinicopathologic variables, and this was presented as a radiomics nomogram. The performance of the nomogram was assessed with calibration, discrimination, and clinical usefulness.

Results: The radiomics signature was significantly associated with pathological LN stage in training and validation cohorts. Multivariable logistic analysis found the radiomics signature was an independent predictor of LN metastasis. The nomogram showed good discrimination and calibration.

Conclusions: The newly developed radiomic signature was a powerful predictor of LN metastasis and the radiomics nomogram could facilitate the preoperative individualized prediction of LN status.

Evaluation of Gastric Carcinomas Histological Patterns in Relation to Tumors Aggressiveness Parameters

Gastric carcinomas are frequent tumors with variable growth patterns that may interfere with the evaluation of histopathological prognostic parameters of the lesions. In this study we analyzed the incidence and statistical relation of histological growth patterns depending on the prognostic parameters of gastric carcinomas for 95 cases. Pure forms were present in 82.2% of cases, from which more frequent subtypes were low grade tubular carcinomas and poorly cohesive with signet-ring cells carcinomas. Mixed forms were present in 17.8% of cases, with the highest incidence of tumors containing well differentiated tubular carcinoma and poorly differentiated papillary carcinoma areas. Analysis of the identified types and subtypes in relation to the histological prognostic parameters indicated significant differences regarding the tumor stage, the mixed subtypes being more frequent in advanced stages. Although mixed subtypes were more commonly associated with vascular and perineural invasion, the aspects were statistically insignificant. Together with tumor stage, the lymphovascular and/or perineural invasion should be taken into consideration as prognostic indicators in the postoperative management of gastric cancer.

Feasibility of Endoscopic Resection in Early Gastric Cancer with Lymphovascular Invasion

BACKGROUND

Lymphovascular invasion (LVI) is associated with the risk of lymph node metastasis (LNM) and poor survival in gastric cancer patients; however, it is unclear whether LVI is a non-curative criteria component in all patients. We evaluated the risk factors of LNM in LVI-positive early gastric cancer (EGC) patients and identified a subgroup with a negligible LNM risk to assess the feasibility of endoscopic resection in these patients.

METHODS

The clinicopathologic and survival data of patients undergoing surgery for gastric cancer were reviewed; LVI-positive EGC patients were selected. Logistic regression analysis was used to test the associations of potential risk factors with LNM, and Kaplan-Meier analysis was used to compare survival curves.

RESULTS

LVI was detected in 1243 (15.5%) patients. In the multivariate logistic analysis, larger tumor size (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.16-1.31; p < 0.001), presence of ulcer (OR 1.80, 95% CI 1.15-2.82; p = 0.010), undifferentiated histology (OR 1.64, 95% CI 1.25-2.16; p < 0.001), submucosal invasion (OR 2.28, 95% CI 1.38-3.76; p = 0.001), middle (OR 2.12, 95% CI 1.26-3.55; p = 0.004) or lower third location (OR 2.28, 95% CI 1.32-3.60; p = 0.002), and younger age (OR 0.98, 95% CI 0.97-0.99; p = 0.002) independently predicted LNM in LVI-positive EGC patients. LVI-positive patients fulfilling the absolute endoscopic resection criteria did not have LNM and there was no significant difference in the overall (p = 0.928) and disease-specific survival (p = 0.821) between these patients and those with LVI-negative EGC.

CONCLUSIONS

Additional surgery after endoscopic resection might be unnecessary in LVI-positive patients meeting the absolute criteria for endoscopic resection.

The overexpression of MDM4: an effective and novel predictor of gastric adenocarcinoma lymph node metastasis

Background

MDM4 is the important negative regulator of the tumor suppressor protein p53, which is overexpressed in various human cancers. This study evaluates the MDM4 expression in patients with gastric adenocarcinoma (GTAC) at the mRNA and protein levels and examines relationships among MDM4 expression, clinicopathological features, and prognosis.

Results

The qRT-PCR and the Western blot analysis showed that the MDM4 expression level was high in GTACN⁺ but not in GTACN⁻. The high expression level of MDM4 was significantly associated with age (P = 0.047), lymph node metastasis (LNM) (P < 0.001), pathological stage (P < 0.001), differentiation status (P = 0.001), and preoperative serum CA19-9 level (P < 0.001). Moreover, the survival analysis showed that Borrmann type, depth of invasion, LNM, and preoperative serum CA19-9 level were independent prognostic factors. The univariate analysis revealed that MDM4 expression influenced GTAC prognosis. Furthermore, the influence of overall prognosis relies on whether or not the high MDM4 expression level could lead to LNM.

Materials and Methods

We investigated MDM4 expression in primary GTAC and paired normal gastric tissues (30 pairs) through qRT-PCR and Western blot analyses. We also performed immunohistochemistry analysis on 336 paraffin-embedded GTAC specimens and 33 matched normal specimens.

Conclusions

MDM4 expression may result in LMN of GTAC. High MDM4 expression levels are associated with LMN of GTAC and influence the prognosis of patients with GTAC.

CT volumetry for gastric adenocarcinoma: association with lymphovascular invasion and T-stages

Purpose

To determine whether gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict presence of lymphovascular invasion and T-stages.

Results

Gross tumor volume increased with the lymphovascular invasion (r = 0.426, P < 0.0001) and T stage (r = 0.656, P < 0.0001). Univariate analysis showed gross tumor volume could predict lymphovascular invasion (P < 0.0001). Multivariate analyses indicated gross tumor volume as an independent risk factor of lymphovascular invasion (P = 0.026, odds ratio = 2.284). The Mann-Whitney U test showed gross tumor volume could distinguish T2 from T3, T1 from T2–T4a, T1–T2 from T3–T4a and T1–T3 from T4a (P = 0.000). In the development cohort, gross tumor volume could predict lymphovascular invasion (cutoff, 15.92 cm³; AUC, 0.760), and distinguish T2 from T3 (cutoff, 10.09 cm³; AUC, 0.828), T1 from T2-T4a (cutoff, 8.20 cm³; AUC, 0.860), T1-T2 from T3-T4a (cutoff, 15.88 cm³; AUC, 0.883), and T1-T3 from T4a (cutoff, 21.53 cm³; AUC, 0.834). In validation cohort, gross tumor volume could predict presence of lymphovascular invasion (AUC, 0.742), and distinguish T2 from T3 (AUC, 0.861), T1 from T2-T4a (AUC, 0.859), T1–T2 from T3–T4a (AUC, 0.875), and T1–T3 from T4a (AUC, 0.773).

Materials and Methods

360 consecutive patients with gastric adenocarcinoma were retrospectively identified. Gross tumor volume was evaluated on multidetector computed tomography images. Statistical analysis was performed to determine whether gross tumor volume could predict presence of lymphovascular invasion and T-stages. Cutoffs of gross tumor volume were first investigated in 212 patients and then validated in an independent 148 patients using area under the receiver operating characteristic curve (AUC) for predicting lymphovascular invasion and T-stages.

Conclusions

Gross tumor volume of resectable gastric adenocarcinoma at multidetector computed tomography demonstrated capability in predicting lymphovascular invasion and distinguishing T-stages.

Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy

Objective

Though D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), the modified D2 (D1 + 7, 8a and 9) lymphadenectomy may be more suitable than D2 dissection for T2 stage GC. The purpose of this study is to elucidate whether the surgical outcome of modified D2 lymphadenectomy was comparable to that of standard D2 dissection in T2 stage GC patients.

Methods

A retrospective cohort study with 77 cases and 77 controls matched for baseline characteristics was conducted. Patients were categorized into two groups according to the extent of lymphadenectomy: the modified D2 group (mD2) and the standard D2 group (D2). Surgical outcome and recurrence date were compared between the two groups.

Results

The 5-year overall survival (OS) rate was 71.4% for patients accepted mD2 lymphadenectomy and 70.1% for those accepted standard D2, respectively, and the difference was not statistically significant. Multivariate survival analysis revealed that curability, tumor size, TNM stage and postoperative complications were independently prognostic factors for T2 stage GC patients. Patients in the mD2 group tended to have less intraoperative blood loss (P=0.001) and shorter operation time (P<0.001) than those in the D2 group. While there were no significant differences in recurrence rate and types, especially lymph node recurrence, between the two groups.

Conclusions

The surgical outcome of mD2 lymphadenectomy was equal to that of standard D2, and the use of mD2 instead of standard D2 can be a better option for T2 stage GC.

Comparison between superficial muscularis propria and deep muscularis propria infiltration in gastric cancer patients: A retrospective cohort study

This study aimed to investigate the clinicopathological characteristics and survival outcomes of the subclassification of pT2 gastric cancers according to the depth of tumor involvement. We retrospectively collected clinicopathological data and survival outcomes for pT2 gastric cancer patients from 2006 to 2011. Patients were classified into the superficial muscularis propria (sMP) and deep muscularis propria (dMP) groups. Eighty-nine patients had sMP gastric cancers and 90 patients had dMP gastric cancers. The rates of lymph node metastasis for the sMP and dMP groups were 55.1% and 64.4%, respectively, P = 0.202. The 5-year overall survival (OS) of patients in the sMP group was significantly better than patients in the dMP group (76% vs 61%, P = 0.018). Multivariate analysis demonstrated that the depth of tumor invasion, lymph node metastasis, and postoperative chemotherapy were prognostic risk factors for the OS. For patients with pN0 stage tumor(s), the sMP group had a significantly better 5-year OS rate than the dMP group (92% vs 62%, P = 0.004); for patients with pN1-N3 stages, the 5-year OS rates were comparable between the sMP and dMP groups (64% vs 61%, P = 0.540). The subclassification of pT2 gastric cancer into the sMP and dMP groups can demonstrate different survival outcomes according to the lymph node status. However, the pT2 stage subclassification in the next tumor, node, metastasis (TNM) staging system is pending and requires more large sample size studies to confirm its importance.

Prognostic significance of lymphovascular invasion in node-negative gastric cancer

BACKGROUND

The aim of this study was to investigate the prognostic value of lymphovascular invasion (LVI) in gastric cancer patients without lymph node metastasis.

METHODS

A total of 699 patients with primary tumor pT1-3/pN0-1 gastric adenocarcinoma who underwent curative resection from 2001 to 2010 were categorized into 3 groups: One-hundred and eleven patients with pN0/LVI(+), 475 with pN0/LVI(-), and 103 with pN1.

RESULTS

The tumors in patients with N0/LVI(+) had more aggressive clinicopathologic features than those in patients with N0/LVI(-). However, there was no significant difference in patient characteristics between patients with pN0/LVI(+) and those with pN1, except for histologic grade. There were no significant differences in the overall survival rate in patients with pN0/LVI(+) compared to those with pN0/LVI(-) or the pN1 stage. However, the recurrence-free survival rate of the pN0/LVI(+) group was lower than that of the pN0/LVI(-) group (p < 0.001), while no significant difference was observed between the pN0/LVI(+) and the N1 groups (p = 0.216). In multivariate analysis, LVI was identified as a poor prognostic factor related to recurrence-free survival in node-negative gastric cancer patients. pT3 stage and less than D2 lymphadenectomy were poor prognostic factors affecting recurrence-free survival, and less than D2 lymphadenectomy was an independent poor prognostic factor for overall survival in pN0/LVI(+) patients.

CONCLUSIONS

LVI could be an indicator of biological aggressiveness and may be a reliable prognostic factor for node-negative gastric cancer. LVI should be considered in postoperative management of gastric cancer.

Overexpression of SPAG9 in human gastric cancer is correlated with poor prognosis

Sperm associated antigen 9 (SPAG9) protein has been found to play an important role in cancer progression but the involved mechanisms are still obscure. Its clinical significance in human gastric cancers remains unexplored. In the present study, SPAG9 expression was analyzed in 147 gastric cancer specimens. We observed weak staining in normal gastric mucosa and positive staining in 65 out of 147 (44.2 %) cancer samples. Overexpression of SPAG9 correlated with local invasion (p = 0.0101), lymph node metastasis (p = 0.0488), TNM stage (p = 0.0002), and relapse (p = 0.0018). Importantly, SPAG9 overexpression correlated with poor overall survival (p = 0.0008). Furthermore, we performed siRNA knockdown of SPAG9 in HGC-27 cells with high endogenous expression and transfected SPAG9 plasmid in SGC-7901 cell line with low endogenous level. SPAG9 overexpression promoted while its depletion inhibited cell proliferation, cell cycle transition, and invasive cell growth. SPAG9 overxpression also increased chemoresistance to 5--fluorouracil (5-FU) in SGC-7901 cells. Further analysis showed that SPAG9 knockdown downregulated and its overexpression upregulated cyclin D1, MMP9, and p-p38 expression. In conclusion, SPAG9 overexpression in gastric cancer correlates with poor prognosis and contributes to gastric cancer cell proliferation, invasion, and chemoresistance. SPAG9 promotes gastric cancer invasion, possibly through p38-MMP9 signaling pathways.

The prognostic significance of lymphovascular invasion in patients with resectable gastric cancer: a large retrospective study from Southern China

Background

The focus of this study was to assess the impact of lymphovascular invasion (LVI) on both the recurrence of cancer and the long-term survival of Chinese patients with resectable gastric cancer (GC).

Methods

A retrospective analysis of the clinicopathological data for 1148 GC patients who had undergone gastrectomy with regional lymphadenectomy was performed. The primary objective was to assess the correlation between LVI and post-surgery outcomes for each patient. This was done by routine H & E staining for LVI on patients’ disease-free survival (DFS) and disease-specific survival (DSS).

Results

LVI was detected in 404 (35.2%) of the 1148 GC patients. The presence of LVI was significantly correlated with the level of CA19-9, the tumor size, the Lauren classification, tumor differentiation, gastric wall invasive depth, lymph node involvement, distant metastasis and an advanced TNM stage. There was a lower DFS and DSS in the patients with LVI as compared to the patients without LVI. A multivariate analysis also identified LVI as an independent prognostic factor of both DSS and DFS.

Conclusions

The presence of LVI is a risk factor for the recurrence of cancer and an independent indicator of a poor outcome in GC patients following surgery. The LVI status should be taken into consideration when determining the best approach for the treatment of the individual.

Comparative analysis of clinicopathologic features and lymph node metastasis between patients with upper and lower gastric carcinoma

AIM: To compare the clinicopathologic features and lymph node metastasis between patients with upper and lower gastric carcinoma.

METHODS: One hundred and seven patients with upper gastric carcinoma and 505 patients with lower gastric carcinoma were analyzed. The clinicopathologic features and the relationship between lymph node metastasis and clinicopathologic features were analyzed.

RESULTS: There were significant difference between patients with upper gastric carcinoma and those with lower gastric carcinoma (P < 0.05) in sex, age, tumor size, subtype, histologic type, growth pattern, stage, depth of invasion, organ invasion, serosal involvement and margin residue. The main factors significantly differently affecting lymph node metastasis between patients with upper gastric carcinoma and those with lower gastric carcinoma were subtype, growth pattern, depth of invasion, and serosal involvement (P < 0.05), while tumor size and histological type showed no significant impact. There was no significant difference in the rate of lymph node metastasis between patients with upper and lower gastric carcinoma (53.27% vs 51.68%), indicating that there was no relationship between tumor location and rate of lymph node metastasis.

CONCLUSION: There are significant differences in clinicopathological parameters and lymph node metastasis between patients with upper and lower gastric carcinoma. Compared with patients with lower gastric carcinoma, those with upper gastric carcinoma often have larger tumors, infiltrating growth, poor differentiation, serosal invasion and advanced stage. This is the possible reason for poor prognosis of upper gastric carcinoma.

Prognostic significance of HER2 expression based on trastuzumab for gastric cancer (ToGA) criteria in gastric cancer: an updated meta-analysis

The prognostic significance of HER2 expression in patients with gastric cancer remains controversial, partially due to the significant heterogeneity of the approaches and criteria used for HER2 assessment among different studies. We therefore conducted a meta-analysis enrolling only studies defining HER2 status by trastuzumab for gastric cancer (ToGA) criteria. Published studies investigating the association between HER2 expression and survival were identified. Only publications that defined HER2 expression using ToGA criteria were enrolled. Meta-analyses were performed by Revman 5.2. Pooled hazard ratio (HR) and its 95 % confidence interval (CI) were calculated to evaluate the risk of disease. A total of 11 studies were enrolled in meta-analyses. Pooled data of nine studies using univariate analysis showed that HER2 expression is not associated with overall survival (OS; pooled HR, 0.97; 95 % CI, 0.84-1.12; P=0.63), which are maintained in six studies of multivariate analysis (pooled HR, 1.01; 95 % CI, 0.75-1.35; P=0.95). The Q statistic test for nine studies of univariate analysis and for six studies of multivariate analysis showed no and low heterogeneity (I (2)=22 % and P=0.25; I (2)=41 % and P=0.13, respectively). Furthermore, pooled data of four studies without heterogeneity (I (2)=0 %, P=0.74) showed that HER2 expression were not associated with relapse-free survival as well, with a pooled HR of 1.08 (95 % CI, 0.84-1.37; P=0.55) in patients with HER2 expression. In conclusion, this meta-analysis indicated that HER2 expression based on ToGA criteria is not related to the survival in patients with gastric cancer.