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Li Z, Li X, Guan S, Zhu G, Lin H, Wu H, Jia J, Guo Z, Cai Z, Zheng Q, Zhang H, Ruan F, Zheng X, Yang C, Xu Y, Ye J. Correlation Analysis Between Tumor Deposit and Clinicopathologic Characteristics and Prognosis of Gastric Cancer: A Multicenter Retrospective Study. Ann Surg Oncol 2024:10.1245/s10434-024-15508-1. [PMID: 38814549 DOI: 10.1245/s10434-024-15508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The mechanism underlying the formation of gastric tumor deposits (TDs) is unclear. We aimed to explore the risk factors for the formation and prognostic value of TDs. METHODS This retrospective analysis included 781 locally advanced gastric cancer (LAGC) patients from four medical institutions in China, from June 2014 to June 2018. The risk factors for TD formation and prognostic value were determined through univariate and multivariate analyses. RESULTS Univariate analysis revealed that TD positivity was closely related to tumor diameter, Borrmann classification, differentiation degree, pT stage, pN stage, pTNM stage, and nerve and vascular invasion (p < 0.05). Multivariate logistic regression revealed that tumor diameter ≥ 5 cm (odds ratio [OR] 1.836, 95% confidence interval [CI] 1.165-2.894, p = 0.009) and vascular invasion (OR 2.152, 95% CI 1.349-3.433, p = 0.001) were independent risk factors for TD positivity. Multivariate Cox analysis revealed that TD positivity (OR 1.533, 95% CI 1.101-2.134, p = 0.011), tumor diameter ≥ 5 cm (OR 1.831, 95% CI 1.319-2.541, p < 0.001), pT4a stage (OR 1.652, 95% CI 1.144-2.386, p = 0.007), and vascular invasion (OR 1.458, 95% CI 1.059-2.008, p = 0.021) were independent risk factors for GC prognosis. The 5-year overall and disease-free survival of the TD-positive group showed significant effects among patients in the pT4a and pN3b stages (p < 0.05). CONCLUSIONS TDs are closely related to tumor diameter and vascular invasion in LAGC patients, and TD positivity is an independent prognostic factor for LAGC patients, especially those at pT4a and pN3b stages.
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Affiliation(s)
- Zhixiong Li
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Xinyu Li
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, 362002, Fujian, China
| | - Shen Guan
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University Fujian Cancer Hospital, Fuzhou, 350004, Fujian, China
| | - Guangwei Zhu
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Huimei Lin
- Department of Anorectal Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, Fujian, China
| | - Haiyan Wu
- Department of Pathology, The First Hospital of Putian City, Putian, 351100, Fujian, China
| | - Jing Jia
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, 362002, Fujian, China
| | - Zipei Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Qiajun Zheng
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Haoxiang Zhang
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Fangqiu Ruan
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Xu Zheng
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Chunkang Yang
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University Fujian Cancer Hospital, Fuzhou, 350004, Fujian, China
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China.
| | - Jianxin Ye
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China.
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Song X, Liu K, Liao X, Zhu Y, Peng B, Zhang W, Zhao L, Chen X, Yang K, Hu J. Clinical significance of tumor deposits in gastric cancer after radical gastrectomy: a propensity score matching study. World J Surg Oncol 2023; 21:325. [PMID: 37833750 PMCID: PMC10571457 DOI: 10.1186/s12957-023-03208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE The value of tumor deposits (TDs) in the prognosis and staging of gastric cancer (GC) is still under debate. This study aims to evaluate the prognostic value of TDs and the best ways to incorporate TDs in the TNM classification of GC. METHODS Patients (n = 3460) undergoing curative gastrectomy for GC in the West China Hospital from 2005 to 2017 were retrospectively reviewed and divided into two groups according to the TD status (positive vs. negative). Later, clinicopathological features and overall survival (OS) between the two groups were compared. Thereafter, the associations between the presence of TD and other clinicopathological factors were evaluated through logistic regression. In addition, univariate and multivariate Cox regression were conducted for determining prognostic factors. The possibility of selection bias was reduced through conducting the 1:1 propensity score matching (PSM) analysis. The modified classification systems proposed previously that incorporated TDs into the TNM staging system were assessed. RESULTS There were 10.5% of patients (362/3460) diagnosed with TDs. TDs were significantly related to unfavorable factors such as advanced T stage and N stage and independently associated with poor prognosis. The 5-year OS of patients with TDs was significantly lower than that of patients without TDs (31.0% vs. 60.9%, P < 0.001), whereas higher than that of patients with peritoneal metastasis (31.0% vs. 5.0%, P < 0.001). In patients receiving chemotherapy, the 5-year OS of patients with TDs was also significantly lower than that of patients without TDs (42.0% vs. 50.9%, P = 0.026). Moreover, the system incorporating TDs in the TNM classification as metastatic lymph nodes outperformed others. CONCLUSIONS TDs are related to the aggressive characteristics and are an independent prognostic factor for GC. Incorporating TDs in the TNM classification as the metastatic lymph nodes increases the accuracy in predicting prognosis.
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Affiliation(s)
- Xiaohai Song
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kai Liu
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xuliang Liao
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Yunfeng Zhu
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - BoQiang Peng
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Weihan Zhang
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Linyong Zhao
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xiaolong Chen
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kun Yang
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Jiankun Hu
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China.
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China.
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Fujikawa K, Omori T, Shinno N, Hara H, Yamamoto M, Yasui M, Matsuda C, Wada H, Nishimura J, Haraguchi N, Akita H, Ohue M, Miyata H. Tumor Deposit Is an Independent Factor Predicting Early Recurrence and Poor Prognosis in Gastric Cancer. J Gastrointest Surg 2023; 27:1336-1344. [PMID: 37014588 DOI: 10.1007/s11605-023-05668-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/11/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Accurate prognostic estimation is crucial; however, the prognostic value of tumor deposits in gastric cancer remains controversial. This study aimed to investigate their prognostic significance. METHODS Clinicopathological and prognostic data of 1012 gastric cancer patients who underwent R0 or R1 surgery from 2010 to 2017 at the Osaka International Cancer Institute were retrospectively reviewed. RESULTS Overall, 6.3% patients had tumor deposits, which were associated with Borrmann type, surgical procedure, type of gastrectomy, extent of lymphadenectomy, tumor size, histology, pT, pN, pM, pStage, lymphatic invasion, vascular invasion, preoperative chemotherapy, and postoperative chemotherapy. Tumor deposit-positive patients had worse 5-year disease-free survival (32.60% vs. 92.45%) and overall survival (41.22% vs. 89.37%) than tumor deposit-negative patients. Subgroup analysis regarding pStage II-III also showed significant differences between patients with and without tumor deposits for 5-year disease-free survival (34.15% vs. 80.98%) and overall survival (43.17% vs. 75.78%). Multivariable analysis showed that older age, undifferentiated histology, deeper tumor invasion, lymph node metastasis, distant metastasis, and presence of tumor deposits were significantly correlated with early tumor recurrence and shorter survival time; these factors were identified as independent prognostic factors. The 5-year disease-free survival of tumor deposit-positive patients was significantly worse than that of patients in the pStage III group and comparable to that of patients in the pT4, pN3, and pM1 groups. The 5-year overall survival of tumor deposit-positive patients was comparable to that of the pT4, pN3, pM1, and pStage III groups. CONCLUSIONS Tumor deposits are strong and independent predictors of tumor recurrence and poor survival.
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Affiliation(s)
- Kaoru Fujikawa
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Takeshi Omori
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan.
| | - Naoki Shinno
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hisashi Hara
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Masaaki Yamamoto
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Masayoshi Yasui
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Chu Matsuda
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hiroshi Wada
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Junichi Nishimura
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Naotsugu Haraguchi
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hirofumi Akita
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Masayuki Ohue
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hiroshi Miyata
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
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4
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Li Z, Wu H, Lin H, Li J, Guo Z, Pan G, Guo Y, Zheng P, Cai Z, Ren J, Zhou J, Ye J, Xu Y. The short- and long-term effect of membrane anatomy-guided laparoscopic D2 lymphadenectomy plus regional complete mesogastrium excision for locally advanced gastric cancer. Surg Endosc 2023:10.1007/s00464-023-10089-8. [PMID: 37157036 DOI: 10.1007/s00464-023-10089-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Retrospectively analyzed the short- and long-term efficacy between laparoscopic D2 lymphadenectomy plus regional complete mesogastrium excision (D2 + rCME) and traditional laparoscopic D2 in the treatment of patients with locally advanced gastric cancer (LAGC), in order to obtain more evidence for D2 + rCME gastrectomy. METHODS A total of 599 LAGC patients who underwent laparoscopy-assisted radical gastrectomy from January 2014 to December 2019, including 367 cases in the D2 + rCME group and 232 cases in the D2 group. Intraoperative and postoperative clinicopathological parameters, postoperative complications and long-term survival in the two groups were statistically analyzed. RESULTS No significant differences in the positive rate of mesogastric tumor deposits, the number of positive lymph nodes and postoperative length of stay were found between the two groups (P > 0.05). In the D2 + rCME group, intraoperative blood loss was significantly reduced (84.20 ± 57.64 ml vs. 148.47 ± 76.97 ml, P < 0.001), the time to first postoperative flatus and first liquid diet intake were significantly shortened (3[2-3] days vs. 3[3-3] days, P < 0.001; 7[7-8] days vs. 8[7-8] days, P < 0.001), and the number of lymph nodes dissected was greater (43.57 ± 16.52 pieces vs. 36.72 ± 13.83 pieces, P < 0.001). The incidence of complications did not significantly differ between the D2 + rCME group (20.7%) and D2 group (19.4%) (P > 0.05). Although there was no statistically difference in 3-year OS and DFS between the two groups. However, the trend was better in D2 + rCME group. In subgroup analysis, patients with positive tumor deposits (TDs) in the D2 + rCME group had significantly better 3-year DFS compared With D2 group (P < 0.05). CONCLUSION Laparoscopic D2 + rCME is safe and feasible for the treatment of LAGC and is characterized by less bleeding, greater lymph node dissection and rapid recovery, without increasing postoperative complications. D2 + rCME group showed a better trend of long-term efficacy, especially significant beneficial for LAGC patients who with positive TDs.
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Affiliation(s)
- Zhixiong Li
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Haiyan Wu
- Department of Pathology, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Huimei Lin
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Junpeng Li
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Zipei Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Guofeng Pan
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Yihong Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Peng Zheng
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jie Ren
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jinfeng Zhou
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jianxin Ye
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China.
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China.
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Xu R, Zhang Y, Zhao J, Chen K, Wang Z. Prognostic value of tumor deposits in lymph node-negative gastric cancer: A propensity score matching study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:845-852. [PMID: 36543660 DOI: 10.1016/j.ejso.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to assess the prognostic value of TD in lymph node-negative GC. METHODS A retrospective study was conducted to collect the clinicopathological data from 1224 patients with lymph node-negative GC. According to their TD status, patients were categorized into TD-positive and TD-negative groups. Patients in both groups underwent a 1:1 propensity score matching analysis. Survival analysis was performed by the Kaplan-Meier method, and the differences between survival curves were measured by log-rank test. The cox proportional hazards model was used for univariate and multivariate analyses. RESULTS The TD-negative group had higher 5-year overall survival(OS) rate than TD-positive group(69.4%VS.36.4%,P < 0.05). Further subgroup analysis indicated that patients in the TD-negative group had higher 5-year OS rates than those in the TD-positive group in the T1-2, T3, and T4 subgroups(all with P < 0.05).The OS rates were decreased with the increase of the number of TD.The univariate Cox regression analysis demonstrated that tumor location in antrum, distal gastrectomy, perineural invasion, T4-stage,lymphovascular invasion and the number of TD were all associated with prognosis in patients undergoing curative gastric resection (P < 0.05).The multivariable analysis revealed that the number of TD, perineural invasion, lymphovascular invasion and T4 stage were independently associated with OS. CONCLUSION In lymph node-negative GC, TD is an independent risk factor for prognosis, regardless of T-stage, and patients with ≥3 TD have a worse prognosis.
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Zhou M, Yang W, Zou W, Yang J, Zhou C, Zhang Z, Wang Y, Zhang J, Wang Y, Li G, Zhang Z, Xia F. Prognostic significance of tumor deposits in radically resected gastric cancer: a retrospective study of a cohort of 1915 Chinese individuals. World J Surg Oncol 2022; 20:304. [PMID: 36138439 PMCID: PMC9502614 DOI: 10.1186/s12957-022-02773-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Tumor deposits (TDs) have been identified as an independent prognostic factor in gastric cancer (GC). However, the associated clinicopathological factors and how to simply and reasonably incorporate TD into the TNM staging system remain undetermined. The aim of the current study was therefore to assess the significance of TD among radically resected GC patients. Methods We retrospectively reviewed 1915 patients undergoing radical resection between 2007 and 2012. The patients were classified into two groups according to TD status (absent vs. present), and the clinicopathologic characteristics, DFS, and OS were compared. Associations of TD presence with other clinicopathologic factors were evaluated by logistic regression analysis. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors for DFS and OS in the primary cohort. Propensity score matching (PSM) was performed to reduce the possibility of selection bias according to the presence of TD. External validation of previously proposed modified staging systems incorporating TD was conducted. Results The detection rate of TD was 10.5% (201/1915). The presence of TD was significantly related to unfavorable clinicopathologic variables, including advanced T and N categories. According to the multivariate Cox regression analysis, the presence of TD was identified as an independent prognostic factor for DFS and OS in the primary cohort (both P < 0.001). In the after-PSM cohort, TD presence also significantly shortened DFS and OS. In the external validation, one system that incorporated TD into the pTNM stage had the best performance. Conclusions The presence of TD was significantly associated with poor survival in radically resected GC patients. The incorporation of TD into the TNM staging system can further improve the predictive capability. A multicenter cohort with a large sample size is needed to determine the appropriate method of incorporation. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02773-1.
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Affiliation(s)
- Menglong Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Wang Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Wei Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Jianing Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Changming Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
| | - Zhiyuan Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Jing Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Yan Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Guichao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. .,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China.
| | - Fan Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. .,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China.
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7
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Lin Q, Bai Q, Huang Q, Huang Y, Gao J, Zhang Y. Partial omentectomy maybe practicable for T3 or shallower gastric cancer patients. Cancer Med 2022; 12:1204-1216. [PMID: 35856487 PMCID: PMC9883580 DOI: 10.1002/cam4.4980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/18/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total omentectomy is often performed with gastrectomy as radical surgery for gastric cancer (GC) patients. However, it remains controversial whether GC patients can benefit from omentectomy. The aim of this study was to analyze the incidence and clinical significance of tumor deposits (TDs) in different anatomical subregions of perigastric omentum in GC patients undergoing gastrectomy with total omentectomy. METHODS From October 2011 to December 2013, 1253 patients who underwent gastrectomy with total omentectomy for GC were retrospective reviewed. The TDs in different anatomical subregions of perigastric omentum were examined. RESULTS Of 1253 patients, TDs positivity was 11.2%. Tumor deposits in the omentum of greater curvature and in the omentum of lesser curvature were associated with lymphovascular invasion, perineural invasion, advanced tumor node metastasis stages, and unfavorable survival. Besides, TDs in the proximal omentum of greater curvature and in the omentum of lesser curvature correlated with older patients and larger tumors. Kaplan-Meier curves showed that patients with TDs had worser overall survival (OS) than those without, regardless of TD positions. Patients with TDs in the omentum of greater curvature had the worst prognosis, followed by patients with TDs in the omentum of lesser curvature and patients with no TDs. Tumor deposits in the proximal omentum of greater curvature was an independent prognostic factor for OS. Moreover, only patients classified as pT4 had TDs in the distal omentum of greater curvature. CONCLUSIONS Patients with TDs in the omentum of greater curvature had the worst prognosis, followed by patients with TDs in the omentum of lesser curvature and patients with no TDs. In addition, partial omentectomy might be practicable for gastric cancer patients classified as T3 or shallower tumors.
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Affiliation(s)
- Qiaowei Lin
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Qianming Bai
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of Pathology, Shanghai Cancer CenterFudan UniversityShanghaiChina
| | - Qiuyi Huang
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yakai Huang
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jianpeng Gao
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yu Zhang
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
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Li X, Yang J. Association of tumor deposits with tumor-infiltrating lymphocytes and prognosis in gastric cancer. World J Surg Oncol 2022; 20:58. [PMID: 35220959 PMCID: PMC8883644 DOI: 10.1186/s12957-022-02507-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/05/2022] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
To investigate the relationship between tumor deposits (TDs) with the clinicopathological characteristics tumor-infiltrating lymphocytes (TILs) and prognosis of gastric cancer. Further analysis was done on the relationship between the number and maximum diameter of TDs with the clinicopathological characteristics and prognosis of gastric cancer.
Methods
The pathological findings of 369 patients with gastric cancer were retrospectively analyzed to observe the expression of TDs and the levels of stromal TILs. The relationship between TDs, clinicopathological characteristics, and levels of stromal TILs was compared using the chi-square test. Kaplan-Meier was used for survival analysis, and the log-rank test was used to determine the relationship between TDs and disease-free survival, cancer-specific survival, and overall survival. The prognostic value of TDs was assessed using multivariate Cox proportional hazards regression analysis. For further analysis, the optimal cutoff values for the number and maximum diameter of TDs were selected based on the receiver operating characteristic (ROC) curve.
Results
TDs were significantly associated with sex, lymphovascular invasion, perineural invasion, pathological T,N stage, and clinical stage (all P < 0.05). TILs levels are lower in TDs(+) group and higher in TDs(−) group. Compared with TDs(−) groups, TDs(+) group had poor disease-free survival, cancer-specific survival, and overall survival. TDs are negatively correlated with TILs, and TILs levels are lower in TDs(+) group and higher in TDs(−) group (P < 0.05). The samples are divided into the number of TDs (< 4 and ≥ 4) and the maximum diameter of TDs (< 7 mm and ≥ 7 mm). The number of TDs was significantly associated with pathological N stage (P < 0.05). The maximum diameter of TDs was significantly correlated with Lauren classification (P < 0.05) .TDs ≥ 4 had lower DFS, CSS, and OS (P < 0.05). The maximum diameter of TDs was not statistically significant with prognosis (P > 0.05).
Conclusion
TDs are independent prognosis predictors of gastric cancer. In the tumor microenvironment, TDs and TILs interact with each other to regulate the development of gastric cancer, thus affecting gastric cancer prognosis of patients. The number of TDs ≥ 4 has a worse prognosis compared to the number of TDs < 4.
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9
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Díaz del Arco C, Ortega Medina L, Estrada Muñoz L, García Gómez de las Heras S, Fernández Aceñero MJ. Pathologic Lymph Node Staging of Gastric Cancer. Am J Clin Pathol 2021; 156:749-765. [PMID: 34273159 DOI: 10.1093/ajcp/aqab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/13/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The TNM classification is the main tool for lymph node (LN) staging in gastric cancer (GC). However, alternative LN staging systems have been proposed, and the role of features other than the number of metastatic LNs is being investigated. Our aim is to discuss the main challenges of LN assessment in GC. METHODS Comprehensive review of the literature on alternative LN staging systems, examined LNs, sentinel LN (SLN) biopsy, LN micrometastases (LNMIs), extracapsular extension (ECE), and tumor deposits (TDs) in GC. RESULTS Many controversies exist regarding LN assessment in GC. The TNM classification shows excellent prognostic performance, but alternative prognostic methods such as the LN ratio or log odds of positive LNs have demonstrated to be better than the TNM system in terms of prognostic accuracy. The value of SLN biopsy and LNMIs in GC is still unclear, and several challenges concerning their clinical impact and pathologic analysis must be overcome before their introduction in clinical practice. Most authors have identified ECE and TDs as independent prognostic factors for survival in GC. CONCLUSIONS Further studies should be performed to evaluate the impact of these features on the TNM classification and patient outcomes, as well as to standardize alternative LN staging systems.
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Affiliation(s)
- Cristina Díaz del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Luis Ortega Medina
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | | | | | - M Jesús Fernández Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
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10
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Clinicopathological factors associated with the presence of tumor deposits in resected gastric cancer patients. Heliyon 2021; 7:e07185. [PMID: 34141939 PMCID: PMC8188374 DOI: 10.1016/j.heliyon.2021.e07185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/29/2021] [Accepted: 05/27/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The role of tumor deposits (TDs) in the staging of gastric cancer is currently debatable. TDs are defined as tumoral nodules in perigastric adipose tissue with no evidence of lymphatic, vascular, or neural structures. Clinicopathological factors related to the presence of TDs are not well defined. This study aimed to identify the clinicopathological factors associated with the presence of TDs in resected gastric cancer patients. Materials and methods This prospective study included patients diagnosed with gastric cancer and treated with D2 radical gastrectomy from January 2019 to January 2020. Univariate and multivariate analyses were performed to determine the factors related to the presence of TDs. Results A total of 111 patients were eligible and TDs were present in 31 of them (28%). In the univariate analysis, male gender (p = 0.027), tumor size ≥ 5cm (p = ≤0.001), serosa and adjacent organs invasion (pT4a and pT4b) (p = ≤0.001), ≥16 metastatic lymph nodes (pN3b) (p = ≤0.001), and TNM stage III tumors (p = ≤0.001) were significantly associated with the presence of TDs. The multivariate analysis showed that a tumors size ≥5 cm (OR = 3.69, 95% CI: 1.17-11.6), serosa and adjacent organs invasion (pT4a and pT4b) (OR = 3.78, 95% CI: 1.31-10.86) and ≥16 metastatic lymph nodes (pN3b) (OR = 3.21, 95%CI:1.06-9.7) were independent risk factors for the presence of TDs. Conclusions Larger tumors (tumor size ≥ 5cm), serosa and adjacent organs invasion (pT4 and pT4b), and ≥16 metastatic lymph nodes (pN3b) were independent risk factors for the presence of TDs.
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11
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Yu S, Zhu Y, Shi X, Diao W, Zhu X, Gao Z, Chen X. The prognostic significance of tumor deposits in patients with head and neck squamous cell carcinomas. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:377. [PMID: 33842598 PMCID: PMC8033359 DOI: 10.21037/atm-20-4369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Background A tumor deposit (TD) is a phenomenon that has not been well studied in head and neck squamous cell carcinoma (HNSCC) but might have prognostic significance. The present study was conducted to explore the presence and the prognostic significance of TDs in patients with HNSCCs. Methods Six hundred forty-two pathologically confirmed HNSCC patients with neck dissection samples were enrolled in this retrospective study. Patients were followed up and evaluated every 3 months in the first 3 years after surgery, and every 6 months thereafter by physical examination and computed tomography (CT)/magnetic resonance imaging (MRI) scans. The five-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were compared in the TD and non-TD groups using multivariable analyses and propensity score matching (PSM) methodology (1:1). Results The 5-year OS, DSS, and RFS rate of all patients was 77.3%, 80.6%, and 71.9%, respectively. In the multivariable analyses, poorer rates of OS (HR =2.345, P<0.001), DSS (HR =2.818, P<0.001), and RFS (HR =2.536, P<0.001) were observed in the TD versus the non-TD group. In the PSM cohort, eighty-one patients who had TDs were paired with 70 patients without TDs. Significantly diminished rates of DSS (P=0.040) and RFS (P=0.004) were found in the TD versus the non-TD group. Conclusions In response to sparse reports regarding TDs in HNSCCs, the present study proposes the TD as an independent poor prognostic factor meriting further research because of its association with diminished OS, DSS, and RFS rates.
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Affiliation(s)
- Shuting Yu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yingying Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohua Shi
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenwen Diao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoli Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiqiang Gao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xingming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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12
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Zhang G, Zhang C, Wang L, Xue L, Jia J, Zuo Z, Sun N, Gao S, Xue Q, He J. The prognostic value of tumor deposits and the impact on the TNM classification system in esophageal cancer patients. J Surg Oncol 2021; 123:891-903. [PMID: 33434341 DOI: 10.1002/jso.26376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/22/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the prognostic significance of tumor deposits (TDs), isolated tumor foci lacking residual lymph nodes, in esophageal cancer (EC). METHODS A retrospective review of patients with EC undergoing esophagectomy between 2005 and 2017 was conducted. The prognostic value of TD was evaluated using a Cox regression model. Patients from different sources and periods were split into discovery and validation sets. A propensity score matching model was used in the validation set to reduce the confounding bias. The impact of TD on the TNM classification system was evaluated. RESULTS The discovery and validation sets included 179 and 2875 patients, respectively. Propensity-matched patients with and without TDs were constructed in the validation set with 132 patients in each group. Overall survival (p < .001 and p = .004, respectively) and disease-free survival (p < .001 and p = .019, respectively) were both decreased in TD positive patients in the discovery set and propensity-matched groups of validation set. Classifying patients with TDs into pN3 stage improved the discriminative power of the current TNM staging system. CONCLUSIONS TD is an independent prognostic factor for EC. The inclusion of TD in the TNM staging system may upstage appropriate patients to help guide therapy, and future studies are warranted.
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Affiliation(s)
- Guochao Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chaoqi Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lide Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Jia
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhichao Zuo
- Department of Radiology, Xiangtan Central Hospital, Hunan, China
| | - Nan Sun
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Chen Y, Xu S, Huang C, Ling Y, Liang C, Miao Y, Sun X, Li Y, Zhou Z. Cancer cells invasion to the gastric bare area adipose tissue: a poor prognostic predictor for gastric cancer. World J Surg Oncol 2020; 18:300. [PMID: 33187517 PMCID: PMC7666447 DOI: 10.1186/s12957-020-02066-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background The relationship between gastric bare area adipose tissues invasion (GBAI) confirmed pathologically and the prognosis of gastric cancer (GC) patients is undefined. Till present, there has not been literature investigating this phenomenon. Here, we aimed at analyzing the implication of GBAI in GC. Methods The data of 1822 patients who underwent radical surgery between January 2000 and December 2013 at the Sun Yat-sen University Cancer Center were retrieved. Pathologically, tumor deposits (TDs) located > 5 mm from the leading edge of the primary tumor and the lymph nodes (LNs) station number 1, 2, 7, and 9 were considered GBAI. Kaplan-Meier method, log-rank test, and Cox’s proportional hazards model were employed to analyze. Results Two hundred and five (11.3%) patients were pathologically diagnosed with GBAI, which was more commonly found in proximal or linitis lastica than distal GC (P < 0.001). There was significant difference in 5-year survival between patients with and without GBAI for stages IIB, IIIA, IIIB, and IIIC, respectively (P < 0.009 for IIB, IIIA, and IIIB; P = 0.021 for IIIC). Among the 205 GBAI patients, 61 had detailed radiological follow-up data in which 26 (34.7%) were found to have retroperitoneal infiltration, 27 (36.0%) had peritoneal metastasis, 10 (13.3%) had hematogenous metastasis, 16 (21.3%) had lymphatic metastasis, and 16 (21.3%) had others. Conclusions GBAI was identified as a predictor of unfavorable prognosis for GC and was more commonly found in the proximal or linitis plastica of the stomach than in distal stomach. Retroperitoneal infiltration was one of the most commonly identified metastatic route for GC associated with GBAI after radical surgery.
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Affiliation(s)
- Yongming Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, China
| | - Shuhang Xu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chunyu Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yihong Ling
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chengcai Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, China
| | - Yuhua Miao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, China
| | - Xiaowei Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, China
| | - Yuanfang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, China.
| | - Zhiwei Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, China.
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14
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Gu L, Chen P, Su H, Li X, Zhu H, Wang X, Khadaroo PA, Mao D, Chen M. Clinical Significance of Tumor Deposits in Gastric Cancer: a Retrospective and Propensity Score-Matched Study at Two Institutions. J Gastrointest Surg 2020; 24:2482-2490. [PMID: 31749098 DOI: 10.1007/s11605-019-04421-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/17/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric cancer (GC) treatment is largely determined by tumor stage. Despite improvements in the mode of treatment of various types of advanced disease, staging is still evolving. The role of tumor deposits (TDs) in staging remains debated. The purpose of this research is to investigate the relationship between TDs and prognosis in GC. METHODS A total of 3098 patients were considered eligible for prognostic analysis (2706 patients in the TDs-negative group and 392 patients in the TDs-positive group). A one-to-one propensity score-matching analysis was performed using a logistic regression mode and the following covariates: age, gender, tumor location, size, differentiation, perineural invasion, lymphovascular invasion, pTNM stage, type of gastrectomy, and the number of lymph nodes retrieved between TDs-negative and TDs-positive group, then 323 patients in each group were analyzed. Univariate and multivariate analyses of prognostic factors were conducted accordingly. The predictive ability of different staging system incorporating TDs was evaluated. RESULTS TDs were present in 14.5% cases and almost all of the patients (99%) suffered from advanced GC. Multivariate analysis showed that pN stage, chemotherapy, and TDs were the independent prognostic factors. The TDs-positive group showed a lower rate of 5-year disease-free survival compared with the TDs-negative group in all patients, stage II, and stage III patients (p = 0.001, 0.029, and 0.003, respectively). The 5-year disease-free survival for patients with TDs and without TDs was 27.6% and 34.4%, respectively. CONCLUSIONS Our research shows that TDs are closely associated with prognosis in GC. TDs should be incorporated into the TNM staging system, which could then accurately improve the staging reliability and prognostic assessment.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Hui Su
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xinlong Li
- Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Hepan Zhu
- Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Xianfa Wang
- Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | | | - Danyi Mao
- Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Manman Chen
- Affiliated Hospital of Medical School Ningbo University and Ningbo City Third Hospital, No. 247, Renming Road, Ningbo, 315020, Zhejiang, China.
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15
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Guo S, Shang M, Dong Z, Zhang J, Wang Y, Zhao Y. The assessment of the optimal number of examined lymph nodes and prognostic models based on lymph nodes for predicting survival outcome in patients with stage N3b gastric cancer. Asia Pac J Clin Oncol 2020; 17:e117-e124. [PMID: 32762113 DOI: 10.1111/ajco.13358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 04/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The optimal number of examined lymph nodes (ELNs) and the prognostic value of different nodal staging systems remain unclear in the context of N3b gastric cancer. AIM To evaluate the optimal number of ELNs and compare the predictive ability of the ELN number, LN ratio (LNR), and log odds of metastatic LNs (LODDS) for overall survival (OS) in patients with resected stage N3b gastric adenocarcinoma in an international database. METHODS A total of 868 patients diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database (training cohort) and 144 patients diagnosed between 2011 and 2016 at the Liaoning Cancer Hospital (validation cohort) were identified. Cutoff values were established with X-tile. The 5-year OS rates were compared using Kaplan-Meier curves. Multivariate analysis was conducted with a Cox regression model. The Harrell's concordance index and Akaike's information criterion were used to compare the predictive accuracy of different nodal staging systems. RESULTS The ELN number, LNR, and LODDS were independent prognostic factors for both the training and validation cohorts in the multivariate analysis. Patient with ≤26 ELNs, LNR of more than 0.9, and LODDS of more than 1.0 were associated with decrease OS. The LNR and LODDS had similar discriminatory ability for OS and performed better than the ELN number in the Eastern and Western populations. CONCLUSION The optimal number of ELN may be 27 or more because LNs retrieved ≤26 was an independent risk factor for the prognosis. The prognostic prediction efficacy of LNR and LODDS was similar and better than that of ELN. Thus, LNR and LODDS could both serve as valid tools to predict OS for stage N3b patients.
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Affiliation(s)
- Shuai Guo
- China Medical University, Shenbei New District, Shenyang, China
| | - Muyan Shang
- China Medical University, Shenbei New District, Shenyang, China
| | - Zhe Dong
- China Medical University, Shenbei New District, Shenyang, China
| | - Jun Zhang
- Department of Gastric Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Yue Wang
- Department of Gastric Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
| | - Yan Zhao
- Department of Gastric Cancer, Liaoning Cancer Hospital& Institute (Cancer Hospital of China Medical University), Shenyang, China
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16
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Zhu Z, Gong Y, Xu H. Clinical and pathological staging of gastric cancer: Current perspectives and implications. Eur J Surg Oncol 2020; 46:e14-e19. [PMID: 32732091 DOI: 10.1016/j.ejso.2020.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023] Open
Abstract
Accurate categorization of invasive depth and lymph node metastasis or optimization of TNM categories is fundamentally critical for prognostic assessment and decision making regarding subsequent therapies after surgery for gastric cancer. Improving the precision of the TNM staging is the ongoing goal. The evolution of the staging system indicates that there is no "ideal staging". Every update has criticized the lack of a standard approach for the stages to date. T staging depends on the accurate determination of the depth of infiltration based on pathological continuous sections. N staging is susceptible to the influence of lymph node detection, and insufficient lymph node detection can lead to N staging migration. M staging is required to improve the detection rate of peritoneal positive free cancer cells to determine the high risk factors of peritoneal metastasis. At present, the quality of standardized pathological diagnosis of gastric cancer requires improvement. Based on a review of the literature and experience from multiple gastric cancer centers, we present a new development in TNM staging and a way to improve clinical and pathological quality control of gastric cancer.
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Affiliation(s)
- Zhi Zhu
- Department of Surgical Oncology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China; Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
| | - Yingbo Gong
- Department of Surgical Oncology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China; Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
| | - Huimian Xu
- Department of Surgical Oncology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China; Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
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Wenquan L, Yuhua L, Jianxin C, Hongqing X, Kecheng Z, Jiyang L, Yunhe G, Yi L, Wang Z, Shaoqing L, Yixun L, Shen Q, Wanguo X, Zhi Q, Lin C. Tumor deposit serves as a prognostic marker in gastric cancer: A propensity score-matched analysis comparing survival outcomes. Cancer Med 2020; 9:3268-3277. [PMID: 32163670 PMCID: PMC7221304 DOI: 10.1002/cam4.2963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/01/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastric cancer (GC) treatment is determined by accurate tumor staging. The value of tumor deposit (TD) in prognostic prediction staging system is not yet determined. METHODS We retrospectively analyzed clinical information on GC patients who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital from July 2014 to June 2016. Propensity score matching (PSM) was performed to reduce the possibility of selection bias according to the presence of TD. RESULTS Of the 1034 GC patients, 240 (23.21%) presented with TD, which was associated with younger age and larger tumor size (all P < .05). TD-positive patients had a worse survival than TD-negative patients before (P < .001) and after (P = .017) matching. Multivariable analysis showed that mortality risk of patients with TD increased by 58%, 62%, 37%, and 40% in the crude (HR = 1.58, 95% CI 1.32-1.89, P < .001), adjusted I (HR = 1.62, 95% CI 1.35-1.94, P < .001), adjusted II (HR = 1.37, 95% CI 1.13-1.66, P = .001), and adjusted III (HR = 1.40, 95% CI 1.16-1.68, P < .001) models before matching. Similarly, in the PSM cohort patients with TD had worse prognosis in the crude (HR = 1.32, 95% CI 1.07-1.63, P = .011), adjusted I (HR = 1.35, 95% CI 1.09-1.67, P = .005), adjusted II (HR = 1.26, 95% CI 1.00-1.58, P = .049), and adjusted III (HR = 1.33, 95% CI 1.07-1.65, P = .010) models. TD had a similar value range between N1 and N2 stages among different models. CONCLUSIONS Among GC patients, TD is associated with survival and may have a role in the staging of patients.
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Affiliation(s)
- Liang Wenquan
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Liu Yuhua
- Institute of Army Hospital Management, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Cui Jianxin
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xi Hongqing
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Zhang Kecheng
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Li Jiyang
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Gao Yunhe
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Liu Yi
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Zhang Wang
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Li Shaoqing
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Lu Yixun
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Qiao Shen
- Medical Big Data Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xue Wanguo
- Medical Big Data Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiao Zhi
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Chen Lin
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
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18
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Tan J, Yang B, Xu Z, Zhou S, Chen Z, Huang J, Gao H, Zheng S, Wen L, Han F. Tumor deposit indicates worse prognosis than metastatic lymph node in gastric cancer: a propensity score matching study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:671. [PMID: 31930072 DOI: 10.21037/atm.2019.10.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The prognostic value of tumor deposit (TD) in gastric cancer is controversial. This study aims to investigate the prognostic value of TD. Methods The consecutive patients diagnosed with gastric cancer from October 2007 to October 2012 were selected. The patients were divided by whether they suffered TD into two groups. The basic data were comparable between the two groups after propensity score matching (PSM), then survival analysis [overall survival (OS) and cancer-specific survival (CSS)] was applied in two groups. After that, all the patients were divided by pN staging and survival analysis were applied in each subgroup. At last, all patients were divided into TD group, pN1 stage group, pN2 stage group, pN3a, and pN3b stage group, OS and CSS were compared between them. Multivariable competing risk analyses tested association of TD with OS and CSS, before and after PSM. Results Eight hundred and three patients were concluded. After PSM, 137 patients with TD and 274 patients without TD were selected, the 5-year OS and CSS rates of patients with TD were significantly worse than patients without TD (OS: 19.7% vs. 42.0%, P<0.001; CSS: 22.6% vs. 45.6%, P<0.001). In all patients' survival analysis, the 5-year OS and CSS rates of TD group were comparable with pN3a group (OS: 19.7% vs. 25.3%, P=0.221, CSS: 22.6% vs. 30.1%, P=0.092) and pN3b group (OS: 19.7% vs. 19.6% P=0.349, CSS: 22.6% vs. 23.5%, P=0.452). Meanwhile, on multivariable cox regression analyses, the presence of TD significantly reduces the OS and CSS of patients in gastric cancer. Conclusions TD has a marked impact on the prognosis of gastric cancer. Even patients with TD had the same prognosis with pN3 stage.
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Affiliation(s)
- Jianan Tan
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Bin Yang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhimeng Xu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510000, China
| | - Shengning Zhou
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhitao Chen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Jing Huang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Han Gao
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Senyou Zheng
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Liqiang Wen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Fanghai Han
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
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19
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Liang Y, Wu L, Liu L, Ding X, Wang X, Liu H, Meng J, Xu R, He D, Liang H. Impact of extranodal tumor deposits on prognosis and N stage in gastric cancer. Surgery 2019; 166:305-313. [PMID: 31221435 DOI: 10.1016/j.surg.2019.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/14/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extranodal tumor deposits have been reported to be associated with a poor prognosis in many malignancies and are also included in the tumor, node, and metastasis staging system for colorectal cancer. METHODS We reviewed retrospectively a total of 2,344 gastric cancer patients who underwent gastrectomy with curative intent at the Tianjin Medical University Cancer Institute and Hospital (Hexi District, Tianjin, China) and the First Affiliated Hospital of Hainan Medical University (Longhua District, Haikou, China). Patients were categorized into 2 groups based on extranodal tumor deposit status: a positive group, including those with extranodal tumor deposits, and a negative group composed of those with no extranodal tumor deposits. Clinicopathologic factors were correlated with extranodal tumor deposits, and their individual prognoses were analyzed. In addition, a pathologically modified node classification system was proposed by incorporating the extranodal tumor deposit status into the 8th ed of the N staging system. The superiority of prognostic prediction between the modified node classification and node stage was compared. RESULTS A total of 645 (27.5%) patients had extranodal tumor deposits. The presence of extranodal tumor deposits was associated with a larger tumor size, Borrmann type III and IV, a deeper depth of invasion, and an advanced node stage. In the multivariate analysis, extranodal tumor deposits were an independent prognostic factor for gastric cancer patients after curative resection. Gastric cancer patients with extranodal tumor deposits demonstrated a lesser 5-year overall survival than those with no extranodal tumor deposits (31.9% vs 61.4%, P < .001). With the strata analysis, statistically significant prognostic differences between the two groups were only observed in patients at the N0-N2 stage. The modified node classification was found to be more appropriate for predicting the overall survival of gastric cancer patients after curative resection than node stage, and the -2 log likelihood of the modified node classification (16,042.890) was smaller than the value of node stage (16,150.811). CONCLUSION Extranodal tumor deposits in gastric cancer patients indicate aggressive characteristics and a poorer prognosis of gastric cancer. We maintain that extranodal tumor deposits should be incorporated into the N staging system to enhance the accuracy of the prognostic prediction of patients with gastric cancer.
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Affiliation(s)
- Yuexiang Liang
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Liangliang Wu
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Lijie Liu
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Xuewei Ding
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Xiaona Wang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Hongmin Liu
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Jin Meng
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Ronghua Xu
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Donglei He
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China.
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20
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Graham Martínez C, Knijn N, Verheij M, Nagtegaal ID, van der Post RS. Tumour deposits are a significant prognostic factor in gastric cancer - a systematic review and meta-analysis. Histopathology 2019; 74:809-816. [PMID: 30376189 PMCID: PMC6850601 DOI: 10.1111/his.13781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
AIMS Tumour deposits (TDs) are clusters of cancer cells in the soft tissue that are discontinuous from the primary tumour. In this review we are exploring their relevance for prognosis in patients with gastric cancer. METHODS AND RESULTS A literature search was performed to identify studies providing data on TDs and prognosis in gastric cancer patients. Eight papers were included in the meta-analysis, which was carried out in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). Of 7445 patients, 1551 had TDs (20.9%). TDs were associated with a decreased overall survival (OS) in univariate (HR = 2.82, 95% CI = 1.9-4.3) and multivariate analyses (HR = 1.65, 95% CI = 1.3-2.1). TDs were also associated with known prognostic factors such as synchronous metastatic disease (RR = 9.5), invasion depth (RR = 1.8), lymph node metastasis (RR = 1.7), lymphatic invasion (RR = 1.7), vascular invasion (RR = 2.6) and poor differentiation (RR = 1.2). CONCLUSIONS We found a strong indication that TDs are independent predictors of prognosis in patients with gastric cancer; hence, TDs should be included in the staging of gastric cancers.
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Affiliation(s)
| | - Nikki Knijn
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
| | - Marcel Verheij
- Department of RadiotherapyRadboud University Medical CentreNijmegenthe Netherlands
| | - Iris D Nagtegaal
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
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21
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Ye J, Ren Y, Dai W, Chen J, Cai S, Tan M, He Y, Yuan Y. Does Lymphadenectomy with at Least 15 Perigastric Lymph Nodes Retrieval Promise an Improved Survival for Gastric Cancer: A Retrospective Cohort Study in Southern China. J Cancer 2019; 10:1444-1452. [PMID: 31031854 PMCID: PMC6485220 DOI: 10.7150/jca.28413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Specific guidelines recommend at least 15 or 16 lymph nodes (LNs) be examined to adequately assess nodal category of gastric cancer (GC), but the requirement for minimum number of regional LNs retrieval is not mentioned. This study aims to investigate survival significance from various numbers of perigastric (N1) LNs retrieval and to determine an optimal number harvested in such region. Study design: From April 1994 to March 2012, 1003 resectable GC patients with at least 15 LNs examined were included. Patients with at least 15 N1 nodes retrieval were assigned into study group, with the rest into control group. The 5-year overall survival (OS) rate was compared between two groups, and an optimal number of examined N1 nodes was detected by a survival joinpoint analysis. Results: 635 (63.3%) patients in study group had median 22 (range, 15-75) N1 nodes and 3 (range, 0-74) positive N1 nodes retrieval, with median 10 (range, 0-14) N1 nodes and 1 (range, 0-29) metastatic N1 nodes examined in control group. The number of N1 nodes retrieval was associated with tumor location (P=0.007), tumor stage (P<0.001) and total number of harvested LNs (r=0.691, P<0.001). Median survival time (79.0 vs. 72.0 months, P=0.462) and actual 5-year OS rate (41.0% vs. 39.2%, P=0.463) were slightly improved in study group compared with control group, with significance obtained via stage-by-stage analysis. The joinpoint analysis indicated that at least seven N1 nodes retrieval achieved survival significance (81.0 vs. 35.0 months, P=0.036), with survival superiority remained until reaching up to 15 N1 nodes. Conclusion: Adequate retrieval of perigastric LNs is essential for radical gastrectomy. A harvest of at least 7-15 perigastric LNs could achieve long-term survival benefit for GC patients.
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Affiliation(s)
- Jinning Ye
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Yufeng Ren
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Weigang Dai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Jianhui Chen
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Shirong Cai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Min Tan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Yulong He
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Digestive Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518106, Guangdong Prov., P.R. China
| | - Yujie Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
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22
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Chen H, Tang Z, Chen L, Li H, Wang X, Liu F, Sun Y. Evaluation of the impact of tumor deposits on prognosis in gastric cancer and a proposal for their incorporation into the AJCC staging system. Eur J Surg Oncol 2018; 44:1990-1996. [DOI: 10.1016/j.ejso.2018.10.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 02/03/2023] Open
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