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Chen YJ, Yeh ST, Ou LH, Lin CS, Chien CT. Impact of the extent of negative lymph nodes in gastric adenocarcinoma undergoing primary surgical resection: An institutional report. J Chin Med Assoc 2021; 84:428-437. [PMID: 33595989 DOI: 10.1097/jcma.0000000000000500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sub-total/total gastrectomy with lymph node dissection (LND) remains an effective therapeutic strategy for resectable gastric adenocarcinomas (GACs). Despite the prognostic significance of positive lymph nodes (PLNs) defined in N-status, few have appraised the impacts of negative lymph nodes (NLNs) and the percentage of NLN (=number of NLNs/number of total lymph nodes [TLNs], %), as well as the extent of TLNs to be dissected in GACs. METHODS We retrospectively analyzed 62 GAC patients (mean age of 67.1 years; 41 men) undergoing primary sub-total/total gastrectomy from a single institute. Candidate variables, including the number of NLNs (≤9 and >9) and the percentage of NLN (≤37.5, 37.5-80.6 and >80.6, %), were evaluated to determine their prognostic impacts and hazard ratios (HRs). RESULTS Under the multivariate Cox proportional-hazards regression model, tumor length exceeding 4 cm (p = 0.017; HR = 2.828), perineural invasion (p = 0.037; HR = 3.182), and lower percentage of NLN (p = 0.016 and p = 0.060; HRs = 1.000, 0.327, and 0.333 for subgroups ≤37.5, 37.5-80.6, and >80.6, respectively) were three independent predictors with elevated HRs for poor prognosis. GAC patients with the percentage of NLN > 80.6 were highly related to those with NLNs > 9 (p < 0.001), and GAC patients with NLNs > 9 were highly related to those with TLNs > 15 (p < 0.001). For all 62 GAC or 42 N(+) GAC patients, those who underwent LND with TLNs>15 tended to have more PLNs (p = 0.018, p = 0.003) and more NLNs (p < 0.001, p = 0.029) than did those with TLNs ≤ 15. Among the 42 GAC patients with TLNs > 15, a lower percentage of NLN (p = 0.026 and p = 0.015; HRs = 1.000, 0.272, and 0.180 for subgroups ≤37.5, 37.5-80.6, and >80.6, respectively) remained an independent predictor of poor prognosis. CONCLUSION The percentage of NLN could predict the prognosis of GAC patients properly. However, an accurate percentage of NLN needs a minimal requirement of TLNs > 15 to detect an adequate number of PLNs and sufficient number of NLNs.
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Affiliation(s)
- Yen-Jen Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Comprehensive Breast Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, RO
| | - Shin-Ting Yeh
- Department of Gerontological Health Care, and College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Liang-Hung Ou
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Chen-Sung Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC
- Center for General Education, Kainan University, Taoyuan City, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
| | - Chiang-Ting Chien
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan, ROC
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Xiao W, Liang H, Zhang H, Jia R, Yang Y, Wang Y, Tang P, Yu Z. Ratio between negative and positive lymph nodes is a novel prognostic indicator for patients with esophageal cancer: A Surveillance, Epidemiology and End Results database analysis. Thorac Cancer 2020; 11:3490-3500. [PMID: 33034409 PMCID: PMC7705634 DOI: 10.1111/1759-7714.13688] [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: 08/27/2020] [Revised: 09/20/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to explore whether the ratio between negative and positive lymph nodes (RNP) could predict the overall survival (OS) of esophageal cancer (EC) patients with lymph node metastasis following esophagectomy. Methods We utilized the Surveillance, Epidemiology and End Results (SEER) database to include the records of 2374 patients with lymph node metastases post‐surgery. All patients were randomly assigned into the training cohort (n = 1424) and validation cohort (n = 950). Multivariate Cox regression analyses were performed to identify independent prognostic factors. A novel RNP ‐based TRNPM staging system was proposed. The prognostic value of N, RNP, TNM and TRNPM staging system was evaluated using the linear trend χ2 test, likelihood ratio χ2 test, and Akaike information criterion (AIC) to determine the potential superiorities. We constructed nomograms to predict survival in both cohorts, and the calibration curves confirmed the predictive ability. Results Univariate analyses showed that N and RNP stage significantly influenced the OS of patients. Multivariate analyses revealed that RNP was an independent prognostic predictor in both the training and validation cohorts. For the stratification analysis in the two cohorts, we found significant differences in the prognosis of patients in different RNP groups on the basis of the different N stages and the number of dissected lymph nodes. In addition, the lower AIC value of RNP stage and TRNPM staging system represented superior predictive accuracy for OS than the N stage and TNM staging system, respectively. Furthermore, the calibration curves for the probability of three‐ and five‐year survival showed good consistency between nomogram predictive abilities and actual observation. Conclusions We demonstrated that compared to the classical pathological lymph nodal staging system, the RNP stage showed superior predictive accuracy for OS and can serve as a more effective prognostic guidance for lymph node positive EC patients.
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Affiliation(s)
- Wanyi Xiao
- Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Huagang Liang
- Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Hongdian Zhang
- Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ran Jia
- Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yueyang Yang
- Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yang Wang
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Peng Tang
- Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Zhang N, Bai H, Deng J, Wang W, Sun Z, Wang Z, Xu H, Zhou Z, Liang H. Impact of examined lymph node count on staging and long-term survival of patients with node-negative stage III gastric cancer: a retrospective study using a Chinese multi-institutional registry with Surveillance, Epidemiology, and End Results (SEER) data validation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1075. [PMID: 33145294 PMCID: PMC7575951 DOI: 10.21037/atm-20-1358a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Accumulating evidence has confirmed the potential prognostic value of examined lymph nodes (ELNs) in patients with gastric cancer (GC). However, there is currently no consensus on the threshold ELN number for predicting both stage migration and long-term survival, especially in patients with stage III GC. This study aimed to validate the need to increase the ELN count to improve its prognostic accuracy in node-negative patients with stage III GC after curative gastrectomy. Methods This retrospective, population-based study analyzed the clinical data of 84 patients with node-negative stage III GC from three high-volume institutions in China and 196 cases from the Surveillance, Epidemiology and End Results (SEER) program registry. The optimal number of ELNs was determined by receiver operating characteristic (ROC) curve analysis. Clinicopathological characteristics significantly related to survival were evaluated using the Kaplan-Meier method and Cox proportional hazards analysis. Stratified analyses were adopted to assess the prognostic predictive ability of the identified optimal number of ELNs in different populations. Survival differences among subgroups were analyzed to assess the impact of ELN count on stage migration according to overall survival (OS) among GC patients. Results The optimal number of ELNs was >31 according to ROC analysis of patients with node-negative stage III GC who underwent gastrectomy. Multivariate analysis identified ELNs as an independent predictor of postoperative OS in patients with node-negative stage III GC in both the Chinese cohort [hazard ratio (HR) 0.235; P<0.001] and the SEER cohort (HR 0.421; P<0.010). Stratified analysis demonstrated that >31 ELNs was a prerequisite for accurate prognostic evaluation of patients with node-negative stage III GC, regardless of sex, tumor size, and other factors. Stage migration between pT4bN0M0 and pT4bN1M0 was detected in patients with >31 ELNs. A nomogram was created to predict OS among patients with node-negative stage III GC. These results were validated using data from the SEER cohort. Conclusions The number of ELNs was significantly associated with prognosis in patients with stage III GC after gastrectomy with systemic lymphadenectomy in both the Chinese and SEER cohorts. The results suggest that >31 ELNs are required for an accurate prognostic evaluation in patients with GC, especially those with node-negative stage III GC.
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Affiliation(s)
- Nannan Zhang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, China
| | - Huihui Bai
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, China
| | - Jingyu Deng
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, China
| | - Wei Wang
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhe Sun
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhenning Wang
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Huimian Xu
- Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiwei Zhou
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, China
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Gu P, Deng J, Wang W, Wang Z, Zhou Z, Xu H, Liang H. Impact of the number of examined lymph nodes on stage migration in node-negative gastric cancer patients: a Chinese multi-institutional analysis with propensity score matching. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:938. [PMID: 32953738 PMCID: PMC7475395 DOI: 10.21037/atm-19-4727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background This propensity score matching (PSM) analysis assessed the influence of examined lymph nodes (ELNs) count on stage migration and survival in node-negative (pN0) gastric cancer (GC) patients. Methods We performed a retrospective analysis of 7,620 GC patients who underwent curative gastric resection in three Chinese medical centers. PSM was used to reduce the confounding effects between the pN0 GC patients with ELNs <16 or ≥16. Survival differences among various subgroups of GC patients were analyzed to assess the impact of the ELNs count on the stage migration in accordance with the overall survival (OS) of pN0 GC patients. Results After matching, the backgrounds of pN0 GC patients in the ELNs <16 (n=825) and ELNs ≥16 (n=826) groups were well-balanced. Survival analyses revealed that the ELNs count was positively correlated with the OS (P=0.001). Multiple Cox analysis indicated that the ELNs count was an independent predictor of the OS in pN0 GC patients. Stage migrations were mainly detected in subgroups of pN0 GC patients with specific pTNM stages, as follows: (I) pT2N0M0 with ELNs <16 vs. pT3N0M0 with ELNs ≥16; (II) pT3N0M0 with ELNs <16 vs. pT3N1M0 with ELNs ≥16; and (III) pT4aN0M0 with ELNs <16 vs. pT4aN1M0 with ELNs ≥16. Conclusions We show that stage migration can be detected in pN0 GC patients, and that it could be gradually reduced or prevented by increasing the ELNs count.
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Affiliation(s)
- Pengfei Gu
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, China
| | - Jingyu Deng
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, China
| | - Wei Wang
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhenning Wang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiwei Zhou
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Huimian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, Tianjin, China
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St-Louis E, Gowing SD, Mossallanejad P, Leimanis ML, Mueller C, Ferri LE. Outcomes after completion total gastrectomy for gastric remnant cancer: experience from a Canadian tertiary centre. Can J Surg 2019. [PMID: 30067186 DOI: 10.1503/cjs.008417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is controversy about the safety and outcomes of completion total gastrectomy (CTG) for gastric adenocarcinoma. We compared a cohort of patients who underwent CTG for gastric remnant cancer (GRC) after partial gastrectomy for benign disease with patients who underwent primary total gastrectomy (PTG) for sporadic gastric cancer. METHODS We retrospectively reviewed a single-institution, prospectively maintained clinical database of patients who had undergone gastrectomy from 2005 to 2016 for demographic, surgical, clinical and tumour pathology data, as well as postoperative, pathologic and oncologic outcomes including complications, length of stay, disease-free survival and overall survival. We used the χ2 and Wilcoxon rank-sum tests to compare groups and performed the Mantel-Cox log-rank test for Kaplan-Meier survival estimates. We compared the CTG group to all patients in the PTG group and to a 5:1 propensity-matched PTG cohort. RESULTS We analyzed data for 64 patients (9 CTG, 55 PTG). The groups were equivalent at baseline and had similar operative, perioperative treatment and pathologic characteristics. After propensity matching, the reoperation rate for complications was higher after CTG than PTG (22% v. 0%, p = 0.03), but there was no significant difference in the overall complication rate or length of stay. At 5 years, there was no difference in disease-free survival (28% v. 58%, p = 0.4) or overall survival (33% v. 44%, p = 0.7). CONCLUSION Our findings suggest that CTG for gastric adenocarcinoma can be undertaken safely a priori with no additional risk of recurrence or death compared to PTG for sporadic gastric cancer.
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Affiliation(s)
- Etienne St-Louis
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Stephen Donald Gowing
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Pedram Mossallanejad
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Mara Laura Leimanis
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Carmen Mueller
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - Lorenzo Edwin Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
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Sano D, Yabuki K, Takahashi H, Arai Y, Chiba Y, Tanabe T, Nishimura G, Oridate N. Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma. Auris Nasus Larynx 2018; 45:846-853. [DOI: 10.1016/j.anl.2017.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/10/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
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Ayhan A, Ozkan NT, Sarı ME, Celik H, Dede M, Akbayır Ö, Güngördük K, Şahin H, Haberal A, Güngör T, Arvas M, Meydanlı MM. Impact of lymph node ratio on survival in stage III ovarian high-grade serous cancer: a Turkish Gynecologic Oncology Group study. J Gynecol Oncol 2018; 29:e12. [PMID: 29185270 PMCID: PMC5709522 DOI: 10.3802/jgo.2018.29.e12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/12/2022] Open
Abstract
Objective The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in patients with stage III ovarian high-grade serous carcinoma (HGSC). Methods A multicenter, retrospective department database review was performed to identify patients with ovarian HGSC at 6 gynecologic oncology centers in Turkey. A total of 229 node-positive women with stage III ovarian HGSC who had undergone maximal or optimal cytoreductive surgery plus systematic lymphadenectomy followed by paclitaxel plus carboplatin combination chemotherapy were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 3 groups: LNR1 (<10%), LNR2 (10%≤LNR<50%), and LNR3 (≥50%). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results Thirty-one women (13.6%) were classified as stage IIIA1, 15 (6.6%) as stage IIIB, and 183 (79.9%) as stage IIIC. The median age at diagnosis was 56 (range, 18–87), and the median duration of follow-up was 36 months (range, 1–120 months). For the entire cohort, the 5-year overall survival (OS) was 52.8%. An increased LNR was associated with a decrease in 5-year OS from 65.1% for LNR1, 42.5% for LNR2, and 25.6% for LNR3, respectively (p<0.001). In multivariate analysis, women with LNR≥0.50 were 2.7 times more likely to die of their tumors (hazard ratio [HR]=2.7; 95% confidence interval [CI]=1.42–5.18; p<0.001). Conclusion LNR seems to be an independent prognostic factor for decreased OS in stage III ovarian HGSC patients.
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Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nazlı Topfedaisi Ozkan
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mustafa Erkan Sarı
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
| | - Husnu Celik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Murat Dede
- Department of Obstetrics and Gynecology, Gulhane Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Özgür Akbayır
- Department of Gynecologic Oncology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey
| | - Kemal Güngördük
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Hanifi Şahin
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ali Haberal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Tayfun Güngör
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Macit Arvas
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Mutlu Meydanlı
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Yamashita H, Deng J, Liang H, Seto Y. Re-evaluating the prognostic validity of the negative to positive lymph node ratio in node-positive gastric cancer patients. Surgery 2017; 161:1588-1596. [DOI: 10.1016/j.surg.2016.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/19/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023]
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9
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Wang S, Zhang B, Li C, Cui C, Yue D, Shi B, Zhang Q, Zhang Z, Zhang X, Wang C. Prognostic value of number of negative lymph node in patients with stage II and IIIa non-small cell lung cancer. Oncotarget 2017; 8:79387-79396. [PMID: 29108317 PMCID: PMC5668050 DOI: 10.18632/oncotarget.18154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background The definitive validation evidence of the implications of lymph node metastases regarding the survival of Non-Small Cell Lung Cancer (NSCLC) patients is lacking. We aimed to evaluate the prognostic impact of several lymph node metastases-associated risk factors including Number of Negative Lymph Node (NLN) and risk-stratify NSCLC patients into subsets with different prognosis. Method A total of 482 patients with N1 and N2 NSCLC were included in this study. The prognostic importance of a set of risk factors was examined by univariate and multivariate analysis. The cut-off points and 5 years survival rates were calculated to test the best grouping system to stratify the patients with difference outcome. Results Our analysis indicated that both Ratio of the Metastatic Lymph nodes (RML) and Number of Negative Lymph Node (NLN) were associated with overall survival (OS) and disease free survival (DFS). RML percentage 20% and 55%, and NLN counts 10 and 30 were proved as the optimal cut-off points to predict OS by classifying patients into 3 groups, respectively. RML and NLN actually are more powerful in predicting survival outcome for male patients compared to female patients. Stratified survival analyses using combined factors indicated that the 5-year survival rate (5-YSR) is high in RML I + NLN I/III subgroup (5-YSR = 57.1% and 43.3%) and low in RML III + NLN II/III subgroup (5-YSR = 0.0 % each). Conclusions NLN is a strong prognostic factor for OS and DFS of stage II/IIIa NSCLC patients, and provides a useful classification scheme for NSCLC patients when combined with RML.
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Affiliation(s)
- Shengguang Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Chenguang Li
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Chao Cui
- Graduate School, Tianjin Medical University, Tianjin, 300070, China.,Department of Thoracic Surgery, Tianjin Haihe Hospital, Tianjin, 300350, China
| | - Dongsheng Yue
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Bowen Shi
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Qiang Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Zhenfa Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Xi Zhang
- Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.,School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.,Tianjin Lung Cancer Center, Tianjin, 300060, China.,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.,National Clinical Research Center for Cancer, Tianjin, 300060, China
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10
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Deng J, Yamashita H, Seto Y, Liang H. Increasing the Number of Examined Lymph Nodes is a Prerequisite for Improvement in the Accurate Evaluation of Overall Survival of Node-Negative Gastric Cancer Patients. Ann Surg Oncol 2016; 24:745-753. [PMID: 27770340 DOI: 10.1245/s10434-016-5513-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study aims to elucidate whether increasing the number of examined lymph nodes (NELN) is mandatory for the accurate prognosis of node-negative gastric cancer (GC) patients after curative gastrectomy in Eastern countries (China and Japan). METHODS The clinicopathological data of 2455 GC patients (including 1137 node-negative cases) were included to demonstrate whether a minimum NELN is inevitable for guaranteeing the accurate prognosis of node-negative GC patients after curative gastrectomy. RESULTS Survival analyses revealed that the NELN significantly positively correlated with overall survival (p < 0.001) and was an independent prognostic predictor (hazard ratio 0.447; p = 0.025) of 1137 node-negative GC patients. Stratum analysis within the Kaplan-Meier method showed that sex, tumor size, and extent of lymphadenectomy did not affect the NELN in predicting the prognosis of all node-negative GC patients. Stage migration was mainly detected in the subgroup of node-negative GC Chinese patients who presented considerably lower mean NELN and more advanced staging than patients from Japan. The NELN was identified as the most intensively independent predictor of prognosis of 600 node-negative GC patients from China, with the smallest Akaike information criterion (176.964) and Bayesian information criterion values (194.552). These findings indicate that increasing the NELN is a prerequisite to guaranteeing precise TNM classification. CONCLUSIONS The NELN should be considered a mandatory requirement for improving the accuracy of prognostic evaluation of GC patients, especially for advanced-stage patients.
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Affiliation(s)
- Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Hiroharu Yamashita
- Department of Stomach and Esophageal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Stomach and Esophageal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China.
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Zhao J, Du F, Zhang Y, Kan J, Dong L, Shen G, Zheng F, Chen H, Zhao J, Ji F, Luo Y, Ma F, Wang Z, Xu B. Impact on long-term survival of the number of lymph nodes resected in patients with pT1N0 gastric cancer after R0 resection: A multicenter study in China. Medicine (Baltimore) 2016; 95:e4420. [PMID: 27495062 PMCID: PMC4979816 DOI: 10.1097/md.0000000000004420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although studies on the association between the number of lymph nodes resected and prognosis in patients with pT2-4N0 stages of gastric cancer have reported consistent results, there is no consensus on the optimal number of lymph nodes to be examined for pT1N0 stage gastric cancer. The aim of this study was to evaluate the long-term effect of the number of lymph nodes removed on the outcomes of patients with pT1N0 stage gastric cancer after R0 resection.From December 2009 to December 2011, 227 patients undergoing R0 resection of pT1N0 stage gastric cancer at 4 Chinese centers were enrolled in this study. Patients were assigned to 2 groups according to the number of lymph nodes dissected (≤15 or > 15). Standard survival methods and restricted multivariable Cox regression models were applied.More women (P = 0.031) were in the ≤15 group than in the >15 group. The mean number of lymph nodes removed from women was greater than that from men (P = 0.007). The 5-year survival rate was significantly higher in the >15 lymph nodes resected group than the ≤15 group. The number of lymph nodes resected was identified as an independent prognostic factor and was significantly correlated with overall survival (OS).A lymphadenectomy with dissection of more than 15 lymph nodes improved the long-term survival of patients with pT1N0 gastric cancer after R0 resection. Therefore, it is necessary to consider removing more than 15 lymph nodes among such patients.
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Affiliation(s)
- Jiuda Zhao
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Feng Du
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | | | - Jie Kan
- People's Hospital of Qinghai Province, Xining, China
| | - Li Dong
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Guoshuang Shen
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Fangchao Zheng
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Hui Chen
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Junhui Zhao
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Faxiang Ji
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Ziyi Wang
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
- Correspondence: Binghe Xu, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China (e-mail: )
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Yamashita K, Hosoda K, Ema A, Watanabe M. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol 2016; 42:1253-60. [PMID: 27017273 DOI: 10.1016/j.ejso.2016.03.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 01/02/2016] [Accepted: 03/01/2016] [Indexed: 12/14/2022] Open
Abstract
TNM staging is no doubt the most critical prognostic factors, representing tumor (T)/lymph node metastasis (N)/distant metastasis (M) in gastric cancer. Lymph node ratio-based N system (Nr) has been repeatedly reported to be of prognostic relevance in advanced gastric cancer independent of stage in the multivariate analysis world-wide, and proposed as more sophisticated than N with regard to predicting accurate prognosis. As a result, proposed TNrM system may predict survival more accurately than the present TNM staging system for patients undergoing limited lymph node analysis. It could adjust stage migration when the lymph node number was used as staging factor. Although correlation of the number of metastatic lymph nodes and lymph node ratio is obvious, biological characteristics other than that could also have been reflected on. It may indicate how successful the operation of lymph node dissection was, or it may be revealing the potential of the patient's lymph node immune-reaction. Recently, high lymph node ratio is closely associated with EGFR expression in advanced gastric cancer. When efficiency of applying lymph node ratio as a biomarker is verified and confirmed in an expansive research, and when cancer causing molecules are identified, as well as the competence as a treatment target is studied, the new biomarker, namely, lymph node ratio, could find itself in a limelight in gastric cancer treatment in the future.
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Affiliation(s)
- K Yamashita
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan.
| | - K Hosoda
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan
| | - A Ema
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan
| | - M Watanabe
- Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kangawa 252-0374, Japan
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Kavaliauskas P, Maziukas R, Samalavicius NE, Kuliavas J, Lunevicius R. Subtotal gastrectomy with conventional D2 lymphadenectomy for carcinoma of the distal gastric portion: A retrospective cohort study on clinical outcomes. Ann Med Surg (Lond) 2016; 6:36-41. [PMID: 27141301 PMCID: PMC4840235 DOI: 10.1016/j.amsu.2016.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/28/2015] [Accepted: 01/16/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The study was aimed to delineate the postoperative morbidity, mortality and long-term follow-up results after R0 subtotal gastrectomy with D2 lymphadenectomy for invasive non-disseminated adenocarcinoma of the distal gastric portion. METHODS Between January 2005 and December 2007, 228 patients with median age at hospitalisation 66.6 ± 11.4 years underwent the above mentioned surgery for histologically proven distal gastric adenocarcinoma. RESULTS Postoperative morbidity was documented in 92 (40.4%) of patients within 30 days. An anastomotic leakage was diagnosed in two (0.9%), peritonitis in two (0.9%), anastomositis in five (2.2%), and prolonged ileus in six (2.6%) patients. Nine patients died (3.9%). The overall 1-year survival rate was 83.8%, and the 5-year survival rate was 54.4%. Gender, age, TNM stage, pN, and N ratio were independent factors predicting a long-term prognosis for patients. CONCLUSIONS A R0 type distal subtotal gastrectomy with standard D2 lymphadenectomy for a histologically proven invasive adenocarcinoma of the distal gastric portion without distant metastasis offers acceptable postoperative morbidity and mortality, and considerably high overall cumulative 5-year survival rate. The probability of cumulative survival decreases five times when the ratio between metastatic and examined lymph nodes is > 0.25.
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Affiliation(s)
- Povilas Kavaliauskas
- School of Medicine, Vilnius University, 21 M.K.Ciurlionio str., LT-03101, Vilnius, Lithuania
| | - Rytis Maziukas
- School of Medicine, Vilnius University, 21 M.K.Ciurlionio str., LT-03101, Vilnius, Lithuania
| | - Narimantas Evaldas Samalavicius
- Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, National Cancer Institute, 1 Santariskiu Str, LT-08660, Vilnius, Lithuania
| | - Justas Kuliavas
- Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, National Cancer Institute, 1 Santariskiu Str, LT-08660, Vilnius, Lithuania
| | - Raimundas Lunevicius
- Emergency General Surgery and Major Trauma Centre, General Surgery Department, University of Liverpool, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
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Deng J, Zhang R, Wu L, Zhang L, Wang X, Liu Y, Hao X, Liang H. Superiority of the Ratio Between Negative and Positive Lymph Nodes for Predicting the Prognosis for Patients With Gastric Cancer. Ann Surg Oncol 2015; 22:1258-1266. [DOI: 10.1245/s10434-014-4121-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Ataseven B, Grimm C, Harter P, Prader S, Traut A, Heitz F, du Bois A. Prognostic value of lymph node ratio in patients with advanced epithelial ovarian cancer. Gynecol Oncol 2014; 135:435-40. [PMID: 25312398 DOI: 10.1016/j.ygyno.2014.10.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/22/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Lymph node status is an established prognostic factor in epithelial ovarian cancer (EOC). Lymph node ratio (number of positive LN/number of resected LN) reflects both qualitative and quantitative lymph node spread as well as surgical effort and extent of disease. We evaluated whether LNR is a more precise prognostic factor than conventional lymph node status in patients with EOC. METHODS The present retrospective study includes 809 patients with EOC, who underwent primary cytoreductive surgery between 2000-2013. Clinico-pathological parameters and survival data were extracted from a prospectively maintained tumor registry database. The optimal cut-off point for LNR was calculated by using Martingale residuals. Survival analyses were calculated using Kaplan-Meier method and Cox regression models. RESULTS Lymphadenectomy was performed in 693 (85.7%) out of 809 patients. Median number of removed LN was 64 (IQR 25-75%: 39-84). LNR of 0.25 was identified as the optimal prognostic cut-off value. The estimated 5-year-OS rates were 69.3% for patients with node-negative EOC compared to 33.1% for patients with any lymph node metastasis (p<0.001). The estimated 5-year-OS rates were 42.5% for patients with LNR≤0.25, and 18.0% for patients with LNR>0.25 (p<0.001). Additionally in multivariate analysis LNR>0.25 was approved to be an independent prognostic factor for overall survival (adjusted HR 1.44, 95% CI 1.04-2.00; p=0.028). CONCLUSION LNR more precisely predicts overall survival than conventional lymph node status in EOC patients undergoing primary debulking surgery.
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Affiliation(s)
- Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
| | - Christoph Grimm
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany
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Li SY, Huang PT, Xu HS, Liang X, Lv JH, Zhang Y, Cai XJ, Cosgrove D. Enhanced intensity on preoperative double contrast-enhanced sonography as a useful indicator of lymph node metastasis in patients with gastric cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1773-1781. [PMID: 25253823 DOI: 10.7863/ultra.33.10.1773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the predictive value of enhanced intensity on double contrast-enhanced sonography in assessing lymph node metastasis of gastric cancer. METHODS A total of 357 patients with gastric cancer were enrolled in this study. Double contrast-enhanced sonography, in which an oral ultrasound contrast agent is combined with an intravenous contrast agent, was performed preoperatively, and the data were analyzed quantitatively. The predictive ability of enhanced intensity, a quantitative double contrast-enhanced sonographic measure, for lymph node metastasis was evaluated retrospectively. RESULTS Compared to negative lymph node metastasis cases, the presence of thicker lesions, deeper invasion, poorer differentiation, and higher enhanced intensity were found in positive cases (P< .05). An enhanced intensity cutoff value of 16.91 dB was the best point for balancing the sensitivity and specificity (71.50% and 79.30%, respectively) for prediction of lymph node metastasis, with the highest Youden index of 0.508. The area under the receiver operating characteristic curve was 0.828 (P < .001; 95% confidence interval, 0.786-0.870). In cases in which the lesions were hyperenhanced (enhanced intensity >16.91 dB), the lesions were significantly thicker and had deeper invasion, poorer differentiation, and more positive metastasis findings compared to non-hyperenhanced cases (enhanced intensity ≤16.91 dB; P < .05). On logistic regression analysis, the enhanced intensity of primary tumors and the invasion depth were significantly associated with lymph node metastasis. CONCLUSIONS Double contrast-enhanced sonography with quantitative analysis may be considered a novel alternative imaging modality for noninvasive preoperative evaluation of lymph node metastasis with good reliability.
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Affiliation(s)
- Shi-Yan Li
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.)
| | - Pin-Tong Huang
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.)
| | - Hai-Shan Xu
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.)
| | - Xiao Liang
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.)
| | - Jiang-Hong Lv
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.)
| | - Ying Zhang
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.)
| | - Xiu-Jun Cai
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.).
| | - David Cosgrove
- Department of Diagnostic Ultrasound and Echocardiography (S.L., H.X., J.L.) and Second Department of General Surgery (X.L., X.C.), Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China; Department of Ultrasonography, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China (P.H., Y.Z.); and Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, England (D.C.)
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Jiao XG, Deng JY, Zhang RP, Wu LL, Wang L, Liu HG, Hao XS, Liang H. Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol 2014; 20:3640-3648. [PMID: 24707149 PMCID: PMC3974533 DOI: 10.3748/wjg.v20.i13.3640] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/09/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the potential impact of examined lymph nodes (eLNs) on long-term survival of node-negative gastric cancer patients after curative surgery.
METHODS: A total of 497 node-negative gastric cancer patients who underwent curative gastrectomy between January 2000 and December 2008 in our center were enrolled in this study. Patients were divided into 4 groups according to eLNs through cut-point analysis. Clinicopathological features were compared between ≤ 15 eLNs group and > 15 eLNs group and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified using the Cox proportional hazards regression model. Stratified analysis was performed to investigate the impact of eLNs on patient survival in each stage. Overall survival was also compared among the four groups. Finally, we explored the recurrent sites associated with eLNs.
RESULTS: Patients with eLNs > 15 had a better survival compared with those with eLNs ≤ 15 for the entire cohort. By the multivariate survival analysis, we found that the depth of invasion and the number of eLNs were the independent predictors of overall survival (OS) of patients with node-negative gastric cancer. According to the cut-point analysis, T2-T4 patients with 11-15 eLNs had a significantly longer mean OS than those with 4-10 eLNs or 1-3 eLNs. Patients with ≤ 15 eLNs were more likely to experience locoregional and peritoneal recurrence than those with > 15eLNs.
CONCLUSION: Number of eLNs could predict the prognosis of node-negative gastric cancer, and dissection of > 15 eLNs is recommended during lymphadenectomy so as to improve the long-term survival.
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Peparini N. Digestive cancer surgery in the era of sentinel node and epithelial-mesenchymal transition. World J Gastroenterol 2013; 19:8996-9002. [PMID: 24379624 PMCID: PMC3870552 DOI: 10.3748/wjg.v19.i47.8996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/17/2013] [Accepted: 11/12/2013] [Indexed: 02/06/2023] Open
Abstract
Lymph node involvement is one of the most important prognostic indicators of carcinoma of the digestive tract. Although the therapeutic impact of lymphadenectomy has not been proven and the number of retrieved nodes cannot be considered a measure of successful cancer surgery, an adequate lymph node count should be guaranteed to accurately assess the N-stage through the number of involved nodes, lymph node ratio, number of negative nodes, ratio of negative to positive nodes, and log odds, i.e., the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes in digestive carcinomas. As lymphadenectomy is not without complications, sentinel node mapping has been used as the rational procedure to select patients with early digestive carcinoma in whom nodal dissection may be omitted or a more limited nodal dissection may be preferred. However, due to anatomical and technical issues, sentinel node mapping and nodal basin dissection are not yet the standard of care in early digestive cancer. Moreover, in light of the biological, prognostic and therapeutic impact of tumor budding and tumor deposits, two epithelial-mesenchymal transition-related phenomena that are involved in tumor progression, the role of staging and surgical procedures in digestive carcinomas could be redefined.
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Peng CW, Wang LW, Zeng WJ, Yang XJ, Li Y. Evaluation of the staging systems for gastric cancer. J Surg Oncol 2013; 108:93-105. [PMID: 23813573 DOI: 10.1002/jso.23360] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/13/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Some staging systems for gastric cancer (GC) have been developed as alternatives to the 6th and 7th TNM staging systems, including the Hybrid, tumor-ratio-metastasis (TRM), and Kiel staging systems. This study evaluated the overall performance of these systems for GC. METHODS A total of 540 GC patients undergoing surgical resection were staged using these five systems. Homogeneity, discrimination power, predictive accuracy, and complexity of these systems were compared. RESULTS Multivariate analyses showed that all of 7th pT, pN, and pM classifications were independent factors for GC prognosis (P < 0.001 for all). Compared with the other four systems, 7th TNM system had improved stage groups homogeneity (7 of 8 stage groups homogeneous), enhanced discrimination power (4 of 5, 5 of 7, 4 of 7, 3 of 7, and 1 of 4 adjacent stage groups were differentiated by the 6th, 7th TNM, Hybrid, TRM, and Kiel systems, respectively), and better prediction value for GC patients' outcome (AUC = 0.801, P < 0.001). In addition, the 7th TNM system did not increase the staging complexity (9 groups and 21 subgroups). CONCLUSIONS The 7th TNM staging system represents advancement in GC staging system for better prediction of clinical outcomes.
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Affiliation(s)
- Chun-Wei Peng
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan, PR China
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Liu H, Deng J, Zhang R, Hao X, Jiao X, Liang H. The RML of lymph node metastasis was superior to the LODDS for evaluating the prognosis of gastric cancer. Int J Surg 2013; 11:419-24. [DOI: 10.1016/j.ijsu.2013.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/11/2013] [Accepted: 03/18/2013] [Indexed: 12/19/2022]
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Wang YL, Feng SH, Zhu J, Zhu GP, Li DS, Wang Y, Zhu YX, Sun GH, Ji QH. Impact of lymph node ratio on the survival of patients with hypopharyngeal squamous cell carcinoma: a population-based analysis. PLoS One 2013; 8:e56613. [PMID: 23431384 PMCID: PMC3576374 DOI: 10.1371/journal.pone.0056613] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/11/2013] [Indexed: 01/16/2023] Open
Abstract
Objective To analyze the impact of the lymph node ratio (LNR, ratio of metastatic to examined nodes) on the prognosis of hypopharyngeal cancer patients. Methods SEER (Surveillance, Epidemiology and End Results)-registered hypopharyngeal cancer patients with lymph node metastasis were evaluated using multivariate Cox regression analysis to identify the prognostic role of the LNR. The categorical LNR was compared with the continuous LNR and pN classifications to predict cause-specific survival (CSS) and overall survival (OS) rates of hypopharyngeal cancer patients. Results Multivariate analysis of 916 pN+ hypopharyngeal cancer cases identified race, primary site, radiation sequence, T classification, N classification, M classification, the number of regional lymph nodes examined, the continuous LNR (Hazard ratio 2.415, 95% CI 1.707–3.416, P<0.001) and age as prognostic variables that were associated with CSS in hypopharyngeal cancer. The categorical LNR showed a higher C-index and lower Akaike information criterion (AIC) value than the continuous LNR. When patients (n = 1152) were classified into four risk groups according to LNR, R0 (LNR = 0), R1 (LNR ≤0.05), R2 (LNR 0.05–0.30) and R3 (LNR >0.30), the Cox regression model for CSS and OS using the R classification had a higher C-index value and lower AIC value than the model using the pN classification. Significant improvements in both CSS and OS were found for R2 and R3 patients with postoperative radiotherapy. Conclusions LNR is a significant prognostic factor for the survival of hypopharyngeal cancer patients. Using the cutoff points 0.05/0.30, the R classification was more accurate than the pN classification in predicting survival and can be used to select high risk patients for postoperative treatment.
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Affiliation(s)
- Yu-Long Wang
- Department of Head & Neck Surgery, Cancer Hospital, Fudan University, Shanghai, People's Republic of China
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