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Lieto E, Auricchio A, Ronchi A, Del Sorbo G, Panarese I, Ferraraccio F, De Vita F, Galizia G, Cardella F. Presence of tumor deposits is a strong indicator of poor outcome in patients with stage III colorectal cancers undergoing radical surgery. J Gastrointest Surg 2024; 28:47-56. [PMID: 38353074 DOI: 10.1016/j.gassur.2023.11.003] [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: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Tumor deposits (TDs) are emerging as an adverse prognostic factor in colorectal cancers (CRCs). However, TDs are somewhat neglected in the current staging system. It has been proposed either to add the TD count to the number of metastatic lymph nodes or to consider TDs as distant metastases; however, the scientific basis for these proposals seems questionable. This study aimed to investigate a new staging system. METHODS A total of 243 consecutive patients with stage III CRC who were undergoing curative resection and adjuvant chemotherapy were included. Each substage of stage III TNM was split according to the absence or presence of TDs. Receiver operating characteristic (ROC) curves and bootstrap methods were used to compare the current vs the new competing staging system in terms of oncologic outcome prediction. RESULTS A high rate of TDs was recorded (124 cases [51%]). TDs were correlated with other adverse prognostic indicators, particularly vascular and perineural invasions, and showed a negative correlation with the number of removed lymph nodes, suggesting a possible multimodal origin. In addition, TDs were confirmed to have a negative impact on oncologic outcome, regardless of their counts. Compared with the current staging system, the new classification displayed higher values at survival ROC analysis, a significantly better stratification of patients, and effective identification of patients at high risk of recurrence. CONCLUSIONS TDs negatively affect the prognosis in CRCs. A revision of the staging system could be useful to optimize treatments. The proposed new classification is easy to implement and more accurate than the current one. This study was registered online on the ClinicalTrials.gov website under the following identifier: NCT05923450.
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Affiliation(s)
- Eva Lieto
- Division of Gastrointestinal Surgical Oncology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annamaria Auricchio
- Division of Gastrointestinal Surgical Oncology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Ronchi
- Division of Pathology, Department of Mental and Physical Health and Rehabilitation Medicine, School of Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giovanni Del Sorbo
- Division of Gastrointestinal Surgical Oncology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Iacopo Panarese
- Division of Pathology, Department of Mental and Physical Health and Rehabilitation Medicine, School of Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Francesca Ferraraccio
- Division of Pathology, Department of Mental and Physical Health and Rehabilitation Medicine, School of Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Gennaro Galizia
- Division of Gastrointestinal Surgical Oncology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Francesca Cardella
- Division of Gastrointestinal Surgical Oncology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Li GC, Zhang HW, Tian HG, Zhao Y, Huang QX, Xu ZY, Xi XH, Zhang K. Clinicopathological difference between gastric cancer in the lesser curvature and gastric cancer in the greater curvature. Medicine (Baltimore) 2022; 101:e29984. [PMID: 35984169 PMCID: PMC9387946 DOI: 10.1097/md.0000000000029984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gastric cancer (GC) is a heterogeneous disease; the tumor distribution and molecular subtype could affect the prognosis of patients with GC. However, the clinicopathological difference between GC in the lesser and that in the greater curvature remains unknown. In this study, we aimed to investigate the difference and provide new clues for the treatment of GC. Between January 2010 and August 2014, 1249 consecutive patients with GC in the lesser or greater curvature were treated in our surgery department; data related to the demographic characteristics, pathological type, tumor grade, tumor size, TNM stage, tumor markers, operative methods, complications, and follow-up were retrospectively analyzed using a univariate analysis and the Kaplan-Meier method. The tumor size in lesser curvature was larger than that in the greater curvature (4.95 ± 2.57 vs 4.43 ± 2.62 cm, P = .034); patients with GC in the lesser curvature had a higher incidence of total gastrectomy and a lower incidence of distal gastrectomy than those with GC in the greater curvature (60.2% vs 43.2%, and 34.8% vs 49.2%, P = .002). No significant differences were found in the 5-year survival rate between patients with GC in the greater curvature and those with GC in the lesser curvature (62.6% vs 66.1%, P = .496). The epidermal growth factor receptor (EGFR) expression rate of tumors in the lesser curvature was 40.55%, which was significantly higher than that of tumors in the greater curvature (25.92%, P = .024), while the 5-year survival rate of patients with EGFR-positive expression was 50.8%, which was significantly lower than that of patients with EGFR-negative expression (64.8%, P = .021). Significant differences were observed in the clinicopathological features between GC in the lesser curvature and that in the greater curvature. These differences contribute to the improvement in the treatment outcome.
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Affiliation(s)
- Guo-Cai Li
- Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, Xi’an, Shaanxi Province, China
- *Correspondence: Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, to the East of Xi Tai Road and to the North of Wei 32 Road, Gao Xin District, Xi’an, Shaanxi Province 710100, China (e-mail: )
| | - Hong-Wei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi Province, China
| | - Hong-Gang Tian
- Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, Xi’an, Shaanxi Province, China
| | - Yun Zhao
- Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, Xi’an, Shaanxi Province, China
| | - Qin-Xian Huang
- Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, Xi’an, Shaanxi Province, China
| | - Ze-Yu Xu
- Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, Xi’an, Shaanxi Province, China
| | - Xiao-Hui Xi
- Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, Xi’an, Shaanxi Province, China
| | - Kai Zhang
- Division of Digestive Surgery, Hospital of Digestive Diseases, Xi’an International Medical Centre, Xi’an, Shaanxi Province, China
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Jeong O, Jung MR, Kang JH. Prognostic Value of the Anatomic Region of Metastatic Lymph Nodes in the Current TNM Staging of Gastric Cancer. J Gastric Cancer 2021; 21:236-245. [PMID: 34691808 PMCID: PMC8505123 DOI: 10.5230/jgc.2021.21.e22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose The numeric N stage has replaced the topographic N stage in the current tumor node metastasis (TNM) staging in gastric carcinoma. However, the usefulness of the topographic N stage in the current TNM staging system is uncertain. We aimed to investigate the prognostic value of the topographic N stage in the current TNM staging system. Materials and Methods We reviewed the data of 3350 patients with gastric cancer who underwent curative gastrectomy. The anatomic regions of the metastatic lymph nodes (MLNs) were classified into 2 groups: perigastric and extra-perigastric. The prognostic value of the anatomic region was analyzed using a multivariate prognostic model with adjustments for the TNM stage. Results In patients with lymph node metastasis, extra-perigastric metastasis demonstrated significantly worse survival than perigastric metastasis alone (5-year survival rate, 39.6% vs. 73.1%, respectively, P<0.001). Extra-perigastric metastasis demonstrated significantly worse survival within the same pN stage; the multivariate analysis indicated that extra-perigastric metastasis was an independent poor prognostic factor (hazard ratio=1.33; 95% confidence interval=1.01–1.75). The anatomic region of the MLNs improved the goodness-of-fit (likelihood ratio statistics, 4.57; P=0.033) of the prognostic model using the TNM stage. Conclusions The anatomic region of MLNs has an independent prognostic value in the numeric N stage in the current TNM staging of gastric carcinoma.
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Affiliation(s)
- Oh Jeong
- Department of Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Hoon Kang
- Department of Surgery, Chonnam National University Medical School, Hwasun, Korea
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Chen MW, Yen HH. Comparison of the sixth, seventh, and eighth editions of the American Joint Committee on Cancer Tumor-Node-Metastasis staging system for gastric cancer: A single institution experience. Medicine (Baltimore) 2021; 100:e27358. [PMID: 34596145 PMCID: PMC8483861 DOI: 10.1097/md.0000000000027358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
In 2018, the eighth edition of the American Joint Committee on Cancer Tumor-Node-Metastasis classification and staging system was implemented. Few reports were made comparing the performance of different editions of the American Joint Committee on Cancer (AJCC) system. Therefore, this study aimed to examine the prognostic predictability from the sixth to the eighth editions of the AJCC staging system for gastric cancer.A total of 414 patients with gastric cancer who underwent surgery at Changhua Christian Hospital from January 2007 to December 2017 were enrolled in the study. To identify the prognostic factors for gastric cancer death, univariate and multivariate analyses were performed. The homogeneity and discrimination abilities of the sixth to eighth editions of the staging system were compared using the likelihood ratio chi-square test, linear trend chi-square test, and Akaike information criterion.The sixth edition of the staging system had the lowest Akaike information criterion value, suggesting a better prognostic stratification than other editions. From the result of the likelihood ratio chi-square test, the T and N staging systems of the seventh and eighth editions had better homogeneity and discriminatory ability than the sixth edition. The eighth edition had better prognostic performance in patients at stage III compared with the seventh edition.The AJCC seventh and eighth editions had improved prognostic predictability of the T and N factors compared with the sixth edition. However, the overall staging performance of the eighth edition is not superior compared to the sixth edition. Further studies with larger sample size should be conducted to compare the performance of different editions of the AJCC staging system for different ethnic populations.
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Affiliation(s)
- Mei-Wen Chen
- Department of Information Management,Chien-Kuo Technology University, Chunghua, Taiwan
- Department of Tumor Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsu-Heng Yen
- Artificial Intelligence Development Center, Changhua Christian Hospital, Changhua, Taiwan
- Division of Gastroenterology, Changhua Christian Hospital,Changhua, Taiwan
- General Education Center, Chienkuo Technology University, Changhua, Taiwan
- Department of Electrical Engineering, Chung Yuan University, Taoyuan, Taiwan
- College of Medicine, National Chung Hsing University,Taichung, Taiwan
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Díaz Del Arco C, Estrada Muñoz L, Sánchez Pernaute A, Ortega Medina L, García Gómez de Las Heras S, García Martínez R, Fernández Aceñero MJ. Towards standardization of lymph-node ratio classifications: Validation and comparison of different lymph node ratio classifications for predicting prognosis of patients with resected gastric cancer. Ann Diagn Pathol 2021; 52:151738. [PMID: 33865185 DOI: 10.1016/j.anndiagpath.2021.151738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The TNM staging system is the main prognostic tool for GC, but the number of metastatic lymph nodes (LN) can be affected by surgical, pathological, tumor or host factors. Several authors have shown that lymph node ratio (LNR) may be superior to TNM staging in GC. However, cut-off values vary between studies and LNR assessment is not standardized. MATERIAL AND METHODS Retrospective study of all GC resected in a western tertiary center (N = 377). Clinical features were collected and pathological features were assessed by two independent pathologists. Eight LNR classifications were selected and applied to our patients. Statistical analyses were performed. RESULTS 315 patients were included. Most tumors were T3 (49.2%) N+ (59.3%). During follow-up, 36.7% of patients progressed and 27.4% died due to tumor. All LNR classifications were significantly associated with clinicopathological features such as Laurén subtype, lymphovascular invasion, perineural infiltration, T stage, tumor progression or death. All LNR classifications were independent prognostic factors for OS and DFS, and ROC analyses calculated similar AUC values for all staging systems. Kaplan-Meier curves showed that Pedrazzani, Wang, Liu and Huang classifications stratified patients better into three (Pedrazzani) or four categories. These classifications tended to downstage TNM N2 and N3 tumors. In cases with less than 16 LNs resected, Pedrazzani and Wang classifications showed the best prognostic performance. CONCLUSIONS Pedrazzani, Wang, Liu and Huang classifications showed good prognostic performance in western GC patients. Larger studies in other cohorts are needed to identify the most consistent LNR classification for GC.
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Affiliation(s)
- Cristina Díaz Del Arco
- Complutense University of Madrid, Av. Séneca 2, 28040 Madrid, Spain; Hospital Clínico San Carlos, c/Profesor Martín Lagos s/n, 28040 Madrid, Spain.
| | - Lourdes Estrada Muñoz
- Rey Juan Carlos University of Madrid, Av. De Atenas s/n, 28922 Alcorcón, Madrid, Spain; Rey Juan Carlos Hospital, c/ Gladiolo s/n, 28933 Móstoles, Madrid, Spain
| | | | - Luis Ortega Medina
- Complutense University of Madrid, Av. Séneca 2, 28040 Madrid, Spain; Hospital Clínico San Carlos, c/Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | | | | | - Mª Jesús Fernández Aceñero
- Complutense University of Madrid, Av. Séneca 2, 28040 Madrid, Spain; Hospital General Universitario Gregorio Marañón, c/ Dr. Esquerdo n° 46, 28007 Madrid, Spain
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Which Lymph Node Staging System Better Predicts Prognosis in Patients With Gastric Carcinoma? A Comparative Study Between 3 Different Lymph Node Classifications for Resected Gastric Cancer in a Western Tertiary Center. Am J Clin Oncol 2021; 44:1-9. [PMID: 33086233 DOI: 10.1097/coc.0000000000000770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastric cancer (GC) is an aggressive disease with high mortality rates. Lymph node (LN) staging of GC is a major source of controversy. The aim of this study is to compare the prognostic value of 3 different LN classifications for patients with resected GC: the eighth TNM staging system, lymph node ratio (LNR, ratio between positive and total LN) and a new anatomic-based classification (Choi classification). MATERIALS AND METHODS A retrospective study of all cases of GC resected in a tertiary hospital in Spain (n=377). Clinical data were collected; histologic slides were reviewed; and univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed. RESULTS In all, 315 patients fulfilled inclusion criteria. Univariate analysis showed that all classifications were significantly associated with tumor death and progression (P<0.001). All staging systems were independent prognostic factors for DFS. Area under the curve ratios for Choi, N stage, and LNR classifications were 0.738, 0.730, and 0.735, respectively. TNM and LNR classifications were independent prognosticators for OS, while Choi classification was an independent factor only in patients with ≥16 LN resected. Area under the curve ratios for Choi, N stage, and LNR classifications were 0.707, 0.728, and 0.732, respectively. Kaplan-Meier curves depending on LNR classification showed the best patient stratification for both OS and DFS. CONCLUSIONS The 3-staging systems had similar prognostic performance, but LNR-based classification stratified patients better. Further studies are needed to evaluate the impact of the number of LN examined, cutoff values, and anatomic extent of LN disease in GC.
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Díaz Del Arco C, Estrada Muñoz L, Sánchez Pernaute A, Ortega Medina L, García Gómez de Las Heras S, García Martínez R, Fernández Aceñero MJ. Development of a simplified tumor-lymph node ratio classification system for patients with resected gastric cancer: A western study. Ann Diagn Pathol 2020; 50:151677. [PMID: 33310591 DOI: 10.1016/j.anndiagpath.2020.151677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/01/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Gastric cancer (GC) shows high recurrence and mortality rates. The AJCC TNM staging system is the best prognostic predictor, but lymph node assessment is a major source of controversy. Recent studies have found that lymph node ratio (LNR) may overcome TNM limitations. Our aim is to develop a simplified tumor-LNR (T-LNR) classification for predicting prognosis of resected GC. METHODS Retrospective study of all GC resected in a tertiary center in Spain (N = 377). Clinicopathological features were assessed, LNR was classified into N0:0%, N1:1-25%, N2:>25%, and a T-LNR classification was developed. Statistical analyses were performed. RESULTS 317 patients were finally included. Most patients were male (54.6%) and mean age was 72 years. Tumors were intestinal (61%), diffuse (30.8%) or mixed (8.1%). During follow-up, 36.7% and 27.4% of patients progressed and died, respectively. T-LNR classification divided patients into five prognostic categories (S1-S5). Most cases were S1-S4 (26.2%, 19.9%, 22.6% and 23.6%, respectively). 7.6% of tumors were S5. T-LNR classification was significantly associated with tumor size, depth, macroscopical type, Laurén subtype, signet ring cells, histologic grade, lymphovascular invasion, perineural infiltration, infiltrative growth, patient progression and death. Kaplan-Meier curves for OS showed an excellent patient stratification with evenly spaced curves. As for DFS, T-LNR classification also showed good discriminatory ability with non-overlapping curves. T-LNR classification was independently related to both OS and DFS. CONCLUSIONS T-LNR classifications can successfully predict prognosis of GC patients. Larger studies in other geographic regions should be performed to refine this classification and to validate its prognostic relevance.
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Affiliation(s)
- Cristina Díaz Del Arco
- Complutense University of Madrid, Av. Séneca 2, 28040 Madrid, Spain; Hospital Clínico San Carlos, c/Profesor Martín Lagos s/n, 28040 Madrid, Spain.
| | - Lourdes Estrada Muñoz
- Rey Juan Carlos University of Madrid, Av. De Atenas s/n, 28922 Alcorcón, Madrid, Spain; Rey Juan Carlos Hospital, c/Gladiolo s/n, 28933 Móstoles, Mardrid, Spain
| | | | - Luis Ortega Medina
- Complutense University of Madrid, Av. Séneca 2, 28040 Madrid, Spain; Hospital Clínico San Carlos, c/Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | | | | | - Mª Jesús Fernández Aceñero
- Complutense University of Madrid, Av. Séneca 2, 28040 Madrid, Spain; Hospital General Universitario Gregorio Marañón, c/Dr. Esquerdo n° 46, 28007 Madrid, Spain
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Prognostic impact of anatomical extent of metastatic lymph node on gastric cancer: a propensity score matching study. Clin Transl Oncol 2020; 23:773-782. [PMID: 32772226 DOI: 10.1007/s12094-020-02468-7] [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: 05/30/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Current gastric cancer staging systems overlook the anatomic extent of metastatic lymph nodes (AEMLNs). This study aimed to analyze the prognostic impact of AEMLNs on gastric cancer (GC). METHODS GC patients with metastatic lymph nodes (MLNs) undergoing curative surgery were retrospectively reviewed and assigned to perigastric (MLNs in station 1-6, PG) and extraperigastric group (7-12, with or without MLNs in PG area, EPG). Overall survival (OS), disease-free survival (DFS) and recurrence patterns were compared before and after 1:1 propensity score matching (PSM). RESULTS 662 patients were enrolled, 341 (51.5%) and 321 (48.5%) of whom were in the PG and EPG, respectively. After PSM (n = 195), EPG showed poorer 5-year OS (43.4% vs 54.5%, p = 0.014) and DFS (65.0% vs 73.4%, p = 0.068) than PG. EPG had higher incidence of peritoneal recurrence (PR) than PG (19.4% vs 7.4%, p = 0.002). Multivariate analysis identified AEMLNs as prognostic factor for OS [HR = 1.409, 95% confidence interval (CI) 1.062-1.868), DFS (HR = 1.600, 95% CI 1.059-2.416) and PR (HR = 3.708, 95% CI 1.685-8.160). CONCLUSIONS The anatomic extent of metastatic lymph nodes has an independent prognostic role for GC. Including this element may improve the accuracy of current staging systems.
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Lauricella S, Caricato M, Mascianà G, Carannante F, Carnazza M, Bonaccorso A, Angeletti S, Ciccozzi M, Coppola R, Capolupo GT. Topographic lymph node staging system shows prognostic superiority compared to the 8th edition of AJCC TNM in gastric cancer. A western monocentric experience. Surg Oncol 2020; 34:223-233. [PMID: 32869748 DOI: 10.1016/j.suronc.2020.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/23/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The current Tumor Node Metastasis staging system (TNM) for gastric cancer classifies the extent of lymph node metastasis based upon the number of lymph nodes involved. Choi et al. have recently proposed a new anatomical classification based upon the regionality of the involved nodes. This new classification seems to have a better predictive prognostic value than the traditional one. We investigated the prognostic role of the new anatomical based classification, reviewing our institutional gastric cancer database. METHODS We performed a retrospective chart review of 329 patients who underwent gastrectomy at our Institution from 2003 to 2017. We excluded from data analysis any patient with distant metastases at the time of first diagnosis and or surgery, pathology other than adenocarcinoma, lymphadenectomy less than D2, impossibility to identify location of lymph nodes (LNs) on pathological report and neoadjuvant chemotherapy. The extent of D2 lymphadenectomy was defined according to Japanese Gastric Cancer Association criteria. LN metastasis were reclassified into three topographic groups (lesser, greater curvature, and extraperigastric nodes) and staged according to Choi. The new N stage was combined with the current pT according to the 8th edition of TNM and a new hybrid TNM stage was established. All patients were followed up until June 2019. The prognostic performance of the new stage and of the current anatomical numeric based system (TNM) was analyzed and assessed by the C-index, AIC and likelihood ratio χ2 value. RESULTS In predicting both Overall Survival (OS) and Disease free Survival (DFS) the new N stage and the new TNM staging system had the highest C-index and likelihood ratio χ2 value and the lowest Akaike Information Criterion (AIC), showing a better accuracy and displaying a better prognostic performance. CONCLUSIONS Our study is the first from the Western world to compare the new hybrid classification, based on the anatomical location of metastatic nodes, to the 8th of American Joint Committee on Cancer (AJCC) TNM staging system. Our findings on a small, monocentric sample suggest that hybrid topographic lymph node staging system is more accurate than TNM.
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Affiliation(s)
- S Lauricella
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy.
| | - M Caricato
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - G Mascianà
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - F Carannante
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - M Carnazza
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - A Bonaccorso
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA
| | - S Angeletti
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico of Rome University, Italy
| | - M Ciccozzi
- Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico of Rome University, Italy
| | - R Coppola
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
| | - G T Capolupo
- Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy
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Young JJ, Pahwa A, Patel M, Jude CM, Nguyen M, Deshmukh M, Huang L, Mohammad SF. Ligaments and Lymphatic Pathways in Gastric Adenocarcinoma. Radiographics 2019; 39:668-689. [DOI: 10.1148/rg.2019180113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jennifer J. Young
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Anokh Pahwa
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Maitraya Patel
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Cecilia M. Jude
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Michael Nguyen
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Monica Deshmukh
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Lizhou Huang
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Shaden F. Mohammad
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
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11
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Chen MW, Chan CP, Lin YJ, Yen HH. Anatomical location-based nodal staging system is superior to the 7th edition of the American Joint Committee on Cancer staging system among patients with surgically resected, histologically low-grade gastric cancer: A single institutional experience. PLoS One 2019; 14:e0211836. [PMID: 30721261 PMCID: PMC6363228 DOI: 10.1371/journal.pone.0211836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Background A hybrid topographic and numeric lymph node (LN) staging system for gastric cancer, which was recently proposed by Japanese experts as a simple method with a prognostic predictive power comparable to the N staging of the American Joint Committee on Cancer (AJCC) Tumor-node-metastasis classification, has not yet been validated in other Asian countries. This study aimed to examine the prognostic predictability of the hybrid staging system with the current AJCC staging system in gastric cancer. Methods Overall, 400 patients with gastric cancer who underwent surgery at Changhua Christian Hospital from January 2007 to December 2017 were included in the study. Univariate and multivariate analyses were performed to identify prognostic factors for gastric cancer-related death. Homogeneity and discrimination abilities of the two staging systems were compared using likelihood ratio chi-square test, linear trend chi-square test, Harrell’s c-index, and bootstrap analysis. Results One-third of the LN-positive patients were reclassified into the new N and Stage system. The concordance rates of the two staging systems and the N staging between the two staging systems were 0.810 and 0.729, respectively. Harrell’s c-indices for the stage and N staging were higher in the 7th AJCC staging system than the hybrid staging system (c-index for stage, 0.771 vs 0.764; c-index for nodal stage, 0.713 vs 0.705). Stratification of the patients according to the histological grade revealed that Harrell’s c-indices for the stage and N stage of the hybrid staging system were comparable with those of the 7th AJCC staging system (c-index for AJCC stage vs hybrid stage, 0.800 vs 0.791; c-index for AJCC N stage vs hybrid N stage, 0.746 vs 0.734) among patients with histologically lower grade gastric cancer. The performance of the new nodal staging system was better than that of the 7th AJCC staging system by likelihood ratio and linear trend tests and bootstrap analysis in the low-grade group. Conclusions The hybrid anatomical location-based classification may have better prognostic predictive ability than the 7th AJCC staging system for LN metastasis of low-grade gastric cancer. Further studies involving different ethnic populations are necessary for the validation of the new staging system.
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Affiliation(s)
- Mei-Wen Chen
- Department of Tumor Center, ChangHua Christian Hospital, ChangHua, Taiwan
- Department of Information Management,Chien-Kuo Technology University, ChungHua, Taiwan
| | - Chien-Pin Chan
- Department of General Surgery, ChangHua Christian Hospital, ChangHua, Taiwan
| | - Yih-Jeng Lin
- Department of Information Management,Chien-Kuo Technology University, ChungHua, Taiwan
| | - Hsu-Heng Yen
- Department of Gastroenterology, ChangHua Christian Hospital, ChangHua, Taiwan
- General Education Center, Chien-Kuo Technology University, ChungHua, Taiwan
- * E-mail:
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12
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Giryes A, Oweira H, Mannhart M, Decker M, Abdel-Rahman O. Exploring the differences between early-onset gastric cancer and traditional-onset gastric cancer. J Gastrointest Oncol 2018; 9:1157-1163. [PMID: 30603136 DOI: 10.21037/jgo.2018.06.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The current study sought to explore the potential clinical, epidemiological and genetic differences between early-onset gastric cancer (E-gastric cancer: defined as 20-39 years) and traditional-onset gastric cancer (T-gastric cancer: defined as ≥40 years). Methods Datasets from the following sources were searched: Surveillance, Epidemiology and End Results database [2000-2014], Behavioral Risk Factor Surveillance Survey and the cancer genome atlas (TCGA). Clinicopathological characteristics, trends, and genetic findings were compared between E-gastric cancer and T-gastric cancer. Moreover, correlations with relevant risk factors were sought after. Results A total of 95,323 gastric cancer patients were identified in the period from 2000 to 2014. While T-gastric cancer was decreasing during the study period (-1.4; P<0.05), E-gastric cancer was stable during the study period. E-gastric cancer is less prevalent in males (51.1% vs. 61.0%; P<0.0001), and white patients (68.9% vs. 71.4%; P<0.0001). E-gastric cancer patients usually present with poorly differentiated histology (55.3% vs. 48.0%; P<0.0001) as well as more aggressive histological subtypes (e.g., diffuse histology or linitis plastica). No difference can be detected with regards to risk factor correlations between E-gastric cancer and T-gastric cancer. Only four patients with E-gastric cancer were available in the provisional TCGA dataset at the time of the study. Conclusions E-gastric cancer is a potentially distinct disease entity with specific clinicopathological and trend patterns compared to conventional T-gastric cancer. Further studies are needed to explore the potential etiologic basis as well as to investigate the clinical consequences of this distinction. The impact of this distinction on minority populations requires further assessment as well.
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Affiliation(s)
| | - Hani Oweira
- Gastrointestinal Tumor Zentrum, Zürich, Switzerland
| | | | - Michael Decker
- Oncology Department, Zentrum für Integrative Onkologie, Zürich, Switzerland
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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13
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Jiang Z, Wang X, Li J, Yang H, Lin X. Aldolase A as a prognostic factor and mediator of progression via inducing epithelial-mesenchymal transition in gastric cancer. J Cell Mol Med 2018; 22:4377-4386. [PMID: 29992789 PMCID: PMC6111871 DOI: 10.1111/jcmm.13732] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/24/2018] [Indexed: 02/03/2023] Open
Abstract
Glycolysis is regarded as the hallmark of cancer development and progression, which involves a multistep enzymatic reaction. This study aimed to explore the clinicopathological significance and potential role of glycolytic enzyme aldolase A (ALDOA) in the carcinogenesis and progression of gastric cancer (GC). ALDOA was screened from three paired liver metastasis tissues and primary GC tissues and further explored with clinical samples and in vitro studies. The ALDOA protein level significantly correlated with a larger tumor diameter (P = .004), advanced T stage (P < .001), N stage (P < .001) and lymphovascular invasion (P = .001). Moreover, the expression of ALDOA was an independent prognostic factor for the 5‐year overall survival and disease‐free survival of patients with GC in both univariate and multivariate survival analyses (P < .05). Silencing the expression of ALDOA in GC cell lines significantly impaired cell growth, proliferation and invasion ability (P < .05). Knockdown of the expression of ALDOA reversed the epithelial–mesenchymal transition process. Mechanically, ALDOA could affect the hypoxia‐inducible factor (HIF)‐1α activity as demonstrated by the HIF‐1α response element–luciferase activity in GC cells. Collectively, this study revealed that ALDOA was a potential biomarker of GC prognosis and was important in the carcinogenesis and progression of human GC.
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Affiliation(s)
- Zhonghua Jiang
- Department of Gastroenterology, The First People's Hospital of Yancheng, Yancheng, China
| | - Xiaohong Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jing Li
- Departments of CyberKnife, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongmei Yang
- Department of Gastroenterology, The First People's Hospital of Yancheng, Yancheng, China
| | - Xin Lin
- Department of Digestive Endoscopy, The First People's Hospital of Wujiang District, Suzhou, China
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14
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Zhao B, Zhang J, Zhang J, Chen X, Chen J, Wang Z, Xu H, Huang B. Anatomical location of metastatic lymph nodes: an indispensable prognostic factor for gastric cancer patients who underwent curative resection. Scand J Gastroenterol 2018; 53:185-192. [PMID: 29228846 DOI: 10.1080/00365521.2017.1415371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although the numeric-based lymph node (LN) staging was widely used in the worldwide, it did not represent the anatomical location of metastatic lymph nodes (MLNs) and not reflect extent of LN dissection. Therefore, in the present study, we investigated whether the anatomical location of MLNs was still necessary to evaluate the prognosis of node-positive gastric cancer (GC) patients. METHODS We reviewed 1451 GC patients who underwent radical gastrectomy in our institution between January 1986 and January 2008. All patients were reclassified into several groups according to the anatomical location of MLNs and the number of MLNs. The prognostic differences between different patient groups were compared and clinicopathologic features were analyzed. RESULTS In the present study, both anatomical location of MLNs and the number of MLNs were identified as the independent prognostic factors (p < .01). The patients with extraperigastric LN involvement showed a poorer prognosis compared with the perigastric-only group (p < .001). For the N1-N2 stage patients, the prognostic discrepancy was still observed among them when the anatomical location of MLNs was considered (p < .05). For the N3-stage patients, although the anatomical location of MLNs had no significant effect on the prognosis of these patients, the higher number of MLNs in the extraperigastric area was correlated with the unfavorable prognosis (p < .05). CONCLUSION The anatomical location of MLNs was an important factor influencing the prognostic outcome of GC patients. To provide more accurate prognostic information for GC patients, the anatomical location of MLNs should not be ignored.
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Affiliation(s)
- Bochao Zhao
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Jingting Zhang
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Jiale Zhang
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Xiuxiu Chen
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Junqing Chen
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Zhenning Wang
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Huimian Xu
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Baojun Huang
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
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15
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Comparative study of the 7th and 8th AJCC editions for gastric cancer patients after curative surgery. PLoS One 2017; 12:e0187626. [PMID: 29131840 PMCID: PMC5683565 DOI: 10.1371/journal.pone.0187626] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 10/06/2017] [Indexed: 01/14/2023] Open
Abstract
Objectives The classification of pathological tumor-node-metastasis (pTNM) staging of gastric cancer was revised in the 8th American Joint Committee on Cancer (AJCC) edition. The major revision was the separation of pN3a and pN3b in the pTNM staging. The current study evaluated the prognostic impact of this change. Methods A total of 1,517 patients who underwent curative surgery for gastric cancer with a retrieved lymph node number ≥15 at our institution from January 1995 to December 2011 were enrolled. Survival was compared for the disease classified according to both the 7th and 8th editions. Results After separation of pN3a and pN3b in the pTNM stage definition, the 8th edition still provides significant survival differences between each stage. The multivariate analysis demonstrated that the pTNM stage in both the 7th and 8th editions was an independent prognostic factors of overall survival and disease-free survival. The 8th edition has a better homogeneity than the 7th edition with a significantly higher likelihood ratio chi-square test. Regarding the OS and DFS, the time-dependent receiver operating characteristic (ROC) curves of the two staging systems are almost overlapping, indicating that the prognostic performance is comparable between the two staging systems. Conclusions Both the 7th and 8th edition-based stages are independent prognostic factors for gastric cancer. The 8th edition has a better homogeneity than the 7th edition; the 8th edition provides discriminant survival differences among each pTNM stage that are comparable to those in the 7th edition.
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16
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Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer. J Gastrointest Surg 2017; 21:1563-1570. [PMID: 28819789 DOI: 10.1007/s11605-017-3539-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Japanese Classification of Gastric Carcinoma includes the left gastric artery (#7) lymph nodes (LNs) in the recommended extent of D1 LN dissection, but this recommendation has not been validated in western institutions. METHODS We reviewed data from a prospectively maintained database of gastric cancer patients who underwent resection at our academic cancer center and had a separate pathologic assessment of #7 LN in 2005-2016. Risk factors for #7 LN metastases and overall survival were examined by uni- and multivariable analyses. RESULTS We identified 173 patients; 114 (66%) were treated with preoperative therapy, most commonly with chemoradiation therapy (47%, 81/173). We identified 22 patients (13%) who had #7 LN metastases, which accounted for 35% (22/63) of node-positive patients. No preoperative factors were associated with #7 LN metastases by univariable analyses. Patients with #7 metastases were not associated with shorter overall survival after adjustment by nodal stage (hazard ratio 1.49, 95% confidence interval 0.67-3.32; p = 0.33). CONCLUSION Metastasis to #7 LN station was common in gastric cancer, but the survival impact was not significant after adjustment by nodal stage. We conclude that #7 LNs should be routinely dissected in gastric cancer patients, and this station should be included within the extent of D1 LN dissection.
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