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Costa PMD, Antunes C, Lages P, Rodrigues J, Peyroteo M, Onofre S, Lara Santos L. Challenging the Dogma: Stage migration or negative lymph nodes, which of them is the main player on gastric cancer prognosis? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108318. [PMID: 38626587 DOI: 10.1016/j.ejso.2024.108318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 04/18/2024]
Abstract
Expanding loco-regional nodes harvesting is expected to increase survival. This improvement may be associated to stage migration (SM). However, the great bulk of harvested lymph nodes observed in large dissections is negative. M&M: 830 patients who received R0 gastrectomy for adenocarcinoma were included. pN+ patients with <26 nodes (n = 209) were included for a simulation to "offer 26 nodes" - SM (proportional and exponential based) was simulated and analysed through machine learning algorithms. Overall Survival (OS), in native and simulated stages, were compared. OS of extended lymphadenectomies (pN+, D ≥ 26, n = 273) was compared with the simulated curves. OS of patients in the following dissection intervals of negative nodes were compared: <16 (n = 233), 16-25 (n = 258), ≥26 (n = 339). RESULTS: After simulation to 26 nodes (pN+, D < 26 patients, n = 209), staging was recomputed. OS of native vs simulated early-stages (I-II) and advanced stages (III) were not different (p > 0.05). OS of patients with lymphadenectomy (≥26) was better than simulated for early and advanced stages (p = 0.008; p = 0.005). OS of patients included in distinct intervals of negative lymph nodes were different (p < 0.001). These intervals were an independent prognostic factor (multivariate analysis). CONCLUSIONS: The influence of Stage Migration was null in this set of simulations and Will Rogers phenomenon was not observed. Extended dissection performed better in OS. But the influence of the number of negative nodes, even in large dissections, was highlighted. By emphasizing the role of negative nodes, we aim to facilitate more informed decision-making in management of gastric cancer patients, ultimately leading to improved treatment outcomes and patient care.
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Affiliation(s)
- P Matos da Costa
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Hospitais de Santa Maria and Garcia de Orta, Affiliated to Universidade de Lisboa, Lisboa, Portugal.
| | - Cláudia Antunes
- Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal.
| | - Patrícia Lages
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Hospitais de Santa Maria and Garcia de Orta, Affiliated to Universidade de Lisboa, Lisboa, Portugal.
| | - Jéssica Rodrigues
- Epidemiology Service, Instituto Português de Oncologia, Porto, Porto Portugal.
| | - Mariana Peyroteo
- Surgical Oncology, Instituto Português de Oncologia, Porto, Porto, Portugal.
| | - Susana Onofre
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Hospitais de Santa Maria and Garcia de Orta, Affiliated to Universidade de Lisboa, Lisboa, Portugal.
| | - Lúcio Lara Santos
- Surgical Oncology, Instituto Português de Oncologia, Porto, Porto, Portugal.
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Díaz Del Arco C, Ortega Medina L, Estrada Muñoz L, Molina Roldán E, García Gómez de Las Heras S, Fernández Aceñero MJ. Prognostic role of the number of resected and negative lymph nodes in Spanish patients with gastric cancer. Ann Diagn Pathol 2023; 67:152209. [PMID: 37689040 DOI: 10.1016/j.anndiagpath.2023.152209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Lymph node (LN) involvement is one of the most critical prognostic factors in resected gastric cancer (GC). Some analyses, mainly conducted in Asian populations, have found that patients with a higher number of total lymph nodes (NTLN) and/or negative lymph nodes (NNLN) have a better prognosis, although other authors have failed to confirm these results. MATERIALS AND METHODS Retrospective study including all patients with GC resected in a tertiary hospital in Spain between 2001 and 2019 (n = 315). Clinicopathological features were collected and patients were categorized according to the NTLN and the NNLN. Statistical analyses were performed. RESULTS Mean NNLN was 17. The NNLN was significantly related to multiple clinicopathological variables, including recurrence and tumor-related death. The classification based on the NNLN (N1: ≥16, N2: 8-15, N3: ≤7) effectively stratified the entire cohort into three distinct prognostic groups and maintained its prognostic value within both the pN0 and pN+ patient subsets. Furthermore, it was an independent prognostic indicator for both overall and disease-free survival. Conversely, the mean NTLN was 21.9. Patients with ≤16 LN retrieved exhibited distinct clinicopathological features compared to those with >16 LN, but no significant differences were observed in terms of recurrence or disease-associated death. The application of alternative cut-off points for NTLN (10, 20, 25, 30, and 40) showed no prognostic significance. CONCLUSIONS In Spanish patients with resected GC the NNLN hold prognostic significance, while the NTLN does not appear to be prognostically significant. Incorporating the NNLN into GC staging may enhance the accuracy of the TNM system.
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Affiliation(s)
- Cristina Díaz Del Arco
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Luis Ortega Medina
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lourdes Estrada Muñoz
- Department of Basic Medical Sciences, School of Medicine, Rey Juan Carlos University, Móstoles, Madrid, Spain; Department of Pathology, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain
| | - Elena Molina Roldán
- Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Biobank, Hospital Clínico San Carlos, Madrid, Spain
| | | | - M Jesús Fernández Aceñero
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Sun Y, Chen C, Hou L, Zhao E. Short-term and long-term outcomes of patients with gastric cancer during versus before the COVID-19 pandemic: cohort study using propensity score matching method. BMC Cancer 2023; 23:913. [PMID: 37770880 PMCID: PMC10537928 DOI: 10.1186/s12885-023-11441-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The negative effects of the novel coronavirus disease 2019 (COVID-19) pandemic on patients with gastric cancer are poorly understood. This study was designed to compare the short-term and long-term outcomes of patients with gastric cancer in the same period before and during the COVID-19 pandemic. METHODS We retrospectively collected consecutive patients with definite diagnosis of gastric cancer at our center between 1 January and 30 June of 2019 (Before COVID-19) and 2020 (During COVID-19). A comparison was made between the number of patients and their characteristics before and during the COVID-19 epidemic. Propensity score matching (PSM) at 1:1 ratio was performed to evaluate the outcomes of patients that underwent laparoscopic radical gastrectomy in two groups. RESULT The total number of patients diagnosed with gastric cancer during the COVID-19 pandemic increased by 21.4%, compared to that before the COVID-19 pandemic. AII the qualified patients were divided Before COVID-19 Pandemic group (BCP n = 99) and During COVID-19 Pandemic group (DCP n = 118). PSM yielded 81 patients with comparable baseline characteristics into each group. Compared to the BCP group, the DCP group had longer surgery time(P = 0.011), more blood loss(P = 0.015), longer postoperative hospital stay(P = 0.002). No statistical differences were observed in terms of type of resection, number of retrieved lymph nodes (LNs), pathology, short-term and long-term complications (P > 0.05). CONCLUSION Patients diagnosed with gastric cancer during the COVID-19 pandemic had comparable short-term outcomes and long-term complications, but worse peri-operative outcomes, compared to that before the COVID-19 pandemic. Further research is needed to investigate long-term outcomes.
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Affiliation(s)
- Yong Sun
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No.36 Nanyingzi Street, Chengde, 067000, Hebei, China
| | - Chao Chen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No.36 Nanyingzi Street, Chengde, 067000, Hebei, China
| | - Lei Hou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No.36 Nanyingzi Street, Chengde, 067000, Hebei, China
| | - Enhong Zhao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No.36 Nanyingzi Street, Chengde, 067000, Hebei, China.
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Bahardoust M, Kheirabadi M, Donyadideh G, Khaleghian M, Haghmoradi M, Tizmaghz A. Effect of the number of negative lymph nodes removed on the survival and recurrence rate after gastrectomy in patients with gastric cancer: a multicenter retrospective cohort study. BMC Surg 2023; 23:246. [PMID: 37605178 PMCID: PMC10441750 DOI: 10.1186/s12893-023-02154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Various factors affect the survival rate of Gastric cancer (GC) patients after gastrectomy. This study aimed to investigate the effect of the number of negative lymph nodes (NLNs) removed on GC patients' survival and recurrence rate after gastrectomy. METHODS In this retrospective, multicenter cohort study, we reviewed the medical profile of 639 patients with a definite diagnosis of GC who underwent gastrectomy from 2010 to 2022 in one of the medical centers affiliated with the Iran University of Medical Sciences. Based on the number of NLNs removed, patients were divided into three groups, including (0-9NLNs), (10-15 NLNs), and (≥ 16 NLNs), including 155, 231, and 253 GC patients, respectively. Demographic characteristics, tumor characteristics, and pathological findings of the patients were extracted by referring to the patient's files. RESULTS The 5-year survival rate of patients was estimated at 48.2%. The 5-year tumor recurrence rate in patients with the number of NLNs 1-9, NLNs 10-15, and ≥ 16 NLNs were 79.4%, 51.1%, and 30.8%, respectively. (Log-rank = 9.24, P 0.001) The multivariate analysis showed that the 5-year survival rate in patients with fewer NLNs removed ≥ 16 was significantly higher than in the other two groups. In addition, age, BMI, tumor size, tumor stage, metastasis, and tumor differentiation were significantly related to the survival of GC patients after gastrectomy. (p < 0.05) CONCLUSION: Paying attention to the number of NLNs removed during gastrectomy can be a key factor in improving the survival prediction of GC patients.
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Affiliation(s)
- Mansour Bahardoust
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Kheirabadi
- Medical student, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Khaleghian
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Meisam Haghmoradi
- Department of Orthopedic Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Adnan Tizmaghz
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Huang X, Hu P, Yan F, Zhang J. Establishment and Validation of a Nomogram Based on Negative Lymph Nodes to Predict Survival in Postoperative Patients with non-Small Cell Lung Cancer. Technol Cancer Res Treat 2022; 21:15330338221074506. [PMID: 35060800 PMCID: PMC8796078 DOI: 10.1177/15330338221074506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background: The importance of the negative lymph node (NLN) count has recently attracted attention. This study aimed to determine the prognostic value of NLN count in patients with non-small cell lung cancer (NSCLC) after radical surgery by constructing NLN-based prognostic models. Methods: This study included 33 756 patients pooled from the case listing session of the US Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 and 545 patients collected from The First Affiliated Hospital of Shandong First Medical University between 2012 and 2016. X-tile software was used to calculate the optimal cutoff value for the NLN count. The associated clinical factors were determined using univariate and multivariate Cox analyses. Nomograms were developed using the SEER database and validated using hospital data. Results: The training cohort was divided into high and low NLN count subgroups based on the cancer-specific survival (CSS) and overall survival (OS), respectively. Multivariate analysis showed that NLN count was an independent prognostic factor, and the high NLN count subgroup had better CSS and OS than those of the low NLN count subgroup (HR = 0.632, 95% CI 0.551-0.724, P < .001 for CSS and HR = 0.641, 95% CI 0.571-0.720, P < .001 for OS). Nomograms were established, exhibiting good discrimination ability with a C-index of 0.789 (95% CI 0.778 −0.798) for CSS and 0.704 (95% CI, 0.694 −0.714) for OS. The calibration plots of the validation cohorts showed optimal agreement with the training cohort, with a C-index of 0.681 (95% CI 0.646 −0.716) for CSS and 0.645 (95% CI 0.614 −0.676) for OS. Conclusions: NLN count is a strong prognostic factor for OS and CSS in NSCLC patients and the prognostic model provides a useful risk stratification for NSCLC patients when applied to clinical practice.
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Affiliation(s)
- Xinyi Huang
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Pingping Hu
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Fei Yan
- Dezhou Seventh People’s Hospital, Dezhou, China
| | - Jiandong Zhang
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
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D2 Lymphadenectomy as an Independent Prognostic Factor in Gastric Cancer. ARS MEDICA TOMITANA 2022. [DOI: 10.2478/arsm-2020-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background: The last decades have been marked by debates based on the importance of lymphadenectomy in gastric cancer, lymphadenectomy being a topic of controversy between the Western Surgical Societies and the Asian side. Lymphadenectomy is currently a globally accepted standard in the treatment of gastric cancer.
Methods: The present study was performed prospectively on a number of 93 patients diagnosed with gastric cancer, who underwent radical gastrectomy with lymphadenectomy in the Surgery Department of the Emergency County Clinical Hospital, Constanta, between January 2012 - December 2016. In 70 cases, an extended D2 or standard D2 lymphadenectomy was performed, and for 23 patients: D1 + lymphadenectomy. The data were statistically analyzed in order to determine the prognostic value of lymphadenectomy in gastric cancer.
Results: The average age was 65.88 ± 8.80 years. The mean number of lymph nodes harvested in D2 lymphadenectomy was 22.8 ± 7.60, with limits between 15 and 43, and the number of positive lymph nodes ranged from a minimum of 0 to a maximum of 37. Histopathological exam of specimens showed that only 17.2% of patients with gastric cancers were without lymph node metastases (pN0), while 45.16% were in the pN3 stage. Analysis of survival curves revealed that 5-year survival was significantly higher in D2 lymphadenectomy compared to D1 + lymphadenectomy (23.8% vs. 8.7%).
Conclusions: The current study validates D2 lymphadenectomy as a standard technique and the superiority of the prognosis in gastric cancer patients through results obtained in terms of 5-year survival.
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Chang CW, Chen CY. Prognostic factors of advanced gastric cancer. J Chin Med Assoc 2021; 84:557-558. [PMID: 33871396 DOI: 10.1097/jcma.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chen-Wang Chang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan, ROC
- MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Chih-Yen Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine and Institute of Emergency and Critical Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
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Wang Y, Lei X, Liu Z, Shan F, Ying X, Li Z, Ji J. Short-term outcomes of laparoscopic versus open total gastrectomy after neoadjuvant chemotherapy: a cohort study using the propensity score matching method. J Gastrointest Oncol 2021; 12:237-248. [PMID: 34012622 DOI: 10.21037/jgo-20-374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Until now, little is known about the benefit of laparoscopic total gastrectomy (LTG) after neoadjuvant chemotherapy (NACT). This study was designed to compare the safety and efficacy of the LTG versus the open total gastrectomy (OTG) approach after NACT treatment in patients with advanced gastric cancer (AGC). Methods This study involved a cohort of 145 patients with AGC who underwent total gastrectomy after NACT at our centre between April 2013 and August 2018 including 24 cases of LTG and 121 OTG. The baseline characteristics were matched based on 1:2 balanced propensity score-matching method. Results Sixty-nine marched cases were finally analysed (23 LTG vs. 46 OTG). All patients underwent R0 resection. Compared to the OTG group, the LTG group had a longer surgery duration (P<0.001), but a shorter incision length (P<0.001) and less intravenous patient-controlled analgesia (IV-PCA) time after surgery (P=0.027). No statistical differences were observed in terms of blood loss, retrieved lymph nodes (LNs), resection margin, length of stay, postoperative pain intensity, and complications (P>0.05). Conclusions LTG had comparable safety and histological findings to OTG after NACT in the perioperative period; however, LTG is less invasive and patients can benefit from less IV-PCA use. Further research is needed to investigate long-term effects. Keywords Gastric cancer (GC); neoadjuvant chemotherapy (NACT); safety; laparoscopic technique.
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Affiliation(s)
- Yinkui Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaokang Lei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zining Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangji Ying
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
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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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Cai Z, Ma J, Li S, Fingerhut A, Sun J, Zang L, Yan C, Liu W, Zhu Z, Zheng M. Impact of microsatellite status on negative lymph node count and prognostic relevance after curative gastrectomy. J Surg Oncol 2021; 123 Suppl 1:S15-S24. [PMID: 33650696 DOI: 10.1002/jso.26325] [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: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The impact of microsatellite instability-high (MSI-H) phenotype on lymph node yield after lymphadenectomy has never been discussed in gastric cancer (GC). In this study, we aimed to assess the association of microsatellite status with negative lymph node count (NLNC) as well as its prognostic value. METHODS We retrospectively analyzed 1491 GC patients and divided them into two groups: MSI-HGC (n = 141 [9.5%]) and microsatellite stability (MSSGC ) (n = 1350 [90.5%]). The NLNC and survival data were compared between the two groups. The log odds of positive lymph nodes (LNs) to negative LNs and the target lymph node examined threshold (TLNT) were calculated in both groups. RESULTS A statistically significant difference was found in median NLNC (26 vs. 23, p < .001) between MSI-HGC and MSSGC patients. MSI status was an independent factor for NLNC (p < .001). NLNC showed positive prognostic value for cases with metastatic lymph node (LN+ ) in both MSI-HGC and MSSGC groups. The TLNT(90%) for MSI-HGC and MSSGC were 33 and 26, respectively. CONCLUSIONS MSI-HGC was associated with higher NLNC in GC patients and this was independent of the presence of LN+ . However, more LNs are needed during pathological examination to capture LN+ cases in MSI-HGC.
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Affiliation(s)
- Zhenghao Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Shuchun Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China.,Department of Surgery, Section for Surgical Research, Medical University of Graz, Graz, Austria
| | - Jing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Chao Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenggang Zhu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
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da Costa PM, Lages P, Onofre S, Ribeiro RM. The impact of negative lymph nodes in the survival outcomes of pN+ patients following radical gastrectomy: the inverse lymph node ratio as a better score to study negative lymph nodes. Updates Surg 2020; 72:1031-1040. [PMID: 32388806 DOI: 10.1007/s13304-020-00757-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
The impact of negative lymph nodes (LNs) on survival of pN+ patients has been recognized. The weight of negative LNs in an inverse lymph node ratio (nR) should be related to its prognostic impact. Five hundred and two consecutive gastric cancer patients, who underwent radical gastrectomy, were included. Patients were split into groups according to the number of harvested nodes and a cross-tabulation with pTNM stages was performed to test differences in the tumor burden. pN+ patients (n = 296) were split into groups of negative LNs harvested. We tested an alternative formula for computing a lymph node ratio: nR = total number of harvested nodes/total number of positive nodes. The median number of negative LNs was significantly different (p < 0.01) between dissection groups, but not the median of positive nodes (p > 0.05). No difference in pTNM percentage distribution was found between these groups (p > 0.05). When tested, the overall survival improved significantly for groups with larger numbers of negative LNs (p < 0.001). A cutoff of nR ≥ 6 was an independent prognostic factor for survival (p = 0.001), and the survival of pN+ patients with nR ≥ 6 was not different from pN0 patients. The impact of the number of negative LNs on the survival of the pN+ patients was demonstrated. The higher numbers in the numerator of the nR was due to the disproportion between harvested negative LNs and metastatic LNs. Larger ratios imply more negative lymph nodes in relation to positive lymph nodes, which was significantly associated with survival. We believe that the proposed nR is a friendlier to use format because of its intuitive interpretation.
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Affiliation(s)
- Paulo Matos da Costa
- Serviço de Cirurgia Geral, Hospital Garcia de Orta, Almada, Portugal.
- Centro Académico de Medicina de Lisboa, Lisboa, Portugal.
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| | - Patrícia Lages
- Serviço de Cirurgia Geral, Hospital Garcia de Orta, Almada, Portugal
- Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Susana Onofre
- Serviço de Cirurgia Geral, Hospital Garcia de Orta, Almada, Portugal
- Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Ruy M Ribeiro
- Laboratório de Biomatemática, Lisboa, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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12
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Zhang W, Zhangyuan G, Wang J, Jin K, Liu Y, Wang F, Yu W, Zhang H, Li G, Yu D, Chen H, Xu Q, Sun B. Effect of lymph nodes count in node-positive gastric cancer. J Cancer 2019; 10:5646-5653. [PMID: 31737101 PMCID: PMC6843880 DOI: 10.7150/jca.30979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 08/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background: The retrieved lymph node (LN) count has been confirmed as a prognostic indicator in various cancers. However, the correlation between LN counts and patient prognosis in gastric cancer with node-positive is not fully studied. Methods: A total of 8475 patients undergoing gastrectomy in Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer were analyzed. Kaplan-Meier methods and multivariable Cox regression models were used to analyze long-term outcomes and risk factors. Moreover, nomograms including LN counts were established to predict overall survival (OS) and cancer-specific survival (CSS), and Harrell's concordance index (c-index) was adopted to evaluate prediction accuracy. Results: Patients were stratified into 1-6, 7-14, and > 14 subgroups according to the optimal cutoff for retrieved LNs in terms of 5-year CSS. Further analysis indicated that higher LN counts were an independent predictor of longer survival in each N category. Nomograms on CSS and OS were established according to all significant factors, and c-indexes were 0.663 and 0.654 (P< 0.001), respectively. Conclusions: These results indicated that the more the LNs retrieved, the better the survival would be. Nomograms incorporating LN counts can be recommended as practical models to provide more accurate prognostic information for GC patients.
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Affiliation(s)
- Wenjie Zhang
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China.,Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Guangyan Zhangyuan
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Jincheng Wang
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China.,Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Kangpeng Jin
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China
| | - Yang Liu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Fei Wang
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Weiwei Yu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Haitian Zhang
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Guoqiang Li
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China
| | - Decai Yu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China
| | - Huihui Chen
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China
| | - Qingxiang Xu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Beicheng Sun
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.,Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China.,Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
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13
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Gao Y, Xu D, Wu YS, Chen D, Xiong W. Increasing negative lymph node count is independently associated with improved long-term survival in resectable perihilar cholangiocarcinomas. Medicine (Baltimore) 2019; 98:e14943. [PMID: 30985643 PMCID: PMC6485858 DOI: 10.1097/md.0000000000014943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To evaluate the prognostic value of numbers of negative lymph nodes (NLNs) for patients with perihilar cholangiocarcinomas.The surveillance, epidemiology, and end results database was used to screen for patients with perihilar cholangiocarcinomas. Kaplan-Meier and Cox regression analyses were used for statistical evaluations. Subsequently, propensity score matching (PSM) was performed to confirm the results.A total of 938 patients with perihilar cholangiocarcinomas met the inclusion criteria. The cut-off number for the grouping of patients with different numbers of NLNs was 17. Both the univariate and multivariate survival analyses demonstrated that there was a significant improvement in terms of cancer-specific survival for patients with >17 NLNs, compared with patients with ≤17 NLNs. Then, the above results were confirmed via a PSM procedure. Additionally, the independent prognostic value of NLNs was evaluated in subgroup univariate and multivariate analyses of patients with stage I or stage II tumors.The numbers of NLNs were evaluated and determined to be important independent prognostic factors for the cancer-specific survival of patients with perihilar cholangiocarcinomas.
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Affiliation(s)
- Yunfeng Gao
- Department of Gynecology, Chengdu Second People's Hospital, Chengdu, Sichuan
- Department of Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Dong Xu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Yu-Shen Wu
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics
| | - Duke Chen
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanchun Xiong
- Department of Gynecology, Chengdu Second People's Hospital, Chengdu, Sichuan
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14
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Ye J, Ren Y, Dai W, Chen J, Cai S, Tan M, He Y, Yuan Y. Does Lymphadenectomy with at Least 15 Perigastric Lymph Nodes Retrieval Promise an Improved Survival for Gastric Cancer: A Retrospective Cohort Study in Southern China. J Cancer 2019; 10:1444-1452. [PMID: 31031854 PMCID: PMC6485220 DOI: 10.7150/jca.28413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Specific guidelines recommend at least 15 or 16 lymph nodes (LNs) be examined to adequately assess nodal category of gastric cancer (GC), but the requirement for minimum number of regional LNs retrieval is not mentioned. This study aims to investigate survival significance from various numbers of perigastric (N1) LNs retrieval and to determine an optimal number harvested in such region. Study design: From April 1994 to March 2012, 1003 resectable GC patients with at least 15 LNs examined were included. Patients with at least 15 N1 nodes retrieval were assigned into study group, with the rest into control group. The 5-year overall survival (OS) rate was compared between two groups, and an optimal number of examined N1 nodes was detected by a survival joinpoint analysis. Results: 635 (63.3%) patients in study group had median 22 (range, 15-75) N1 nodes and 3 (range, 0-74) positive N1 nodes retrieval, with median 10 (range, 0-14) N1 nodes and 1 (range, 0-29) metastatic N1 nodes examined in control group. The number of N1 nodes retrieval was associated with tumor location (P=0.007), tumor stage (P<0.001) and total number of harvested LNs (r=0.691, P<0.001). Median survival time (79.0 vs. 72.0 months, P=0.462) and actual 5-year OS rate (41.0% vs. 39.2%, P=0.463) were slightly improved in study group compared with control group, with significance obtained via stage-by-stage analysis. The joinpoint analysis indicated that at least seven N1 nodes retrieval achieved survival significance (81.0 vs. 35.0 months, P=0.036), with survival superiority remained until reaching up to 15 N1 nodes. Conclusion: Adequate retrieval of perigastric LNs is essential for radical gastrectomy. A harvest of at least 7-15 perigastric LNs could achieve long-term survival benefit for GC patients.
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Affiliation(s)
- Jinning Ye
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Yufeng Ren
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Weigang Dai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Jianhui Chen
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Shirong Cai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Min Tan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
| | - Yulong He
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Digestive Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518106, Guangdong Prov., P.R. China
| | - Yujie Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China.,Center of Gastric cancer, Sun Yat-Sen University, Guangzhou, 510080, Guangdong Prov., P.R. China
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15
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Li X, Zhang W, Zhang X, Wang H, Xu K, Yao H, Yao J, Liang X, Hu Z. The prognostic value of negative lymph node count for patients with gastric cancer who received preoperative radiotherapy. Oncotarget 2018; 8:46946-46954. [PMID: 28159939 PMCID: PMC5564535 DOI: 10.18632/oncotarget.14943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/27/2016] [Indexed: 12/23/2022] Open
Abstract
Negative lymph node (NLN) count provides accurate prognostic information in patients with gastric cancer. However, it is unclear whether NLN still has prognostic value for patients received preoperative radiotherapy. In this study, Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer patients were used for analysis. Clinicopathological characteristics and survival time were collected. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors for survival. NLN count was validated as an independent prognostic factor in both univariate and mulivariate analysis (P < 0.001). X-tile plots identified 12 as the optimal cutoff value to divide the patients into high and low risk subsets in terms of survival rate. Nomogram based on cancer-specific survival was successfully established according to all significant factors. The C-index was 0.630 (95% CI: 0.605–0.655). Subgroup analysis showed that NLN count was a prognosis factor for patients with advanced gastric cancer (stage ypII and ypIII). In conclusion, our results firmly demonstrated that NLN count was an independent prognostic factor for patients with gastric cancer who received preoperative radiotherapy. It provides more accurate prognostic information especially for patients with advanced gastric cancer (stage ypII and ypIII). Nomograms based on cancer-specific survival could be recommended as practical models to evaluate prognosis.
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Affiliation(s)
- Xinxing Li
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Weigang Zhang
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Xianwen Zhang
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Haolu Wang
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Kai Xu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Houshan Yao
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Jun Yao
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Xiaowen Liang
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Zhiqian Hu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
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16
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Woo Y, Goldner B, Son T, Song K, Noh SH, Fong Y, Hyung WJ. Western Validation of a Novel Gastric Cancer Prognosis Prediction Model in US Gastric Cancer Patients. J Am Coll Surg 2017; 226:252-258. [PMID: 29277711 DOI: 10.1016/j.jamcollsurg.2017.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/09/2017] [Accepted: 12/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND A novel prediction model for accurate determination of 5-year overall survival of gastric cancer patients was developed by an international collaborative group (G6+). This prediction model was created using a single institution's database of 11,851 Korean patients and included readily available and clinically relevant factors. Already validated using external East Asian cohorts, its applicability in the American population was yet to be determined. STUDY DESIGN Using the Surveillance, Epidemiology, and End Results (SEER) dataset, 2014 release, all patients diagnosed with gastric adenocarcinoma who underwent surgical resection between 2002 and 2012, were selected. Characteristics for analysis included: age, sex, depth of tumor invasion, number of positive lymph nodes, total lymph nodes retrieved, presence of distant metastasis, extent of resection, and histology. Concordance index (C-statistic) was assessed using the novel prediction model and compared with the prognostic index, the seventh edition of the TNM staging system. RESULTS Of the 26,019 gastric cancer patients identified from the SEER database, 15,483 had complete datasets. Validation of the novel prediction tool revealed a C-statistic of 0.762 (95% CI 0.754 to 0.769) compared with the seventh TNM staging model, C-statistic 0.683 (95% CI 0.677 to 0.689), (p < 0.001). CONCLUSIONS Our study validates a novel prediction model for gastric cancer in the American patient population. Its superior prediction of the 5-year survival of gastric cancer patients in a large Western cohort strongly supports its global applicability. Importantly, this model allows for accurate prognosis for an increasing number of gastric cancer patients worldwide, including those who received inadequate lymphadenectomy or underwent a noncurative resection.
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Affiliation(s)
- Yanghee Woo
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Bryan Goldner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kijun Song
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, City of Hope National Medical Center, Duarte, CA; Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Gastric Cancer Center, Yonsei Cancer Hospital, Seoul, Republic of Korea; Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
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17
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Lu H, Guo R, Yang H, Wang H, Liang X, Hu Z, Li X. The prognostic value of negative lymph node count for patients with cervical cancer after radical surgery. Oncotarget 2017; 9:2810-2818. [PMID: 29416813 PMCID: PMC5788681 DOI: 10.18632/oncotarget.23596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022] Open
Abstract
Negative lymph node (NLN) count has been recognized as a prognostic indicator in various cancers. However, the relationship between NLN count and the prognosis of cervical cancer is still unknown. In this study, 10, 500 cervical cancer patients after radical surgery were selected from Epidemiology and End Results Program (SEER) data. Clinicopathological characteristics were collected for analysis, including year of diagnosis, age, race, grade, primary site, FIGO stage and cause specific survival (CSS). Univariate and multivariate Cox proportional hazards model was used to assess risk factors for survival of patients. X-tile plots identified 6 as the optimal cutoff value of NLN count to divide patients into high and low risk subsets in terms of CSS (χ2 = 183.95, P < 0.001). The rate of 5-year CCS of cervical cancer patients was improved with an increase in NLN count from 0 to 23 (all P < 0.001). NLN count was validated as an independently prognostic factor by the multivariate Cox analysis (HR: 1.571, 95% CI: 1.370~1.801, P < 0.001). Subgroup analysis showed that NLN count was a prognosis factor in FIGO stage I (χ2=35.023, P < 0.001), stage II (χ2 = 12.910, P < 0.001), stage III + IV (χ2 = 9.732, P = 0.002) and unknown stage (χ2 = 16.654, P < 0.001). Conclusively, this study demonstrated the NLN count was an independent prognostic factor for cervical cancer patients.
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Affiliation(s)
- Hao Lu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Rong Guo
- The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Haotian Yang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia.,School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Haolu Wang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia
| | - Xiaowen Liang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia
| | - Zhiqian Hu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xinxing Li
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
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18
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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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Zhuo C, Ying M, Lin R, Wu X, Guan S, Yang C. Negative lymph node count is a significant prognostic factor in patient with stage IV gastric cancer after palliative gastrectomy. Oncotarget 2017; 8:71197-71205. [PMID: 29050356 PMCID: PMC5642631 DOI: 10.18632/oncotarget.17430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/27/2017] [Indexed: 12/13/2022] Open
Abstract
Negative lymph node (NLN) count has been validated as a protective predictor in various cancers after radical resection. However, the prognostic value of NLN count in the setting of stage IV gastric cancer patients who have received palliative resection has not been investigated. Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer patients were used for analysis in this study. Kaplan-Meier survival curves and multivariate Cox proportional hazards model were used to assess the risk factors for patients’ survivals. The results showed that NLN count and N stage were independently prognostic factors in patients with stage IV gastric cancer after palliative surgery (P< 0.001). X-tile plots identified 2 and 11 as the optimal cutoff values to divide the patients into high, middle and low risk subsets in term of cause-specific survival (CSS). And NLN count was proved to be an independently prognostic factor in multivariate Cox analysis (P< 0.001). The risk score of NLN counts demonstrated that the plot of hazard ratios (HRs) for NLN counts sharply increased when the number of NLN counts decreased. Collectively, our present study revealed that NLN count was an independent prognostic predictor in stage IV gastric cancer after palliative resection. Standard lymph node dissection, such as D2 lymphadectomy maybe still necessary during palliative resection for patients with metastatic gastric cancer.
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Affiliation(s)
- Changhua Zhuo
- Department of Gastrointestinal Surgical Oncology, Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Mingang Ying
- Department of Gastrointestinal Surgical Oncology, Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Ruirong Lin
- Department of Gastrointestinal Surgical Oncology, Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Xianyi Wu
- Department of Gastrointestinal Surgical Oncology, Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Shen Guan
- Department of Gastrointestinal Surgical Oncology, Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Chunkang Yang
- Department of Gastrointestinal Surgical Oncology, Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
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Li X, Lu H, Xu K, Wang H, Liang X, Hu Z. Negative lymph node count is an independent prognostic factor for patients with rectal cancer who received preoperative radiotherapy. BMC Cancer 2017; 17:227. [PMID: 28351352 PMCID: PMC5370465 DOI: 10.1186/s12885-017-3222-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background Negative lymph node (NLN) count has been reported to provide more accurate prognostic information than the N stage alone in patients with rectal cancer (RC). Since preoperative radiotherapy (Pre-RT) can significantly affect the LN status, it is unclear whether NLN count still has prognostic value count on survival of patients with RC who received Pre-RT. Methods In this study, clinicopathological characteristics, number of positive LNs and survival time were collected from Surveillance, Epidemiology, and End Results Program (SEER)-registered RC patients. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors for survival. Results X-tile plots identified 9 (P < 0.001) as the optimal cutoff NLN value to divide the patients into high and low risk subsets in terms of cause specific survival (CSS). NLN count was validated as independently prognostic factor in univariate and multivariate analysis (P < 0.001). Subgroup analysis showed that NLN count was an independently prognostic factor for patients with stage ypII (P = 0.002) and ypIII (P < 0.001). Conclusions Our results firmly demonstrated that NLN count provides accurate prognostic information for RC patients with Pre-RT.
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Affiliation(s)
- Xinxing Li
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China
| | - Hao Lu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China
| | - Kai Xu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China
| | - Haolu Wang
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Xiaowen Liang
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.
| | - Zhiqian Hu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China.
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Zheng G, Feng F, Guo M, Xu G, Liu S, Liu Z, Sun L, Hong L, Yang J, Lian X, Fan D, Zhang H. Harvest of at Least 23 Lymph Nodes is Indispensable for Stage N3 Gastric Cancer Patients. Ann Surg Oncol 2016; 24:998-1002. [PMID: 27830390 DOI: 10.1245/s10434-016-5667-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The National Comprehensive Cancer Network (NCCN) recommends that at least 15 lymph nodes (LNs) be removed during radical gastrectomy. This study aims to investigate the optimal number of LNs resected for radical gastrectomy. PATIENTS AND METHODS From September 2008 to March 2015, a total of 1990 gastric cancer patients were enrolled in this study. Clinicopathological features and survivals were recorded, and the association between the number of LNs resected and the prognosis of gastric cancer were analyzed. RESULTS Overall, 1520 males (76.4%) and 470 females (23.6%) were included in the study, with a median age of 57 years (range 20-90). The median number of LNs resected was 24 (range 15-83) for stage N1, 25 (range 15-62) for stage N2, 25 (range 15-88) for stage N3a, and 28 (range 16-73) for stage N3b. The optimal cut-off value for the number of LNs resected was 22 for stage N3a (p = 0.000) and N3b (p = 0.003) patients, while no other cut-off value was significantly superior to 15 for stage N1-2 patients (both p > 0.05). Age, tumor size, tumor depth, and number of LNs resected were independent prognostic predictors for stage N3a patients, while resection type and number of LNs resected were independent prognostic predictors for stage N3b patients. Removing more than 22 LNs exhibited a significant survival benefit compared with removing 15-22 LNs for stage N3a and N3b patients (29.7 vs. 21.6%, p = 0.000; 12.9% vs. 0%, p = 0.003, respectively). CONCLUSION Removing at least 23 LNs could yield better survival outcomes in stage N3 gastric cancer patients.
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Affiliation(s)
- Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Man Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guanghui Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shushang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Li Sun
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Liu Hong
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jianjun Yang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiao Lian
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Daiming Fan
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China.
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