Survival of proper hepatic artery lymph node metastasis in patients with gastric cancer: implications for D2 lymphadenectomy

BACKGROUND AND AIMS

There is a discrepancy between the American Joint Committee on Cancer (AJCC) guidelines (7th edition) and the Japanese treatment guidelines (3rd edition) with regard to the extent of D2 lymphadenectomy for gastric cancer. In the AJCC, hepatic artery station (No.12a) lymph node (LN) metastasis is classified as distant metastasis, whereas in the Japanese guidelines, this classified is regional metastasis. This study aimed to evaluate whether it is appropriate to reclassify No.12a LN metastasis as distant metastasis in consideration of survival outcome.

METHODS

In this retrospective analysis, data from patients with gastric cancer who underwent regular D2 or greater lymphadenectomy between 1996 and 2006 were evaluated to determine any association between the clinicopathological features of hepatic artery LNs and survival prognosis.

RESULTS

Among the 247 patients with gastric cancer who underwent No.12 LN harvest, 45 (18.2%) were positive for No.12a LN metastasis. No.12a LN metastasis was significantly associated with poor clinicopathological features, advanced tumor stage, and poor overall survival. The 5-year survival rate of patients with No.12a LN metastasis was significantly better than that of patients with distant metastasis (P < 0.05), but was similar to that of patients with LN involvement in the D2 lymphadenectomy region (P > 0.05). No.12a LN metastasis was shown to significantly influence survival outcome in univariate analysis, but was not identified as a significant independent predictor in multivariate analysis. In logistic multivariate regression analysis, T stage, N stage, and station No.3, 5, and 6 LN metastasis were independent predictors of No.12a LN involvement.

CONCLUSIONS

It is inappropriate to reclassify No.12a LN metastasis as distant metastasis. We propose that this be considered as regional metastasis and be included in the extent of D2 lymphadenectomy to improve survival outcomes in patients with gastric cancer.

The comparative study of tumor angiogenesis and CT enhancement in pancreatic carcinoma

PURPOSE

The purpose of this work was to study the correlation of pancreatic phase Computed tomography (CT) enhancement, intratumoral microvessel density (MVD) and pathologic grades in pancreatic carcinoma and to evaluate the relationship between CT enhancement degree and the malignancy degree of pancreatic carcinoma.

METHODS

34 patients with pancreatic carcinoma underwent CT scanning before resection. The enhancement degrees and forms of tumor were observed in pancreatic phase. The operational sample was stained with HE and CD34 marked by immunohistochemistry. MVD and histopathological grades of pancreatic carcinoma were examined. CT enhancement of the tumor, MVD counting in hot spot areas of neoplastic parenchymal cells and pathological grades of pancreatic carcinoma were comparatively analyzed.

RESULT

Highly differentiated pancreatic adenocarcinoma was identified in 16 patients, moderately differentiated tumor in seven and poorly differentiated tumor in 11. Isodensity CT enhancement was demonstrated in 13 cases, slight low density enhancement in nine, slight low density enhancement along with small cyst lesion in nine and slight low density enhancement along with large cyst lesion in three. The counting of MVD with CD34 marked by immunohistochemistry in hot spot areas of neoplastic parenchyma cells were small in ten cases, medium in 16 and large in eight. The pathological grades correlated with CT enhancement of tumor (r=0.7857, P<0.001). The pathological grade correlated with MVD counting of tumor (r=0.3613, P<0.05). The CT enhancement of tumor correlated with MVD (r=0.6768, P<0.001).

CONCLUSION

There was obvious and significant correlation between CT enhancement, pathological grades and MVD numbers in the hot spot areas of tumor. The extent of CT enhancement was inversely proportional to the malignancy degree of pancreatic carcinoma, and inversely proportional to MVD numbers in the hot spot areas of neoplastic parenchyma. The MVD in the hot spot areas of neoplastic parenchyma cells could also reflect the prognosis of the patients, and was directly proportional to malignancy degree of pancreatic carcinoma.

Comparison of clinicopathological features of gastric carcinoma, between 2 times periods, at a single institute in China

PURPOSES

This study aims to compare the clinicopathological features of gastric carcinoma between two different time periods, and to investigate the prognostic factors for gastric carcinoma.

PATIENTS AND METHODS

One thousand sixteen consecutive gastric cancer patients were divided into two groups according to the operation date, period I (1994-1999) and period II (2000-2006). The clinicopathological features and prognosis were compared between the two periods.

RESULTS

There were significant differences in the proportions of early gastric carcinoma, different tumor node metastasis (TNM) staged patients, specialized operation and adjuvant chemotherapy between the two periods. The 5-year survival rate after curative resection within period II, were significantly higher than those within period I. Stratification analysis revealed that the survival rates of the patients with curative resection, lymph node metastasis, advanced disease, different TNM stages, specialized operations, without adjuvant chemotherapy within period II, were significantly higher than those within period I. Multivariate regression analysis revealed that Borrmann type, histologic type, depth of invasion, lymph node metastasis, curative resection, adjuvant chemotherapy, and different time periods were independent prognostic factors for gastric carcinoma.

CONCLUSIONS

The treatment efficacy of gastric carcinoma within the recent period improved highly when compared with that within the early period. It was the elevated diagnostic rate of early gastric cancer, standardized radical operation, and adjuvant chemotherapy that contributed to such improvement.