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- - - - - Relationship between rates of lymph node metastasis according to T, size of the lesion, macroscopic classification, degree of tumor differentiation and histological type of Lauren.
Source publication
to evaluate the incidence of lymph node metastasis in early gastric cancer, identifying risk factors for its development.
we conducted a prospective study of patients with gastric cancer admitted to the Section of the Esophago-Gastric Surgery of the Surgery of Service HUCFF-UFRJ, from January 2006 to May 2012.
the rate of early gastric cancer was 1...
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Skip metastasis (SK) is an exceptional pattern of lymph node metastasis and the incidence of skip metastasis is not infrequent in gastric cancer (GC). In the present study, we evaluated the clinical significance of skip LN metastasis in GC patients.
Methods:
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Background:
The high risk of lymph node metastasis (LNM) in gastric papillary adenocarcinoma causes endoscopist worry about the suitability of endoscopic resection for early gastric papillary adenocarcinoma (EPAC). We compared risk factors and attempted to establish a scoring system to stratify the LNM risk in EPAC patients.
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Materials and Methods
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Citations
... Esophagogastroduodenoscopy (EGD) and endoscopic biopsy are commonly used to confirm the diagnosis of gastric metastasis from breast cancer, but endoscopic findings are variable, and routine endoscopic biopsies are negative in many cases [4]. The average time to gastric metastasis after the diagnosis of breast cancer is reported to be within 5-10 years [5], with an average survival time after gastric metastasis diagnosis to be as short as 7 months (0 to 41 months), even in uncomplicated cases. Therefore, it requires prompt diagnosis and treatment [3]. ...
Metastatic breast cancer can spread to the bone, brain, liver and lung. However, metastasis to the stomach is rare. Gastric metastasis mostly presents within 10 years from the diagnosis of the primary breast cancer. We present a rare case of gastric metastasis occurring 20 years after mastectomy, diagnosed through immunohistochemistry.
... The overall prevalence of LN metastases in T1 tumors is 8%-31%, while the overall prevalence of LN metastases in T2-T4 tumors is considerably higher; 45%-90% [13][14][15]. This difference in metastases rates suggest the necessity for a more tailored approach based on the gastric T-stage. ...
Background
Gastrectomy with lymph node dissection is the cornerstone of curative treatment of gastric cancer. Extent of lymphadenectomy may differ depending on T-stage, as the rate of lymph node metastases may differ. The objective of this systematic review is to investigate and compare the prevalence of nodal metastases in the individual lymph node stations between different T-stages.
Methods
Data reporting and structure of this systematic review follows the PRISMA checklist. The Medline and PubMed databases were systematically searched. The search included the following Mesh terms: "Stomach Neoplasms", "Lymphatic Metastasis" and "Lymph Node Excision". The primary outcome was the highest prevalence of nodal metastases per T-stage.
Results
The initial search resulted in 175 eligible articles. Five articles met the inclusion criteria and were accordingly analyzed. Concerning the lymph node stations 1 to 7, the lymph nodes along the lesser gastric curvature (station 3) show the highest metastases rate (T1: 5.5%, T2: 21.9%, T3: 41.9%, T4: 71.0%). Concerning the lymph node stations 8 to 20, the lymph nodes around the common hepatic artery (station 8) show the highest metastases rate (T1: 0.8%, T2: 7.9%, T3: 14.0%, T4: 28.2%).
Conclusion
An overall low prevalence of nodal metastases in the individual lymph node stations in early, T1 gastric carcinomas and an overall high prevalence in more advanced, T3 and T4 gastric carcinomas endorse a more tailored approach based on the different gastric T-stages. In addition, a less extensive lymphadenectomy seems justified in early T1 carcinoma.
Synopsis
This systematic review provides an overview of the prevalence of nodal metastases for the individual lymph node stations between different T-stages, showing an overall low prevalence in early, T1 gastric carcinomas and an overall high prevalence in the more advanced, T3 and T4 gastric carcinomas.
... Studies concerning the overall survival and locoregional recurrence after D1 versus D2 lymphadenectomies did not distinct between the different T-stages. Yet there is a considerable difference in lymph node metastasis rates between T-stages (T1: 10-40%, T2-4: 45-90%) (8)(9)(10). Since the incidence of lymph node metastases in gastric cancer is closely related to the T-stage, patients with early gastric cancer may benefit from a D1 lymphadenectomy while in patients with more advanced gastric cancer a more extensive D2 lymphadenectomy should be performed. ...
Background:
The incidence of lymph node metastases is closely related to the T-stage, and therefore Eastern guidelines advice a D1 lymphadenectomy for early gastric cancer and a D2 lymphadenectomy for advanced gastric cancer. The aim of this study was to compare the lymph node metastases rate in the stations dissected with a D2-lymphadenectomy (stations 8-12) yet spared with a D1-lymphadenectomy, between different T-stages in a Western patient cohort.
Methods:
For this retrospective study, patients who underwent a gastrectomy in the Amsterdam University Medical Center (UMC), location Academic Medical Center (AMC), between 2011 and 2016 were identified from a prospectively maintained database. The primary outcome was to compare the rate of lymph node metastases in station 8-12 between different cT-stages.
Results:
One hundred twelve patients met our inclusion criteria. There were no positive lymph nodes in the lymph nodes stations 8-12 in cT1 and (y)pT1-stage tumors. The more advanced cT2-4 and (y)pT2-4 stage tumors show a high metastases rate (11.1% to 40.0%) in the lymph node stations 8-12.
Conclusions:
The results from this study endorse the Japanese Gastric Cancer Guideline; in early gastric cancer, a D1 lymphadenectomy is sufficient, while in advanced gastric cancer a D2 lymphadenectomy should be performed.
... In our series, the incidence of LNM was 19.2% in all EGC patients. Previous publications in Latin America reported similar results, but with a small number of patients [36,37]. ...
Purpose
This study aimed to identify the clinicopathological factors associated with the presence of lymph node metastasis (LNM) in patients diagnosed with early gastric cancer (EGC) and treated with radical gastrectomy.
Methods
Patients who underwent radical gastrectomy for gastric cancer from January 1990 to December 2019 were identified from a prospectively compiled database.Patients with pathological diagnoses of EGC were included. Univariate and multivariate analyses were conducted to identify risk factors associated with LNM.
Results
From 501 patients with EGC, 96(19.2%) presented LNM.In 279 patients with tumors with submucosal infiltration(T1b), 83(30%) patients had LNM. Among 219 patients who presented tumors > 3cm, 63(29%) patients had LNM. Thirty-one percent of patients with ulcerated tumors presented LMN(33 out of 105). In 76 patients and 24 patients with lymphovascular and perineural invasion, the percentage of LMN was 84% and 87%,respectively. In the univariate analysis, tumor diameter > 3cm, undifferentiated tumors, ulcerated tumors, submucosal invasion, lymphovascular, and perineural invasion showed a significant association with the presence of LNM.In the multivariate analysis, a tumor size > 3cm, submucosal invasion, lymphovascular, and perineural invasion were independent predictors of LMN in EGC. Patients who presented differentiated tumors, without ulceration, infiltration of the mucosa, and a tumor diameter ≤ 2cm, none presented LNM. Four patients(3%) who complied with the new Japanese indications for endoscopic treatment presented LNM.
Conclusions
The presence of lymph node metastasis in patients with EGC was independently related to larger tumors (tumor diameter > 3cm), submucosal invasion, lymphovascular and perineural invasion.
... The percentage of well differentiated tubular adenocarcinoma was 11.2%, significantly lower than 24.8% (34/304 vs 2752/11104, χ 2 = 29.650, p < 0.001) and 19.9% (34/304 vs 41/206, χ 2 = 7.442, p = 0.006) reported by Japan In 39 cases of gastric EMR/ESD in this study, 38 cases showed negative horizontal and vertical margins and no lymphovascular infiltration in histopathological assessment, which were considered to be curative. ...
... [13,16,17]), but lower than in Western data (53.8%-69.8% [14,18,19]), suggesting the relatively conservative attitude of Chinese and Western pathologists in the diagnosis of EGCs to some degree. Because of the difference in diagnostic criteria, the rates of early pT1-stage welldifferentiated adenocarcinoma patients are lower in China than those in Japanese and Korean, and many conclusions of Japanese and Korean studies on EGC may not be suitable to Chinese patients. ...
... [13,16,17,23], and lower than that in Western reports (22.4%-30.8%) [14,18,19]. This may reflect the differences of diagnostic criteria of EGC, which result in the increase in the number of cases of infiltrating submucosa, especially submucosa deep layer of EGC, leading to increased LNM rate of EGC patients. ...
Aims
The aim of this research was to identify the clinicopathological characteristics of early gastric cancer (EGC) based on the WHO criteria, and to analyze predictors for lymph node metastasis (LNM) in EGC in a Chinese study population.
Methods
We retrospectively collected data of 304 Chinese EGC patients, including 265 patients undergoing radical gastrectomy and 39 patients undergoing endoscopic resection. Histological features were accessed by three experienced pathologists. Univariate analysis and multivariate analysis were used to identify the correlation between clinicopathological features and LNM.
Results
Among the 304 cases with EGC, the rate of well differentiated tubular adenocarcinoma was 11.2%, significantly lower than that of Japanese and South Korean, which was 24.8% and 19.9% respectively (p<0.001 and p = 0.006), but similar to that of a Western result, which was 11.9% (p = 0.860). Among the 265 patients who underwent gastrectomy, 18.5% of the patients had LNM. Univariate analysis showed that macroscopic type, differentiation degree, invasion depth, infiltration pattern (INF), lymphovascular invasion and ulceration were related to LNM. Multivariate analysis revealed that lymphovascular invasion (p < 0.001, OR = 6.549), ulceration (p = 0.035, OR = 2.527) and INF c (p = 0.042, OR = 3.424) were the independent risk factors of LNM in EGC.
Conclusions
The pathological diagnosis standard of well differentiated tubular adenocarcinoma in China significantly differs from that in Japan and South Korea, but is similar to western countries. LNM is more likely to occur in EGCs with lymphovascular invasion, ulceration and INF c.
... Ren [26] reports that tumor invasion depth is an independent risk factor for lymph node metastasis in gastric cancers. A study by Bravo [27] indicates that the risk of lymph node metastasis by tumor in ltration into the submucosa is 3.103 times higher than that of the tumor con ned to the mucosa. We obtained similar results in our study, with the only difference being the type of cancer evaluated. ...
Background:Surgery combined with chemo-radiotherapy is a recognized model for the treatment of gastric and colon cancers. Lymph node metastasis determines the patient's surgical or comprehensive treatment plan.The purpose of this study was to compare preoperative scores to better predict lymph node metastasis in patients with gastric and colon cancers.
Methods:A total of 768 patients with gastric cancer (312) and colon cancer (462) were enrolled in our study. Preoperative serum markers, immune markers, and clinical tumor characteristics were evaluated by single-factor analysis. Logistic analysis was used to identify independent predictors of lymph node metastasis in patients with gastric and colon cancers. These independent risk factors were integrated into preoperative scores, which was evaluated by receiver operating characteristic (ROC) curves.
Results:The result showed that serum markers (CA125, hemoglobin, albumin), immune markers (S100, CD31, d2–40), and tumor characteristics (pathological type, tumor size) were independent risk factors for lymph node metastasis in patients with gastric and colon cancers. The preoperative scores reliably predicted lymph node metastasis in patients with gastric and colon cancers with a higher area under the ROC curve (0.901). Compared to the other independent risk factors, the area under the ROC curve of this indicator was 0.923 and 0.870, for gastric and colon cancers, respectively. Based on the ROC curve, the ideal cutoff value of preoperative scores to predict lymph node metastasis was established to be 287.
Conclusion: The preoperative scores is a useful indicator that could be used to predict lymph node metastasis in patients with gastric and colon cancers.
... According to the Lauren classification, GC may be divided into intestinal, diffuse and mixed types (28). A previous study indicated that patients with intestinal-type GC have an improved prognosis, compared with those with other Lauren types (30). The intestinal type of GC is described as a tumor with glandular architecture and resembling colonic carcinoma (31), and its relative frequency is ~54% (32). ...
A number of previous studies have reported that numerous long non-coding RNAs (lncRNAs) are dysregulated in gastric cancer (GC) and are involved in a series of biological and pathological processes. Total RNA was extracted from the cancerous tissues and matched normal adjacent tissues (NATs) of 96 patients with GC. The expression level of AB007962, a novel lncRNA, was determined by reverse transcription-quantitative polymerase chain reaction. The association between AB007962 expression levels and clinicopathological features were analyzed. Kaplan-Meier curves were also constructed in order to evaluate prognosis. Finally, publicly accessible data from The Cancer Genome Atlas was used to further verify the expression levels and clinical significance of AB007962. In conclusion, it was determined that the expression level of AB007962 was significantly reduced, compared with matched NATs in GC tissues (P=0.003). Survival analysis indicated that patients with intestinal-type GC with a reduced expression of AB007962 had a reduced prognosis, compared with those with an increased expression. AB007962 may be involved in the progression of GC and act as a novel prognostic biomarker for patients with GC, particularly in intestinal-type GC.
... The incidence of lymph node metastasis in patients with a cancer size of 3-5 cm is 64.9%, 80% in patients with a cancer size of 5-7 cm and 84.3 % in patients with a cancer size of >7 cm [9]. Additionally, early gastric cancer (EGC) has nodal metastases in 38.9% in poorly differentiated or undifferentiated types of tumor, in 41.7% with Lauren diffuse type and in 33.3% with a size larger than 3 cm [12]. Yang et al. [13] found that venous invasion, submucosal invasion or antral tumor location were independent predictors for LN metastasis in multivariate analysis. ...
Forty percent of patients with gastric cancer are node negative, so they have an unnecessarily extended lymph node dissection with a higher rate of morbidity and mortality. Successful sentinel lymph node (SLN) mapping may help to reduce the number of extended lymphadenectomy.
Sentinel lymph node biopsy (SNB) is indicated in patients with T1 or T2 tumors;
primary lesions < than 4 cm in diameter; and clinical N0 gastric cancer.
The injection method and selection of tracers for SLN mapping in gastric cancer remain controversial. However, the use of dual tracer and in cases with non palpable lesions, the submucosal marking method is recommended.
The identification rate and sensitivity are the highest in time performing SLN biopsy after
dye injection ≥15 min, the number of SLNs ≥5 and application of the basin dissection.
The cardinal problem in the SNB concept is the intraoperative false negative rate, the combination of hematoxylin-eosin and immunohistochemical staining has the highest sensitivity of intraoperative pathologic detection by frozen tissue sections.
The application of SNB has a beneficial side effect, as it significantly increased the number of harvested LN and the ratio of the number of the harvested LN per time, although an extensive surgical experience is necessary for application of SNB concept.
If the SLN contains tumor deposit(s), extended dissection is warranted, but if findings are negative, the patient could be spared additional complications associated with extended dissection.
Finally, the SNB could be suitable for tumors following endoscopic resection and could represent a new era of sentinel node navigation surgery in early gastric cancer. However, the clinical application of SLN biopsy should be limited to the patients of cT1N0M0 gastric cancer within the confines of prospective randomized trial.
... The incidence of lymph node metastasis in patients with a cancer size of 3-5 cm is 64.9%, 80% in patients with a cancer size of 5-7 cm and 84.3 % in patients with a cancer size of >7 cm [9]. Additionally, early gastric cancer (EGC) has nodal metastases in 38.9% in poorly differentiated or undifferentiated types of tumor, in 41.7% with Lauren diffuse type and in 33.3% with a size larger than 3 cm [12]. Yang et al. [13] found that venous invasion, submucosal invasion or antral tumor location were independent predictors for LN metastasis in multivariate analysis. ...
... More than 15 lymph nodes were removed for 72% of the patients and only 9% of cases included less than ten dissected lymph nodes. Also, patients with insufficient lymphanodectomy were not excluded from our study to avoid discrepancies as we compared our study results to five other studies from Western countries, where patients with less than 15 examined lymph nodes were included [18,20,[22][23][24]. Moreover if only patients with ≥15 resected LN would have been analyzed, the percentage of lymph node metastasis would not be much higher than in the whole series (T1a cancer -5,1% vs 5,6%, T1b cancer 31,9% vs 36%). ...
Background
Current risk factors for lymph node metastasis in early gastric cancer have been primarily determined in Asian countries; however their applicability to Western nations is under discussion. The aim of our study was to identify risk factors associated with lymph node metastasis in Western cohort patients from the Eastern European country - Lithuania. MethodsA total of 218 patients who underwent open gastrectomy for early gastric cancer were included in this retrospective study. After histolopathological examination, risk factors for lymph node metastasis were evaluated. Overall survival was evaluated and factors associated with long-term outcomes were analyzed. ResultsLymph node metastases were present in 19.7% of early gastric cancer cases. The rates were 5/99 (4.95%) for pT1a tumors and 38/119 (31.9%) for pT1b tumors. Submucosal tumor invasion, lymphovascular invasion, and high grade tumor differentiation were identified as independent risk factors for lymph node metastasis. Submucosal tumor invasion and lymphovascular invasion were also associated with worse 5-year survival results. Conclusion
Our study established submucosal tumor invasion, lymphovascular invasion, and high grade tumor differentiation as risk factors for lymph node metastasis.
