Clinical Impact of the Extent of Lymph Node Micrometastasis in Undifferentiated-Type Early Gastric Cancer

Lee, Tomohiro; Tanaka, Hiroaki; Ohira, Masaichi; Okita, Yoshihiro; Yoshii, Mami; Sakurai, Katsunobu; Toyokawa, Takahiro; Kubo, Naoshi; Muguruma, Kazuya; Tanaka, Sayaka; Ohsawa, Masahiko; Hirakawa, Kosei

doi:10.1159/000358803

Cited by 26 publications

(19 citation statements)

References 27 publications

(35 reference statements)

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“…The risk of lymph node metastasis is known to be higher in EGC with undifferentiatedtype histology compared to intestinal type EGC due to lymphovascular invasion, which was estimated to be 14% in a study of post-gastrectomy patients [51] . Moreover, micrometastasis which is associated with worse disease-free survival was reported as 13.3% in the EGC with undifferentiated-type histology [52] . However, there is no definitive method to detect lymph node metastasis accurately before surgery.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Bang¹,

Baik²,

Is³

et al. 2015

WJG

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Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Bang¹,

Baik²,

Is³

et al. 2015

WJG

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“…On the other hand, the diffuse form of GC are directly triggered by bioactive in ammation of the gastric mucosa [34,35]. Diffuse forms are normally prevalent in younger patients with an elevated risk of LN metastasis compared with intestinal types [36][37][38]. Our study demonstrated that Lauren classi cation was an independent risk index for LN metastasis and diffuse type was related with elevated risk of LN metastasis relative to the intestinal form.…”

Section: Discussionmentioning

confidence: 65%

A Genomic-Clinicopathologic Nomogram for the Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer

Zhong

Xuan

Qian

et al. 2020

Preprint

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Background: Preoperative evaluation of the lymph node (LN) state is of pivotal significance for therapy strategy decisions in gastric cancer (GC) patients. However, there is lack of noninvasive method that can identify such status preoperatively. We aimed at developing a genomic biosignature based model to forecast the possibility of LN metastasis in GC patients.Methods: We employed the RNA profile retrieving strategy and conducted RNA expression profiling in a large GC cohort (GSE62254, n = 300) from Gene Expression Ominus (GEO). In the exploratory stage, 300 GC patients from GSE62254 were involved and the differentially expressed RNAs (DERs) for LN-status were determined using R software. The GC samples in GSE62254 were randomly divided into a learning set (n = 210) and a verification set (n = 90). By performing the Least absolute shrinkage and selection operator (LASSO) regression approach, a set of 23-RNA signature was established and the signature based nomogram was subsequently built for distinguishing LN condition. The diagnostic effectiveness of this model was assessed, as well as the clinical performance subsequently assessed using the decision curve analysis (DCA). Metascape was used for bioinformatic analysis of the DERsResults: Based on this genomic signature, we established a nomogram which robustly distinguished LN status in the learning (AUC = 0.916, 95% CI 0.833–0.999) and verification sets (AUC = 0.775, 95% CI 0.647–0.903). DCA demonstrated the clinical value of this nomogram. Functional enrichment analysis of the DERs was conducted using bioinformatics methods which posited that these DERs were involved with several lymphangiogenesis-correlated cascades.Conclusions: Here, we present a genomic signature based nomogram that integrates the 23-RNA biosignature based scores and Lauren classification. This model can be readily utilized to estimate the possibility of LN metastasis with good performance in GC. The uncovering of the DERs reveals the prospective biogenesis of LN metastasis in GC.

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“…The relationship between tumour invasion depth, lymph node metastasis, distant metastasis and prognosis in diffuse GC also showed the same trends. Studies have shown that lymph node metastasis is an independent factor in the prognosis of patients [20][21] . Patients with node-negative disease have a higher 5-year survival rate than that of patients with lymph node metastasis, and the survival time of patients with lymph node metastasis decreases with an increase in the number of metastatic lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Intestinal-type gastric cancer carries a better prognosis but a higher risk of lymph node metastasis than diffuse-type: a SEER study of nearly 28,000 patients

Zhang¹,

Chen²,

Hong³

et al. 2020

Preprint

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Background: The impact of Lauren type, namely intestinal and diffuse types, on prognosis and lymph node metastasis (LNM) for gastric cancer (GC), requires further exploration, since current samples are deficient and the results are inconsistent.We aimed to translate the widely used WHO classifications into Lauren types and analyze the impact with the largest sample size available.Methods: Corresponding Lauren types of the WHO classification system in the Surveillance, Epidemiology, and End Results (SEER) database were included to identify all patients with histological diagnoses of intestinal-type or diffuse-type GC.Results: 4,338 intestinal-type and 22,990 diffuse-type GC were included in our study. Compared with intestinal-type, diffuse-type had a relatively poor prognosis after adjustment for other risk factors (HR, 1.236; P<0.001). Similar to patients with all stages of GC, the prognosis of patients with early diffuse GC was also poor (HR, 1.295; P=0.001). Surgical operation and radiotherapy markedly improved the DSS for patients (P<0.05). To our surprise, the risk of intestinal LNM in all stages of GC was higher than that in the diffuse type (OR=0.891; P=0.036). Although, there was no positive correlation between LNM and Lauren’s GC (OR=1.096; P=0.467) in early stage.Conclusion: Intestinal-type GC carries a better prognosis but a higher risk of LNM than diffuse-type. Patients with intestinal-type GC are likely to gain a greater benefit from receiving surgical treatment, but it is worth noting that clinicians should pay more attention to their lymphatic metastasis.*Contributed equally.The first author: Chanqiong Zhang, Guangyu Chen

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Clinical Impact of the Extent of Lymph Node Micrometastasis in Undifferentiated-Type Early Gastric Cancer

Cited by 26 publications

References 27 publications

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis

A Genomic-Clinicopathologic Nomogram for the Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer

Intestinal-type gastric cancer carries a better prognosis but a higher risk of lymph node metastasis than diffuse-type: a SEER study of nearly 28,000 patients

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