Clinical significance of occult micrometastasis in lymph nodes from patients with early gastric cancer who died of recurrence

Maehara, Yoshihiko; Oshiro, Takeshi; Endo, Kazuya; Baba, Hideo; Oda, Shinya; Ichiyoshi, Yuji; Kohnoe, Shunji; Sugimachi, Keizō

doi:10.1016/s0039-6060(96)80138-3

Cited by 226 publications

(153 citation statements)

References 20 publications

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“…The use of immunohistochemistry revealed that LN involvement was not detected in 19 of all 95 cases, 16 of which had mi. This relatively low detection rate of previously undetected tumor cells might be explained by the restriction to node-negative patients and corresponds well with results of other studies that have reported rates between 10.0 and 49.0 % for pN0 patients [6,10,[12][13][14][15][21][22][23]. The study could not show a significant decline in overall survival for mi-positive patients although patients with micrometastatic nodal involvement had a slightly higher mortality rate (37.5 vs. 26.6 % for mi-negative patients).…”

Section: Survival Analysissupporting

confidence: 91%

“…Many previous studies regarding the prognostic influence of immunohistochemically detected mi lack a consistent definition of the term mi. Frequently, all tumor cells detected by immunohistochemistry were defined as mi [6,9,10,12,14,16,21,23]. In contrast, this study discriminates between mi and ITC based on the size of metastasis as recommended by the UICC.…”

Section: Survival Analysismentioning

confidence: 98%

“…Immunohistochemistry is a frequently described method to detect ITC and mi not visible in routinely performed haematoxylin and eosin (HE) stain [6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Besides immunohistostaining serial sectioning and molecular methods are options to improve the accuracy of pathologic examination.…”

Section: Introductionmentioning

confidence: 99%

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Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases

Jeuck

Wittekind

2014

Gastric Cancer

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Background Immunohistochemically detected micrometastases of the regional lymph nodes in previously pN0-classified gastric cancer have been incorporated in the TNM staging system. This study aims to determine the incidence of such micrometastases in gastric carcinoma and to investigate their impact on stage grouping and prognosis. Methods Ninety-five patients with gastric carcinoma classified as pN0 by conventional histological examination were enrolled. All patients underwent gastric resection with regional lymphadenectomy between 2006 and 2010. A total of 2018 lymph nodes was obtained (median, 20 Lymph nodes) and immunohistostained with anti-pan cytokeratin antibody (KL1). Results Micrometastases were detected in regional lymph nodes by immunohistostaining in 16 out of all 95 patients. Fourteen patients were upstaged by micrometastasis-positive regional lymph nodes. Three patients demonstrated lymph nodes with isolated tumor cells alone. A significantly higher incidence of micrometastases was observed in patients with diffuse histologic type (p = 0.007) and total gastrectomy (p = 0.007). When isolated tumor cells were also regarded as lymph node involvement, the recurrence rate was significantly higher for node-positive than for node-negative patients and for those younger than 70 years (33.3 and 6.7 %, respectively; p = 0.026; n = 39). Overall survival analysis revealed no significant difference between micrometastasis-positive and micrometastasis-negative patients. ConclusionImmunohistostaining of regional lymph nodes in node-negative gastric carcinoma patients leads to an increased detection of micrometastases with significant implications for the staging system. Although no impact on survival time was shown, the higher recurrence rate for node-positive patients younger than 70 years indicates a prognostic value of immunohistochemically detectable micrometastases.

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Section: Survival Analysissupporting

confidence: 91%

Section: Survival Analysismentioning

confidence: 98%

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Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases

Jeuck

Wittekind

2014

Gastric Cancer

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“…Moreover, micrometastasis in the lymph node has been detected by cytokeratin (CK) immunostaining [12][13][14]. The clinicopathological significance of these so-called micrometastases in the lymph nodes and the correlation of these micrometastases with the reduced expression of E-cadherin (E-cad), which has been recognized as an important factor in tumor metastasis [15], have not been extensively discussed.…”

Section: Introductionmentioning

confidence: 99%

Significant correlation between micrometastasis in the lymph nodes and reduced expression of E-cadherin in early gastric cancer

et al. 2001

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“…Therefore, radical lymphadenectomy for gastric cancer has become a standard procedure, resulting in the long-term survival of patients with lymph node metastasis (Maehara et al, 1992). Nevertheless, several authors have reported that complete resection with radical lymphadenectomy that led to a nodenegative (pN0) final diagnosis according to routine histological haematoxylin -eosin (HE) staining did not prevent recurrence (Maehara et al, 1996;Siewert et al, 1996;Ishida et al, 1997). The key causative factor of recurrent gastric cancer is lymph node micrometastasis.…”

mentioning

confidence: 99%

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

et al. 2005

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The monoclonal antibody D2-40 is a specific lymphatic endothelial markers and D2-40 staining have been applicable to evaluate lymphatic invasion in various malignant neoplasms. In the present study, we investigated lymph node micrometastasis determined by immunohistochemistry (IHC) and reverse transcription -polymerase chain reaction (RT -PCR) in all dissected lymph nodes obtained from 80 patients with node-negative gastric cancer, and analysed the relationship between micrometastasis and clinicopathological findings including lymphatic invasion of the resected primary tumour using D2-40 immunohistochemical staining. The incidence of micrometastasis determined by IHC and RT -PCR was 11.3% (nine out of 80) and 31.3% (25 out of 80), respectively. Although haematoxylin -eosin (HE) staining revealed lymphatic invasion in 11.3% (nine out of 80) of patients, D2-40 staining uncovered new invasion in 23.8% (19 out of 80) of patients. In the diagnosis of HE and D2-40 staining, the incidence of micrometastasis was significantly higher in patients with lymphatic invasion than in those without lymphatic invasion (P ¼ 0.0150 and Po0.0001, respectively). Micrometastasis correlated more closely with D2-40 than with HE staining. We demonstrated a high incidence of micrometastasis and lymphatic invasion and a correlation between them even in pN0 gastric cancer. When planning less invasive treatment, the presence of such occult cancer cells should be considered.

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Clinical significance of occult micrometastasis in lymph nodes from patients with early gastric cancer who died of recurrence

Cited by 226 publications

References 20 publications

Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases

Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases

Significant correlation between micrometastasis in the lymph nodes and reduced expression of E-cadherin in early gastric cancer

Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer

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