Criteria for predicting the recurrence and metastasis of stage I and II gastric cancer without lymph node metastasis

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Abstract. the 5-year relapse-free survival rate (5y-rFs) and the 5-year overall survival rate (5y-os) were calculated for 972 patients (stage I, 206 IntroductionIn recent years, the outcome of patients with primary colorectal cancer in Japan has shown marked improvement with the development of more effective surgical techniques and adjuvant modalities such as chemotherapy and radiation therapy. It has been reported that the 5-year survival rate of patients after curative resection of Dukes' B/stage II colorectal cancer without lymph node metastases is approximately 80-85% (colon, 84.5±2.8%; rectum, 79.8±4.0%) (1-3). on the other hand, the 5-year survival rate of patients with Duke's c/ stage III cancer and lymph node metastases is approximately 60-70% (colon, 74.0±3.5%; rectum, 64.7±4.3%) (1-3). even after curative resection, approximately 30-40% of these patients eventually suffer the life-threatening development of distant metastasis/recurrence. According to the tnM classification, colorectal cancer patients with lymph node metastasis are classified as stage III, which is further divided into stage IIIA (T1/2N1, ≤3 metastatic nodes), stage IIIB (T3/4aN1) and stage IIIc based on the number of metastatic nodes (4). In the 7th edition of the general rules for clinical and pathological studies on cancer of the colon, rectum and Anus (grcpsc; Japanese classification) published in 2006, considerable changes have been made. thus, instead of the Japanese classification being based on the sites of lymph node metastasis, a more specific classification based on the number of lymph node metastases is now employed. According to the revised rules, N1 patients (≤3 nodes) and N2 patients (≥4 nodes) are classified as stage IIIa and IIIb, respectively, regardless of their t factor (5). lymph node metastasis in breast cancer patients is generally considered to be a manifestation of systemic disease, therefore breast cancer stages are subcategorized according to the number of involved lymph nodes. this also reflects the viewpoint that, in various cancers, the number of lymph node metastases is an important prognostic factor that determines the outcome and the survival of the patient (4,6-8). Abbreviations: 5y-rFs, 5-year relapse-free survival; 5y-os, 5-year overall survival; grcpsc, general rules for clinical and pathological studies on cancer of the colon, rectum and Anus;

Section: Discussionmentioning

confidence: 99%

Is the T1/2N1 (≤3 nodes) category actually stage IIIA (TNM)/IIIa (Japanese classification) in patients with primary colorectal cancer?

Mukai

Kishima²,

Fukumitsu³

et al. 2011

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“…It has been suggested that fatal hematogenous metastasis to the liver or lungs may develop after curative resection of esophageal cancer when tumor cells that are disseminated throughout the body during the perioperative period survive and grow in these distant organs (3,4). Many studies have shown that the presence of cytokeratinpositive occult neoplastic cells (ONCs) floating in the sinuses of LNs far from the primary tumor is closely related to distant metastasis/recurrence (11)(12)(13)(14)(15)(16)(17). ONCs are very small numbers of malignant cells that cannot be detected in body fluids such as the portal blood or peripheral blood without complex techniques, but are trapped in the microcirculation of lymph nodes surrounding the primary tumor and can be semiquantitatively counted by using a relatively easy immunostaining technique (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…To detect patients without LN metastasis who have an increased risk of the recurrence/metastasis of stage I/II cancer of the breast, stomach, or colorectal region, it has been reported that those who fulfill at least 2 of the following 3 criteria can be classified as a high-risk group: i) positivity for both lymphatic invasion (ly) and venous invasion (v) in the primary tumor; ii) dissection of ≤14 lymph nodes at operation; and iii) positivity for ONCs (11,14,15,17). On the other hand, to identify a high-risk group for the recurrence/metastasis of stage II/III cancer of the breast, stomach, or colorectal region with LN metastasis, it seems appropriate to include patients who meet at least 2 of the following 3 criteria: i) exclusion of patients with D2 or D3 (D means the dissection number, which identifies the extent of LN dissection) and >n1 (n, number, which indicates the extent of LN metastasis) who have fewer than 3 metastatic nodes (<3 nodes); ii) inclusion of patients with serosal exposure (>se) or adventitial exposure (>a2), or with a tumor diameter >2 cm (>t2); and iii) inclusion of those with ONCs in the LN sinuses (12,13,16).…”

Section: Introductionmentioning

confidence: 99%

Predicting recurrence and metastasis of primary esophageal cancer with or without lymph node metastasis

Tajima¹,

Mukai²,

Sato³

et al. 2006

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Abstract.We studied 42 patients, consisting of 11 stage I/II patients who were node-negative (LN -) and 31 stage II/III patients who were node-positive (LN + ). In the LN -patients, detection of occult neoplastic cells (ONCs) in lymph nodes had a sensitivity of 0.0% (0/5), a false-positive (FP) rate of 33.3% (2/6), a specificity of 66.7% (4/6), a false-negative (FN) rate of 100% (5/5), a positive predictive value (PPV) of 0.0% (0/2), and a negative predictive value (NPV) of 44.4% (4/9). In the LN + patients, the sensitivity of ONCs was 25.0% (5/20), FP rate was 36.4% (4/11), specificity was 63.6% (7/11), FN rate was 75.0% (15/20), PPV was 55.6% (5/9), and NPV was 31.8% (7/22). In LN -patients, positivity for at least 2 of the 3 high-risk criteria had a sensitivity of 20.0% (1/5), FP rate of 16.7% (1/6), specificity of 83.3% (5/6), FN rate of 80.0% (4/5), PPV of 50.0% (1/2), and NPV of 55.6% (5/9). In LN + patients, these criteria had a sensitivity of 75.0% (15/20), FP rate of 9.1% (1/11), specificity of 90.9% (10/11), FN rate of 25.0% (5/20), PPV of 93.8% (15/16), and NPV of 66.7% (10/15). These results suggest that the high-risk criteria may be useful for predicting recurrence or metastasis in stage II/III lymph node-positive patients with esophageal cancer.

“…It is also known that colorectal cancer may cause fatal metastasis/recurrence in the liver or lungs after curative resection of the primary tumor, probably because free cancer cells circulate during the perioperative period and survive to proliferate in a distant organ after escaping from the immune system (8)(9)(10)(11). Many investigators have reported that cytokeratin-positive occult neoplastic cells (ONCs), which represent circulating cancer cells, in lymph node sinuses distant from the primary tumor are closely related to the distant metastasis/recurrence of cancer (12)(13)(14)(15)(16)(17)(18)(19). ONCs can be counted by immunostaining and represent floating malignant cells that have been trapped by the lymph nodes (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Alternating hepatic arterial infusion and systemic chemotherapy for stage IV colorectal cancer with synchronous liver metastasis

Mukai

Oida²,

Tajima³

et al. 2006

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Abstract. Among 41 patients with synchronous liver metastases of colorectal cancer, 15 patients underwent synchronous resection of their liver metastases and achieved a median survival time (MST) of 1,441 days (versus 748 days for the 26 patients without resection, p=0.038), a median relapse-free survival time of 652 days (MST not reached), and a recurrence rate in the residual liver of 20% (3/15 patients). The alternating hepatic arterial infusion and systemic chemotherapy showed partial response (PR) in 6 cases, stable disease (SD) in 8 cases, and progressive disease (PD) in 1 case (n=15/26). They had an objective response rate of 40% (6/15), tumor control rate (≥ SD) of 93.3% (14/15), one-year progression-free survival rate of 35.7%, 50% time to progression of 270 days, one-year survival rate of 76.2%, and two-year survival rate of 50.8% (MST not reached). Grade 3 leucopenia was observed in 2/15 patients (13.3%). These results suggest that the present alternating therapy may become a standard regimen for patients in whom synchronous resection of liver metastases is impossible and patients who have stage IV colorectal cancer with a risk of recurrence in the remnant liver and/or at extrahepatic sites such as the lungs.