Detection and Prediction of Micrometastasis in the Lymph Nodes of Patients With pN0 Gastric Cancer

Abstract

We demonstrated that the incidence of MM and/or TCM in the lymph nodes of patients with gastric cancer is quite high, and that such metastasis is associated with the prognosis of patients with pN0. Examination of E-cad expression in biopsy tumor specimens may be useful for predicting MM and/or TCM.

Occult Tumor Cells in Lymph Nodes of Patients with Gastric Cancer: A Systematic Review on Their Prevalence and Predictive Role

“…Some authors mentioned an association between the prevalence of MM and the reduction of E-cadherin, suggesting that the examination of its expression in biopsy tumor specimens may be useful [22]. Kim et al [41], using routine histological examination, detected a considerably high rate (about 17%) of LN MM in patients classified as pN0, in which a reduced E-cadherin expression was observed.…”

“…However, other MM and ITC definitions were described: Nakajo et al [22] defined MM as clusters of tumor cells with stromal reaction; Lee et al [2] as tumor deposits in LN with histological evidence of malignant activity, such as gland formation or stromal reaction (even if they were smaller than 0.2 mm), and Cai et al [23] as the presence of one or more aggregates or clusters of more than 2 tumor cells. The most recent studies [4,6,24,25,26,27,28,29,30] used the UICC definition of OTC in a standardized manner.…”

“…Some of the studies using IHC analyzed only one section [2,11,13,15,22,29,32], while others analyzed multiple sections [1,4,6,12,14,16,17,18,20,23,38,39,45,46] of LN. Cai and colleagues [12,16,17,23] observed that amongst resected LN with no evidence of metastasis by HE staining, 13% were found to contain occult cancer cells when only one section of each node was immunostained.…”

“…The majority of the studies (n = 27) [2,3,4,6,10,12,13,15,18,20,21,22,23,24,25,27,28,29,31,34,38,39,41,42,43,44,45] included only N0 patients and reported an OTC detection rate from 0.4 [28] to 28.6% [16]. It was reported that patients classified as ≥N1 had a higher prevalence of MM.…”

“…AE1/AE3 was the most used marker (n = 16) [3,5,14,18,22,24,25,26,28,29,31,34,35,38,41,45] when IHC was employed. This method consists in a monoclonal antibody cocktail that reacts against a broad spectrum of human cytokeratins.…”