Extracapsular lymph node spread

Alakus, Hakan; Hölscher, Arnulf H.; Grass, Guido; Hartmann, E.; Schulte, Christian; Drebber, Uta; Baldus, Stephan; Bollschweiler, Elfriede; Metzger, Ralf; Mönig, Stefan P.

doi:10.1002/cncr.24764

Cited by 45 publications

(15 citation statements)

References 21 publications

(21 reference statements)

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“…ECS is a common phenomenon in metastatic lymph nodes. Extracapsular lymph node spread is a significant risk factor for peritoneal metastasis of gastric cancer as reported by several authors [ 13 , 14 ]. The rate of postoperative peritoneal recurrence is higher in Borrmann type IV gastric cancer than other Borrmann type gastric cancer.…”

Section: Discussionmentioning

confidence: 97%

Prognostic impact and implications of extracapsular lymph node spread in Borrmann type IV gastric cancer

et al. 2017

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The purpose of this study was to evaluate the relationship between extracapsular lymph node spread (ECS) and clinicopathology and its influence on the prognosis in patients with Borrmann type IV gastric cancer. Between 2002 and 2014, clinical data were reviewed from 486 patients with Borrmann type IV gastric cancer who underwent curative resection. Of the 486 patients, lymph node metastasis was found in 456. ECS was detected in 213 (46.7%) patients with lymph node metastasis. A positive lymph node with ECS was significantly correlated with the N category, lymphatic/venous invasion, tumor location, and TNM stage. For the whole patients, the mean OS was 34.7 months, and the 5-year OS rate was 15.5%. The 5-year OS rate of node-negative patients was 48%, for node-positive patients without ECS 18.7%, and for node-positive patients with ECS 5.7% (P = 0.000). In a multivariate analysis, adjusted for tumor location, lymphatic/venous invasion, body mass index (BMI), and TNM stages, ECS remained an independent prognostic factor. For patients with the same N category and TNM stage, those with ECS still had a worse survival rate. Recurrent sites were confirmed in 367 patients. The most frequent recurrent site was the peritoneum. There was a significant difference between ECS+ (N = 150) and ECS- (N = 142) patients (P = 0.008). Our results suggested that ECS was an independent prognostic value for Borrmann type IV gastric cancer patients with curative resection and a subgroup indicated a significantly worse long-term survival for patients with the same N or TNM stages. ECS+ was an adverse factor for peritoneal metastasis.

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Section: Discussionmentioning

confidence: 97%

Prognostic impact and implications of extracapsular lymph node spread in Borrmann type IV gastric cancer

et al. 2017

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“…The prognostic impact of ExCLNI has been shown to be significant mainly in head and neck malignancies. Recent studies have evaluated the prognostic value of ExCLNI in other gastrointestinal malignancies such as esophageal, colon, and gastric cancer, adenocarcinoma of the ampulla of Vater, and pancreatic carcinoma [17-22]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer

et al. 2012

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BackgroundLymph node metastasis is one of the most important prognostic factors for extra-hepatic bile duct carcinoma (ExHBDC). Extra capsular lymph node involvement (ExCLNI) is the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The prognostic impact of ExCLNI has been shown to be significant mainly in head and neck malignancies. Recently, the prognostic impacts of ExCLNI have evaluated in gastrointestinal malignancies. However no data is available regarding the incidence and prognostic significance of extra-capsular lymph node involvement (ExCLNI) in resectable ExHBDCs. The aim of the present study is first to evaluate the incidence of ExCLNI in surgically-treated ExHBDCs and second, to determine the prognostic impact of ExCLNI in patients with surgically-treated ExHBDCs.MethodsA total of 228 patients (110 cases of hilar cholangiocarcinoma and 118 cases of distal cholangiocarcinoma) with surgically-treated ExHBDCs were included in this retrospective study. ExCLNI was defined as the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The existence of ExCLNI and its prognostic value were analyzed as a subgroup of lymph node metastasis.ResultsExCLNI was detected in only 22% of patients with lymph node metastasis of surgically-treated ExHBDC. The presence of ExCLNI correlated with distal cholangiocarcinoma (p = 0.002). On univariate analysis for survival, perineural invasion, vascular invasion, histological grade, and lymph node metastasis were statistically significant factors. On multivariate analysis, only lymph node metastasis was identified as a significant independent prognostic factor in patients with resectable ExHBDC. Subgroups of lymph node metastasis including the presence of ExCLNI, location of lymph node metastasis, and the number of lymph node metastasis had no statistically significant impact on survival.ConclusionExCLNI was present in only 22% of the LNM (7% of overall patients) in patients with surgical treated ExHBDCs. And ExCLNI would have no impact on the survival of patients with surgically-treated ExHBDCs.

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“…Extracapsular growth has become an important part of oncological studies in the last years. The association of ECG and poorer prognosis, both in gastric cancer [ 4 ] and in gastrointestinal malignancies in general [ 3 ], turns the parameter ECG into an interesting target for recent studies regarding tumours of the gastrointestinal tract [ 5 , 16 , 17 ]. Its association with histomorphological parameters such as TNM-category, lymphovascular invasion and tumour grading [ 6 , 7 ] implies ECG to be a morphological marker for a more aggressive biological phenotype of gastrointestinal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The extra-capsular growth (ECG) describes the extension of neoplastic cells beyond the lymph node capsule into the perinodular soft tissue. Being a prognostic factor for cancer in several organs [ 1 , 2 ] including the gastrointestinal tract [ 3 , 4 ], ECG has already found access to staging systems such as the squamous cell carcinoma of the vulva and the head and neck [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the parameter ECG is also suggested to be included as a prognostic parameter in colorectal cancer staging systems [ 6 ]. In gastric cancer, ECG is associated with poorer 5-year survival and was also found to be an independent prognostic factor [ 4 , 7 ]. ECG is associated with larger tumour size, advanced pT- and pN-category and lymphovascular and perineural invasion [ 4 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Extra-capsular growth of lymph node metastasis correlates with poor prognosis and high SOX9 expression in gastric cancer

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Angele²,

Schüller³

et al. 2018

BMC Cancer

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BackgroundExtra-capsular growth (ECG) describes the extension of neoplastic cells beyond the lymph node capsule. Aim of this study was to investigate the prognostic value of ECG and its association with a stem cell like phenotype indicated by expression of the transcription factor SOX9 in gastric cancer.MethodsBy histological evaluation, 199 patients with nodal positive gastric cancer or adeoncarcinoma of the esophageal-gastric junction (AEG) were divided into two groups according to the presence (ECG) or absence (ICG) of extracapsular growth in at least one nodal metastasis. Of these, 194 patients were stained for SOX9 and SOX2 using immunohistochemistry. Seventeen nodal negative patients (pT3/4, pN0, pM0) served as controls.ResultsSeventy-three patients (36.7%) showed ECG. ECG was associated with lower overall survival (p < 0.0001), advanced pT- (p = 0.03) and pN- category (p < 0.0001) and lymphovascular invasion (p = 0.014). In multivariate analysis, ECG was found to be an independent prognostic factor (HR = 2.1; 95% CI 1.7–3.4; p = 0.001). SOX9 expression correlated significantly with ECG (96% SOX9 high in ECG patients vs. 79% SOX9 high in patients with ICG; p = 0.002). Controls showed significantly reduced SOX9 expression compared to nodal positive carcinomas (59% vs. 85% high SOX9 expression; p = 0.006). No significant correlation of ECG and SOX2 (59% SOX2 negative in ECG patients vs. 64% in patients with ICG, p = 0.48) could be obtained.ConclusionsPatients with ECG exhibit poorer prognosis and ECG was found to be an independent prognostic factor. Thus, ECG turns out to be a morphological biomarker for a more aggressive phenotype in gastric cancer. This is supported by the fact that ECG correlates with the expression of SOX9, which has been described in the context of pro-oncogenic properties of tumours. However, the fact that SOX2 failed to show significant results indicate that ECG is not associated with a distinct cancer stem cell phenotype in gastric cancer.

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Extracapsular lymph node spread

Cited by 45 publications

References 21 publications

Prognostic impact and implications of extracapsular lymph node spread in Borrmann type IV gastric cancer

Prognostic impact and implications of extracapsular lymph node spread in Borrmann type IV gastric cancer

Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer

Extra-capsular growth of lymph node metastasis correlates with poor prognosis and high SOX9 expression in gastric cancer

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