Frequência e fatores preditivos relacionados a metástase linfática em câncer gástrico precoce

Milhomem, Leonardo Medeiros; Cardoso, Daniela Medeiros Milhomem; Mota, Eliane Duarte; Fraga-Júnior, Ailton Cabral; Martins, Edésio; Mota, Orlando Milhomem da

doi:10.1590/s0102-67202012000400005

Cited by 6 publications

(3 citation statements)

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“…Multiple Cox regression analysis showed that only N staging could independently predict the prognosis of EGC patients. Inconsistent with previous studies [ 18 ], we found that N staging was the only independent prognostic factor and that tumor size, tumor cell differentiation and depth of tumor infiltration could not independently predict EGC patient prognosis. The four above-mentioned clinicopathological factors correlated with LNM and therefore could not directly predict EGC prognosis.…”

Section: Discussionsupporting

confidence: 74%

Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer

et al. 2015

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BackgroundLymph node metastasis (LNM) has been shown to be related to the prognosis of early gastric cancer (EGC). The choice of optimal treatment depends on an accurate pre-operative assessment of LNM status in EGC patients. However, in China, where EGC cases account for only a small part of gastric cancer (GC) cases, there are not enough data to make an accurate assessment. Therefore, this study, which involved a relatively large number of EGC patients, aimed to explore the relationship between clinicopathological characteristics and LNM in EGC.MethodsClinicopathological data from 205 EGC patients who underwent surgical resection at Sun Yat-Sen University Cancer Center from January 2000 to December 2011 were retrospectively analyzed. Clinicopathological characteristics were assessed to identify effective predictive factors for LNM and overall survival.ResultsLNM occurred in 52 (25.37%) EGC cases; of these cases, 18 occurred in intra-mucosal cancers (13 N1, 4 N2 and 1 N3), and 34 occurred in sub-mucosal cancers (22 N1, 7 N2 and 5 N3). Logistic regression analysis demonstrated that tumor differentiation (P=0.002), depth of tumor infiltration (P=0.004), vessel invasion (P=0.012), tumor size (P=0.020) and gender (P=0.022) were risk factors associated with LNM in EGC, listed in order of priority. The overall survival rate was 90.2%. Kaplan-Meier survival analysis showed that overall survival of EGC patients was significantly correlated with LNM (P=0.001), N staging (P<0.001) and invasion of lymphatic or blood vessels (P=0.010), but it was not correlated with tumor size, depth of tumor infiltration or tumor cell differentiation. Moreover, a multiple Cox regression analysis demonstrated that only N staging (P=0.001) could serve as an independent prognostic predictor in EGC patients.ConclusionsBecause LNM independently predicts the prognosis of EGC, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and laparoscopic partial gastrectomy should be cautiously used in high-risk EGC patients. A pre-operative assessment of LNM status based on clinicopathological factors may be useful for therapy planning.

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Section: Discussionsupporting

confidence: 74%

Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer

et al. 2015

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“…The ulcers induced in the present study were large in diameter and deeply penetrated into the muscular layer. According to some authors, the large size of gastric ulcer was closely related with difficulties in its treatment [ 3 ], the likelihood of ulcer malignancy [ 6 , 46 , 4 ] and lymph node metastasis [ 5 , 47 ]. Extensive, deeply penetrating ulcers destroy deeper tissues of the gastric wall, including nerve pathways.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Antral Ulcers on Intramural Gastric Nerve Projections Supplying the Pyloric Sphincter in the Pig (Sus scrofa domestica)—Neuronal Tracing Studies

Załęcki

2015

PLoS ONE

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BackgroundGastric ulcerations in the region of antrum pylori represent a serious medical problem in humans and animals. Such localization of ulcers can influence the intrinsic descending nerve supply to the pyloric sphincter. The pyloric function is precisely regulated by intrinsic and extrinsic nerves. Impaired neural regulation could result in pyloric sphincter dysfunction and gastric emptying malfunction. The aim of the study was to determine the effect of gastric antral ulcerations on the density and distribution of intramural gastric descending neurons supplying the pyloric sphincter in pigs.Methodology/Principal FindingsThe experiment was performed on 2 groups of pigs: healthy gilts (n=6) and gilts with experimentally induced peptic ulcers in the region of antrum pylori (n=6). Gastric neurons supplying pyloric sphincter were labeled using the retrograde neuronal tracing technique (20μl of Fast Blue tracer injected into the pyloric sphincter muscle). After a week survival period the animals were sacrificed and the stomachs were collected. Then, the stomach wall was cross-cut into 0.5cm thick sections taken in specified intervals (section I - 1.5cm; section II - 3.5cm; section III - 5.5cm; section IV – 7.5cm) starting from the sphincter. Consecutive microscopic slices prepared from each section were analyzed under fluorescent microscope to count traced neurons. Obtained data were statistically analyzed. The total number of FB-positive perikarya observed within all studied sections significantly decreased from 903.3 ± 130.7 in control to 243.8 ± 67.3 in experimental animals. In healthy pigs 76.1 ± 6.7% of labeled neurons were observed within the section I, 23.53 ± 6.5% in section II and only occasional cells in section III. In experimental animals, as many as 93.8 ± 2.1% of labeled cells were observed within the section I and only 6.2 ± 2.2% in section II, while section III was devoid of such neurons. There were no traced perikarya in section IV observed in both groups of pigs.Conclusions/SignificanceObtained results revealed for the first time significant impact of antral ulcerations on intramural descending nerve pathways supplying the pyloric sphincter in pigs, animals of increasing value in biomedical research and great economic importance.

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“…Zheng’s group [ 39 ] reported that the five- and ten-year survival rates were significantly lower in patients with lymph node metastases which are low-frequency events (2.6–4.6% of mucosal cancers) in early gastric cancer with mucosal invasion [ 16 , 40 ]. However, the incidence of lymph node metastasis in submucosal cancers has been reported as approximately 20% [ 41 , 42 ]. The submucosa is divided into 3 layers: SM1, SM2, and SM3 according to their depth and some reports indicate that these metastases began in the SM3 layer [ 43 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Resection Compared with Gastrectomy to Treat Early Gastric Cancer: A Systematic Review and Meta-Analysis

et al. 2015

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BackgroundEndoscopic resection and gastrectomy are treatment modalities for early gastric cancer, but their relative benefits and risks are unclear. We conducted a systematic review and meta-analysis to compare endoscopic resection and gastrectomy for treating early gastric cancer.MethodsWe searched PubMed, Embase, and the Cochrane Library until April 2015 for studies comparing endoscopic resection with gastrectomy for treatment of early gastric cancer. Outcome measures were five-year overall survival (OS), length of hospital stay and postoperative morbidity. We calculated pooled hazard ratio (HR), weighted mean difference (WMD) and odds ratio (OR) using random effects models.ResultsSix studies comprising 1,466 patients (618 endoscopic resection and 848 gastrectomy) met inclusion criteria. Five-year OS was similar between endoscopic resection and gastrectomy (HR, 1.06; 95%CI: 0.61 to 1.83). Endoscopic resection was associated with shorter hospital stays (WMD, -6.94; 95%CI: -7.59 to -6.29) and reduced overall postoperative morbidity (OR, 0.36; 95%CI: 0.17 to 0.74).ConclusionsWhile five-year OS is similar between endoscopic resection and gastrectomy, endoscopic resection offers a shorter hospital stay and fewer complications than gastrectomy for treating early gastric cancer. Endoscopic resection is a reasonable treatment for early gastric cancer with a negligible risk of lymph node metastasis.

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Frequência e fatores preditivos relacionados a metástase linfática em câncer gástrico precoce

Abstract: Ulceration, lesions larger than 50 mm, infiltration of the submucosal layer and lymphatic invasion are independent risk factors related to lymphatic metastasis in early gastric cancer.

Cited by 6 publications

References 30 publications

Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer

Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer

The Influence of Antral Ulcers on Intramural Gastric Nerve Projections Supplying the Pyloric Sphincter in the Pig (Sus scrofa domestica)—Neuronal Tracing Studies

Endoscopic Resection Compared with Gastrectomy to Treat Early Gastric Cancer: A Systematic Review and Meta-Analysis

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