Impact of lymphovascular invasion in patients with stage I gastric cancer

Kunisaki, Chikara; Makino, Hirochika; Kimura, Junko; Takagawa, Ryo; Kubo, Takashi; Ono, Hideki; Akiyama, Hirotoshi; Fukushima, Tadao; Nagahori, Yutaka; Takahashi, Masazumiu

doi:10.1016/j.surg.2009.08.012

Cited by 56 publications

(40 citation statements)

References 14 publications

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“…Although the overall stage is determined by a combination of T and N stage, our findings may suggest that the overall stage may independently affect the prognosis beyond each of T stage and N stage. Of the six independent variables we observed, one or more were repeatedly observed as risk factors for recurrence in each of the previous studies with a smaller patient population with early-stage GC [12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. In general, metastasis to lymph nodes has been reported to be one of the most significant risk factors for recurrence of early-stage GC [17,29].…”

Section: Discussionmentioning

confidence: 76%

“…Considering that patients with a less advanced stage of GC benefited more from adjuvant chemotherapy than patients with a more advanced stage (hazard ratios for RFS of 0.521 in stage II GC, 0.696 in stage IIIA GC, and 0.788 in stage IIIB GC), and the 5-year RFS rate of the high-risk group identified in our study is close to that of the stage II GC group in ACTS-GC, it is expected that stage I GC patients belonging to the high-risk group might benefit from adjuvant chemotherapy after curative resection. Kunisaki et al [16] also observed some patients with stage I GC whose long-term outcomes are as poor as those of patients with stage II GC. They studied 1,880 patients with histologically proven stage I GC to identify lymphovascular invasion as a poor prognostic factor in stage IB GC patients.…”

Section: Discussionmentioning

confidence: 96%

“…Patients with early-stage GC generally have an excellent prognosis after curative (R0) resection. In cases of stage I GC, the 5-and 10-year survival rates have been reported to be over 90 % and 85-90 %, respectively [15,16]. However, there is recurrence in a small but definite number of patients even with stage I GC after curative resection.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer

et al. 2015

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Background The therapeutic benefit of adjuvant chemotherapy has not been proven in stage I gastric cancer (GC). The aim of this study was to identify stage I GC patients at high risk of recurrence or death. Results With a median follow-up of 54 months (range 0-60 months), 212 patients (7.6 %) experienced recurrence or death, and the 5 -year recurrence-free survival (RFS) rate and overall survival rate were 89.9 and 93.4 %, respectively. With a multivariate analysis, six factors (age over 65 years, male gender, stage IB GC, lymphovascular invasion, perineural invasion, and elevated level of carcinoembryonic antigen) were independent poor prognostic factors for RFS (p \ 0.05). Patients with more than two of six poor risk factors had a 5-year RFS rate of 79 %, whereas patients with fewer risk factors had a 5-year RFS rate of 97 % (p \0.001). Conclusions In this study cohort, we identified six independent risk factors for RFS. The patients with more than two risk factors are expected to have significant risk of recurrence or death after curative resection and should be considered as candidates for adjuvant treatment.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer

et al. 2015

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“…In the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial, which showed the benefit of perioperative chemotherapy in patients with gastric cancer, 32% of the study cohort had stage T2 tumors; patients with T2 lesions are likely to benefit from preoperative treatment (1). Reports showing lower survival rates in patients with T2 lesions than in those with T1 lesions, independent of lymph node status, further support the idea of providing pre-or post-operative treatment for patients with T2 lesions (12,16). Because we consider, in accordance with NCCN guidelines, that patients with stage T2 and higher tumors are likely to benefit from preoperative treatment, we aimed to assess the ability of EUS to distinguish T1 vs. T2-T4 lesions.…”

Section: Discussionmentioning

confidence: 78%

Preoperative accuracy of gastric cancer staging in patient selection for preoperative therapy: race may affect accuracy of endoscopic ultrasonography

Ikoma¹,

Lee²,

Bhutani³

et al. 2017

J. Gastrointest. Oncol.

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Background: Over the last 15 years, large randomized controlled studies have validated the benefit of preoperative therapy for patients with resectable gastric cancer. Computed tomography (CT) and endoscopic ultrasonography (EUS) are commonly used to select patients for preoperative treatment, but studies of preoperative staging accuracy that focus on patient selection for preoperative therapy are rare; therefore, whether CT or EUS can reliably identify patients eligible for preoperative therapy is still unclear. Our purpose was to determine the accuracy of EUS and CT for preoperative staging of gastric cancer and to identify factors that may affect their usefulness in selecting patients for preoperative therapy. Methods:We reviewed the medical records of 8,260 patients with gastric or gastroesophageal adenocarcinoma treated at our institution from 1995 to 2013, identifying those who underwent gastrectomy without preoperative treatment. We compared T stage and N status from preoperative EUS and CT reports with those drawn from surgical pathology reports. Clinicopathologic and demographic variables associated with incorrect preoperative staging were investigated using univariate and multivariate analyses. Results:We identified 187 patients who underwent preoperative staging by EUS (n=145) and/or CT (n=134) before gastrectomy. The accuracy, sensitivity, and specificity of EUS in distinguishing stage T1 from more advanced tumors were 82%, 78%, and 85%, respectively. Variables associated with underestimation of EUS T stage were lymphovascular invasion [odds ratio (OR), 7.51; 95% confidence interval (CI), 1.91-29.50; P<0.01] and white race (OR, 3.75; 95% CI, 1.31-10.75; P=0.01). The accuracies, sensitivities, and specificities for determining N status were, respectively, 65%, 49%, and 79% with CT and 66%, 29%, and 95% with EUS. Lymphovascular invasion was associated with a false negative result (OR, 3.79; 95% CI, 1.34-10.70; P=0.01), and well-or moderately differentiated histology was associated with a false positive result for CT N status (OR, 7.14; 95% CI, 2.00-25.44; P<0.01).Conclusions: EUS is accurate in distinguishing T1 from T2-T4 lesions; both CT and EUS have low sensitivities and high specificities in determining N status. These accuracies and variables associated with inaccurate staging, including race, should be considered when selecting gastric cancer patients for preoperative therapy.

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“…The incidence is highest in Japan, Korea, China, Latin America and Eastern Europe. In western countries like the United States, the incidence is lower, with 21,000 new cases diagnosed each year [2]. Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.…”

Section: Introductionmentioning

confidence: 99%