Paraaortic lymph node micrometastasis and tumor cell microinvolvement in advanced gastric carcinoma

Natsugoe, Shoji; Nakashima, Saburo; Matsumoto, Masataka; Nakajo, Akihiro; Miyazono, Futoshi; Kijima, Fumio; Ishigami, Sumiya; Aridome, Kuniaki; Hokita, Shuichi; Baba, Masamichi; Takao, Sonshin; Aikou, Takashi

doi:10.1007/s101200050043

Cited by 31 publications

(17 citation statements)

References 23 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This behavior of ITC is consistent with the concept that lymph node metastases proceed from the perigastric area to the next area in order. ITC were found even in distant lymph nodes, including paraaortic lymph nodes, as reported before [21]. This shows that ITC can also reach lymph node stations far away from the primary tumor, but further discussion may have to be limited because only a proportion of patients in the present study underwent super-extended lymph node dissection including the paraaortic area.…”

Section: Discussionsupporting

confidence: 79%

The prognostic significance of isolated tumor cells in the lymph nodes of gastric cancer patients

et al. 2010

Self Cite

View full text Add to dashboard Cite

presence/absence of lymph node, peritoneal, and distant metastases. Complete tumor removal is deemed to be the only potentially curative treatment in patients with gastric cancer. Locally advanced gastric cancer frequently recurs after a curative operation, and even early gastric cancer relapses occasionally [1]. In patients with recurrent disease, it is considered that such disease arises, presumably from residual tumor cells, in the form of occult micrometastases, left behind at the time of apparently curative surgery.Recent advances in immunohistochemistry (IHC) and molecular biological techniques [2] allow the identifi cation of discrete and occult tumor cells in the lymph nodes [3], peripheral [4] blood, and bone marrow [5][6][7] of patients with malignant diseases that remain undetected during routine pathological examination. After some debate regarding the terminology for occult tumor cells, micrometastases (MM) are now defi ned as deposits of tumor cells measuring 2 mm or less but larger than 0.2 mm, while the term "isolated tumor cells (ITC)" refers to single tumor cells or clusters of tumor cells measuring 0.2 mm or less [8,9]. The prevalence and prognostic signifi cance of ITC are still controversial.The aim of this study was to analyze whether the presence of ITC in the lymph nodes of gastric cancer patients treated by curative resection portends a worse prognosis. Methods PatientsA total of 402 patients with pathological T2N0M0 or T2N1M0 gastric cancer (T2, tumor invades the muscularis propria or subserosa, N0, no lymph node metastases; N1, with perigastric lymph node metastases; M0, no distant metastases) who underwent gastrectomy with

show abstract

Section: Discussionsupporting

confidence: 79%

The prognostic significance of isolated tumor cells in the lymph nodes of gastric cancer patients

et al. 2010

Self Cite

View full text Add to dashboard Cite

show abstract

“…In patients with advanced gastric cancer, the reported incidence of pathological metastasis to the PALNs is 8.5-30.0% (4)(5)(6)(7)(8). In one study, micrometastasis was detected by immunohistochemical staining in 64% of patients who underwent prophylactic PALN dissection (9). In several Japanese specialized centers, including ours, prophylactic PALN dissection was aggressively performed for advanced gastric cancer from the 1980s to the early 1990s.…”

mentioning

confidence: 92%

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Kaito

Kinoshita

Tokunaga

et al. 2017

View full text Add to dashboard Cite

Abstract. Background: The role of para-aortic lymph node (PALN) dissection for far-advanced gastric cancer is controversial in patients with tumor diameter of ≥120 mm (HR=3.37;. Patients with none of these factors survived significantly longer than those with any of these factors respectively; p<0.001). Conclusion: Pathologically PALN-positive patients achieve long survival; however, the indications for PALN dissection should be carefully considered.Para-aortic lymph node (PALN) metastasis from gastric cancer is classified as distant metastasis in both the 7th classification of the International Union against Cancer (1) and the 3rd English edition of the Japanese Gastric Cancer Classification (2). Thus, systemic chemotherapy is recommended as first-choice treatment in the current guidelines (3). In patients with advanced gastric cancer, the reported incidence of pathological metastasis to the PALNs is 8.5-30.0% (4-8). In one study, micrometastasis was detected by immunohistochemical staining in 64% of patients who underwent prophylactic PALN dissection (9). In several Japanese specialized centers, including ours, prophylactic PALN dissection was aggressively performed for advanced gastric cancer from the 1980s to the early 1990s. In 1995, a multi-institutional prospective randomized controlled trial comparing standard D2 dissection versus D2 plus PALN dissection for serosa-positive advanced gastric cancer without gross metastasis to the PALNs was conducted in Japan (JCOG9501) (10). This trial proved that the 5-year overall survival (OS) rates did not differ between the two groups (69.2% vs. 70.3%, respectively) and concluded that prophylactic PALN dissection is not effective (6). However, the incidence of pathologically positive PALNs in this trial was only 8.5%; thus, the benefit of PALN dissection for those patients could not be fully investigated.In general, the prognosis of patients with pathologicallypositive PALNs is thought to be unfavorable, even after systematic PALN dissection. However, it is known that a certain subpopulation of these patients can achieve long survival. The reported postoperative 5-year survival rate of patients with pathologically-positive PALNs is 16-25% (4, 6, 8, 11, 12). Due to progress in modern powerful perioperative chemotherapy regimens, it was recently suggested that the prognosis of these patients can be improved. A recent phase II trial (JCOG 0405) investigated the feasibility of neoadjuvant chemotherapy (2-3 cycles of S1+cisplatin) followed by radical gastrectomy with systematic PALN dissection for patients with clinically diagnosed metastasis to the PALNs (13). The R0 resection rate was 82% and the 5-year OS rate 57%. These 3685

show abstract

“…Stachura et al 34 , in 1998, after had studied retrospectively 40 patients with early gastric cancers for the presence of micrometastasis in regional lymph nodes by cytokeratin 18 immunostaining related that micrometastasis had no effect on patients survival and takes more than the diagnosis of micrometastasis alone to estimate its real prognostic significance in theirs series. Fukawaga et al 5 Reversely, there are several authors that agree that there is significant difference in prognostic and survival among patients with and without lymph node micrometastasis 8,9,10,17,19,26,28,39 . Ishida et al 9 , in 1997, reported 2446 lymph nodes removed from 109 gastric cancer patients stained with hematoxilin-eosin, Alcian blue in combination with periodic acid-Schiff stain and antibodies against cytokeratin and carcinoembryonic antigen (CEA).…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of occult lymph node micrometastasis in gastric cancer: a histochemical and immunohistochemical study based on 1997 UICC TNM and 1998 JGCA classifications

Dell'Aquila

Lopasso

Falzoni

et al. 2008

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

BACKGROUND: Micrometastasis is a single or a cluster of malignant cells inside the lymph node that are not detected by routine histopathological sections. Micrometastasis is related to poorer prognosis in many gastric cancer studies the real significance of these cells is still controversial. AIM: To evaluate if lymph node micrometastasis is a significant independent prognostic factor and important risk factor for recurrence in gastric cancer. METHODS: A total of 1290 lymph nodes from 28 patients with gastric cancer, since 1998 until 2003, treated by radical resection (D2 and modified D3 lymphadenectomies) were studied. Three sections per lymph node were stained by Hematoxilin-Eosin, histochemical (AB-PAS) and immunohistochemical (AE1-AE3) techniques. Kaplan-Meier's survival curves and Log-rank/Cox tests were used in order to compares lymph node micrometastasis positivity, depth (pT) and location of tumor in gastric wall, histologic type, lymphatic, vascular and perineural invasion, lymph node status (pN) and stage. RESULTS: There were worse prognosis and recurrence in patients with positive lymph node micrometastasis related to vascular and perineural invasions, advanced lymph node status and advanced stages. CONCLUSION: Lymph node micrometastasis seems to be a significant independent prognostic factor and important risk factor for recurrence in gastric cancer, in a context of radical D2 lymphadenectomy

show abstract

Paraaortic lymph node micrometastasis and tumor cell microinvolvement in advanced gastric carcinoma

Cited by 31 publications

References 23 publications

The prognostic significance of isolated tumor cells in the lymph nodes of gastric cancer patients

The prognostic significance of isolated tumor cells in the lymph nodes of gastric cancer patients

Prognostic Factors and Recurrence Pattern of Far-advanced Gastric Cancer with Pathologicallypositive Para-aortic Lymph Nodes

Prognostic significance of occult lymph node micrometastasis in gastric cancer: a histochemical and immunohistochemical study based on 1997 UICC TNM and 1998 JGCA classifications

Contact Info

Product

Resources

About