Prognostic significance and the role in TNM stage of extranodal metastasis within regional lymph nodes station in gastric carcinoma

Abstract

The role of extranodal metastasis (ENM) in TNM stage in gastric carcinoma (GC) is controversial. This study was aimed to make a detailed investigation of the prognostic significance and the role in TNM stage of ENM in GC. The patients with primary GC, who underwent gastrectomy with curative intention in West China Hospital from January 2005 to December 2011, were retrospectively enrolled. The prognosis and clinicopathological traits were compared between ENM positive (ENMP) and negative (ENMN) groups in all patients, TNM I-II, III and IV stages, respectively. The significance of the number and the role in TNM stage of ENM were also assessed. In our study, 1457 patients were enrolled, with 1324 (90.9%) in ENMN group and 133 (9.1%) in ENMP group. ENMP group had significantly more advanced GC and worse prognosis (all p<0.05) than ENMN group in all patients, TNM I-II stages and TNM III stage. ENM>2 subgroup had remarkably larger tumor size (p=0.002) and more advanced N stage (p=0.016) than ENM=1-2 subgroup. The number of ENM was an independent prognostic factor in ENMP group (p=0.029). The prognosis of ENM>2 in TNM I-III stages was significantly worse than ENMN patients in TNM III stage. The C-index of TNM stage plus the number of ENM was significantly higher than that of current TNM stage alone (p=0.005). In conclusion, the patients in ENMP subgroup had more advanced GC and worse prognosis than those in ENMN subgroup. It might be more reasonable to categorize ENM>2 into TNM IV stage.

Prognostic significance and role in TNM stage of tumor deposits in esophageal cancer

“…The equally higher positive rate of TDs was seen in Nagtegaal (16) report who had integrated six studies with 1,520 patients of rectal cancer and concluded the positive rate of TDs in patients with rectal cancer was 26% (395/1,520). Chen (20) reported the positive rate of extranodal metastasis in gastric cancer was 9.1% (133/1,457), which was almost the same as our research. Thus, the rare found in patients with EC can be elucidated by the lower rate of TD positive rate partially.…”

“…Forth, in our study, TDP rate in both metastatic and non-metastatic lymph node group was 13.9% and 5.4% respectively (P=0.000). Additionally, in our study, the TDs were connected with more advanced N stage significantly (P<0.001), meanwhile the same results were found in rectum cancer (14,(22)(23)(24)(25) and gastric cancer (15,18,20,26,27), however, the N stage was not demonstrated to be related to TDs independently in our study but confirmed in Sakai (7) study (P=0.003; HR =1.089, 95% CI: 1.033-1.142), at the same time, Lee (26) study (P<0.001; HR =5.024, 95% CI 2.138-11.804) and Chen (20) study (P<0.001; OR =1.357, 95% CI: 1.152-1.599) found N stage was related to TDs in gastric cancer independently as well.…”

“…Wang (21) retrospectively researched 1,829 patients with rectum cancer, and concluded the positive rate of TDs was higher in T3 stage (65.7%) than in T2 stage (17.3%) and T4 stage (11.9%) but less in T1 stage (5.2%) (P<0.001; OR =1.332, 95% CI: 1.123-1.579). In the meantime, more advanced T stage was also found in extranodal metastasis group in Chen study (20), which was also independently correlated to the extranodal metastasis of gastric cancer (P=0.001; OR =1.395, 95% CI: 1.138-1.712).…”

“…Fifth, the poor prognosis of patients in TDP group can be observed via Kaplan-Meier curves and Cox proportional hazard regression model. And the prognostic significance of TDs was confirmed through the Cox proportional hazard regression (P=0.003; HR =2.633, 95% CI: 1.386-5.001), which was also demonstrated in few series about gastrointestinal surgery (17,18,20,21). Furthermore, in order to investigate the relationship between TD and the TNM stage, the prognosis of each TNM stage had been shown in our study, in which the significant difference of prognosis was found in TNM II stage and TNM III stage with both p value lower than 0.001.…”

Calcium Carbonate Nanoparticles Can Activate the Epithelial–Mesenchymal Transition in an Experimental Gastric Cancer Model

“…Gastric cancer (GC) is the fifth most common cancer in the world and has the third highest mortality rate [1,2]. Most cases of GC are diagnosed at an advanced stage with metastasis, and thus have poor prognosis [2,3]. In this regard, studying the mechanisms of GC progression is an urgent task and experimental modeling plays an important role.…”