Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer

Chen, Zheng; Gao, Zhiqiang; Sun, An-Qi; Huang, Haibo; Wang, Zhenning; Li, Kai; Gao, Shan

doi:10.12998/wjcc.v7.i18.2712

Cited by 3 publications

(3 citation statements)

References 34 publications

(29 reference statements)

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“…First, this is a retrospective study with inherent selection bias, the clinical characteristics are quite different in the 2 comparison groups. 16 So we have used the PSM analysis to lessen the baseline differences from nonrandom assignments. Second, given the heterogeneity of GNEC, its prognosis is also significantly impacted by the clinical settings.…”

Section: Discussionmentioning

confidence: 99%

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

Chu

et al. 2021

Technol Cancer Res Treat

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Objectives: Gastric neuroendocrine carcinoma (GNEC) is a class of rare histological subtypes in gastric cancer (GC). This retrospective case-control study aimed to explore the clinicopathological features and overall survival (OS) of patients with GNEC. Methods: A large population of GNEC and intestinal-type GC (IGC) patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The 1:1 propensity score matching (PSM) analysis was initiated to adjust the confounders between GNEC and IGC cohorts. Kaplan-Meier (KM) plots with log-rank tests were used to compare the survival differences in GNEC versus IGC. Additionally, Cox proportional hazard regression models were adopted to characterize the prognostic factors relevant to OS of the GNEC patients. Results: An entity of 4596 patients were collected, including 3943 (85.8%) IGC patients and 653 (14.2%) GNEC patients. The PSM analysis well-balanced all confounders in GNEC versus IGC (all P > .05). The KM plots showed that GNEC had significantly superior OS to IGC both before and after PSM analysis. Before PSM, the median OS was 52 (33.6-70.4) months in GNEC versus 32 (29.3-34.7) months in IGC ( P = .0015). After PSM, the median OS was 26 (18.3-33.7) months in GNEC versus 21 (17.7-24.3) months in IGC ( P = .0039). Stratified analysis indicated that GNEC had superior survivals to IGC in early stage patients and those who received surgery. In Cox regression analysis, age ≥ 60, tumor size > 50 mm, stage II-IV, T2, and N3 were independent risk factors for the GNEC patients (hazard ratio [HR]>1, P < .05). By contrast, year 2010 to 2015, female, and surgery were independent protective factors for these patients (HR < 1, P < .05). Conclusions: GNEC has unique clinicopathological features quite different from IGC and may have a superior survival to IGC in early stage patients. The prognostic factors identified here may assist the clinicians to more individually treat these patients.

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Section: Discussionmentioning

confidence: 99%

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

Chu

et al. 2021

Technol Cancer Res Treat

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“…Several retrospective studies (10,22,23,27,28) have confirmed that adding 14v to D2 dissection improves survival outcomes for patients with distal advanced GC (Table II). Eom et al (22) confirmed that 14v dissection improves the OS rates of patients with clinical stage III/IV GC in the middle or lower third of the stomach.…”

Section: No 14v Ln Dissection For Distal Local Advanced Gcmentioning

confidence: 95%

Current status of extended ‘D2 plus’ lymphadenectomy in advanced gastric cancer (Review)

Liang

2021

Oncol Lett

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The extent of lymph node (LN) dissection has been a topic of interest in gastric cancer (GC) surgery. D2 lymphadenectomy is considered the standard surgical procedure for most resectable advanced GC cases. The value and indications of more extended lymphadenectomy than D2 remain unclear. Currently, the controversial stations beyond the D2 range are mainly focused on no. 14v, no. 16a2/b1 and no. 13 LN stations. The metastatic rate of no. 14v LN is relatively high in advanced distal GC, particularly in patients with suspicious no. 6 LN metastasis. D2 plus no. 14v LN dissection may be attributed to improved survival outcomes for patients with obvious no. 6 LN metastasis. Although GC with para-aortic lymph node (PALN) metastases is considered an M1 disease beyond surgical cure, patients with limited PALN metastases may benefit from the treatment strategy of adjuvant chemotherapy followed by D2 plus no. 16a2-b1 LN dissection. In addition, D2 plus no. 13 LN dissection may be an option in a potentially curative gastrectomy for GC with duodenal invasion. The present review discusses the current status and future perspectives of D2 plus lymphadenectomy.

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“…From the viewpoint of the distance from the tumor to the main lymphatic flow, presumably, GC located on the greater curvature wall is more likely to metastasize to lymph node station No.6 (16), which has lymphatic flow to stations No.14v and No.16, making lymphadenectomy difficult (17)(18)(19). Jung et al reported a worse prognosis in patients with GC on the greater curvature than those in patients with GC with other locations (15).…”

Section: Comparisons Of 5-year Overall Survival (Os) Rates According ...mentioning

confidence: 99%

Tumor Location on the Vertical Section of the Anterior Wall Is Related to Favorable Prognosis and Low Incidence of Lymph Node Metastasis in Lower-third Gastric Cancer

et al. 2021

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Background/Aim: This retrospective study investigated the clinical significance of vertical location in gastric cancer (GC) and the optimal treatment strategy according to the vertical location. Patients and Methods: Between 1997 and 2018, 1,304 consecutive patients with GC who underwent curative surgical resection with lymphadenectomy were analyzed retrospectively. Results: Patients with GC in the anterior wall (AW) had a significantly better prognosis compared to those in other sites of the lower third stomach (p=0.040). Multivariate analysis showed that tumor location in the AW was an independent prognostic factor and was associated with a lower incidence of lymph node metastasis (LNM) (p=0.023). The frequency of LNM in the area of D2 was lower in patients with AW GC than those with GC in other locations. Conclusion: Patients with AW GC had a favorable prognosis, with a lower incidence of LNM in lower-third GC.

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Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer

Cited by 3 publications

References 34 publications

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

Current status of extended ‘D2 plus’ lymphadenectomy in advanced gastric cancer (Review)

Tumor Location on the Vertical Section of the Anterior Wall Is Related to Favorable Prognosis and Low Incidence of Lymph Node Metastasis in Lower-third Gastric Cancer

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