Recurrence in early gastric cancer with lymph node metastasis

Saka, Makoto; Katai, Hitoshi; Fukagawa, Takeo; Nijjar, Rajwinder; Sano, Takeshi

doi:10.1007/s10120-008-0485-4

Cited by 87 publications

(59 citation statements)

References 19 publications

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“…Seven out of 17 patients with hematogenous metastasis had lymph node metastasis and 10 out of 51 patients with lymph node metastasis had vessel invasion, showing a positive correlation between them. This discovery supports the hypothesis that hematogenous recurrence of EGC may be caused by vessel involvement by malignant cells in the mucosal and submucosal layers (20). Histological differentiation status also strongly correlated with hematogenous metastasis (HR=3.65), with well/moderately differentiated tumors more frequently involved in hematogenous metastasis.…”

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confidence: 82%

Long-term survival results and prognostic factors of early gastric cancer

Huang

Wang

Xing

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. In spite of the favorable prognosis of early gastric cancer (EGC), recurrence or second primary cancers present in certain patients after curative surgery. It is crucial to identify who are at high risk and when. In the present study, 323 patients with EGC who underwent curative surgery were studied. A total of 22 patients (6.8%) died of recurrence, 9 patients (2.8%) died of a second primary cancer and 65 patients (20.1%) died of comorbid diseases during the 0.3-33 years of follow-up. Among the 22 patients with recurrence, hematogenous metastases were noted in over half of the cases (77.3%, 17/22); of these cases 15 patients had a recurrence within the first decade after surgery. Histological differentiation and nodal status were correlated with recurrence. Among the second primary cancers, remnant gastric, liver, lung and colon were the most common sites, and the second primary cancers primarily occurred in the second decade after surgery (6/9). Multivariate analysis identified nodal status (HR=4.20), vessel involvement (HR=3.40) and histological differentiation (HR=3.52) as independent prognostic factors for disease-free survival. However, gender, age and differentiation were independent influencing factors for overall survival. Comorbid diseases, recurrence and second primary cancers are the main cause of death in EGC patients after curative resection. Thus, treatment of comorbid diseases and a periodic follow-up schedule may contribute to improved prognosis. IntroductionEarly gastric cancer (EGC) is defined as gastric carcinoma confined to the mucosa and/or submucosa irrespective of lymph node involvement and tumor size, according to the Japanese Classification of Gastric Carcinoma (JCGC) (1). Compared to advanced gastric cancer (AGC), EGC has a more favorable prognosis after curative resection; the 5-year survival rate is higher than 90% in Japan (2), Korea (3), and slightly lower in Italy, France and the US (4-6). In spite of the very favorable prognosis of EGC, recurrence or second primary cancers present in certain patients after curative surgery, with the recurrence or second primary cancer rate varying from 1.4 to 13.7% (5,7-11). It is crucial to understand the prognostic factors and features of recurrence in patients with EGC and to identify who are at high risk and when; a subsequent follow-up schedule or adjuvant therapy may be considered accordingly.The incidence of EGC is approximately 10% among in-patients with gastric carcinoma in China. However, due to the relatively low incidence of recurrence and favorable prognosis after curative resection for EGC, relevant studies have been limited. Furthermore, most previous reports have focused on short-term survival results and few have investigated survival over 10 years (4,5,7,(9)(10)(11). In the present study, we assessed the long-term survival profiles of patients with EGC at our single institute through 0.3-33 years of follow-up. Survival rate, characteristics of recurrence and causes of death were analyzed, and prognostic factors were als...

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Section: For Hr ---------------------------------------supporting

confidence: 82%

Long-term survival results and prognostic factors of early gastric cancer

Huang

Wang

Xing

et al. 2011

Experimental and Therapeutic Medicine

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“…The presence of lymph node metastasis is the most important prognostic factor in EGC [14][15][16][17]. Radical surgery with lymph node dissection has provided an excellent therapeutic outcome; the 5-year survival rate after curative resection is more than 90%, including fi ndings in recent European series [4,14,[16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Radical surgery with lymph node dissection has provided an excellent therapeutic outcome; the 5-year survival rate after curative resection is more than 90%, including fi ndings in recent European series [4,14,[16][17][18][19][20][21]. In Japan, analyses of databases containing a large number of pathology reports, patients' histories, and long-term survival data from major leading hospitals have demonstrated that the 5-year cancer-specifi c survival rates of EGC limited to the mucosa or the submucosa are 99% and 95%, respectively [4].…”

Section: Discussionmentioning

confidence: 99%

Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Gotoda²,

et al. 2009

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“…Although the outcome of patients with EGC following curative surgery is excellent, cancer recurrence is a rare event and could occur even after curative gastrectomy with an incidence of 1.4-2.7% (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Metachronous liver and bone metastasis from small early gastric carcinoma without lymph node involvement: A case report

Namikawa

Shiga

Ichikawa

et al. 2012

Molecular and Clinical Oncology

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Abstract.A 65-year-old man was referred to our Hospital for examination of gastric cancer initially diagnosed by medical check-up. Esophagogastroduodenoscopy demonstrated a superficial depressed-type gastric cancer in the antrum, and abdominal computed tomography showed no evidence of distant metastases. A tumor measuring 11 mm in diameter was removed by endoscopic submucosal dissection (ESD). Since histological examinations of ESD specimens showed a well-differentiated adenocarcinoma invading the submucosal layer with lymphatic invasion, the patient subsequently underwent laparoscopy-assisted distal gastrectomy with regional lymph node dissection, resulting in no residual carcinoma and no lymph node metastasis. The patient developed solitary liver metastasis one year later and was treated with trastuzumab plus capecitabine/cisplatin since results of the immunohistochemical analysis of the resected specimens demonstrated overexpression of the human epidermal growth factor receptor 2 (HER2). The patient was alive 12 months after surgical resection of the liver metastasis and subsequently developed bone metastasis. Controversy remains over the role of HER2 status as a prognostic factor in gastric cancer. However, it has been generally reported that HER2 overexpression correlates with aggressive biological behavior and poor prognosis. HER2 overexpression is a potentially useful predictive factor for tumor recurrence and poor prognosis even in early gastric cancer cases. IntroductionEarly gastric cancer (EGC) is defined as the presence of a lesion confined to the mucosa or submucosa, regardless of the presence of regional lymph node metastasis, and has a good prognosis with appropriate treatment (1). Although the outcome of patients with EGC following curative surgery is excellent, cancer recurrence is a rare event and could occur even after curative gastrectomy with an incidence of 1.4-2.7% (2-5).Endoscopic resection with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is widely accepted as the standard treatment for EGC without lymph node metastasis and enables a clinician to resect a target lesion en bloc (6,7). Most EGC confined to the mucosa can be curatively treated by endoscopic resection, since lymph node metastasis is rare in such cases. Endoscopic resection is currently considered appropriate for the treatment of intestinaltype gastric cancer cases without central ulceration that are <2 cm in diameter, according to guidelines for EMR/ESD established by the Japanese Gastric Cancer Association (7). However, gastrectomy with lymph node dissection should be performed in patients with submucosal invasion with or without margin involvement following endoscopic resection (8,9).In this study, a case of metachronous liver and bone metastasis after laparoscopy-assisted distal gastrectomy is described, following initial treatment by ESD for small EGC without lymph node metastasis, showing human epidermal growth factor receptor 2 (HER2) overexpression. All diagnostic procedures and therapy...

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Recurrence in early gastric cancer with lymph node metastasis

Cited by 87 publications

References 19 publications

Long-term survival results and prognostic factors of early gastric cancer

Long-term survival results and prognostic factors of early gastric cancer

Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Metachronous liver and bone metastasis from small early gastric carcinoma without lymph node involvement: A case report

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