Yoon Young Choi1, Ji Yeong An1, Ali Guner1, Dae Ryong Kang2, In Cho1,3, In Gyu Kwon1,4, Hyun Beak Shin1, Woo Jin Hyung1, Sung Hoon Noh5,6. 1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. 2. Department of Medical Humanities & Social Medicine, Office of Biostatistics, Ajou University School of Medicine, Seoul, Republic of Korea. 3. Department of Surgery, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea. 4. Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea. 5. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. jar319@yuhs.ac. 6. Brain Korea 21 PLUS Project for Medical Science, Seoul, Republic of Korea. jar319@yuhs.ac.
Abstract
BACKGROUND: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. METHODS: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. RESULTS: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95% confidence interval 1.13-2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95% confidence interval 0.92-2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). CONCLUSIONS: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.
BACKGROUND: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. METHODS: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. RESULTS: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95% confidence interval 1.13-2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95% confidence interval 0.92-2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). CONCLUSIONS: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.
Authors: Fania S Doekhie; Wilma E Mesker; J Han J M van Krieken; Niels F M Kok; Henk H Hartgrink; Elma Klein Kranenbarg; Hein Putter; Peter J K Kuppen; Hans J Tanke; Rob A E M Tollenaar; Cornelis J H van de Velde Journal: Am J Surg Pathol Date: 2005-09 Impact factor: 6.394
Authors: Gennaro Galizia; Eva Lieto; Annamaria Auricchio; Francesca Cardella; Andrea Mabilia; Anna Diana; Paolo Castellano; Ferdinando De Vita; Michele Orditura Journal: PLoS One Date: 2017-04-05 Impact factor: 3.240