Jia Xu1,2, Hui Cao2, Jun-Young Yang1, Yun-Suhk Suh1, Seong-Ho Kong1, Se-Hyung Kim3, Sang-Gyun Kim4, Hyuk-Joon Lee1,5,6, Woo-Ho Kim6,7, Han-Kwang Yang8,9,10. 1. Department of Surgery, Seoul National University Hospital, Seoul, Korea. 2. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. 3. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 5. Department of Surgery, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-Gu, Seoul, 110-744, Korea. 6. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. 7. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea. 8. Department of Surgery, Seoul National University Hospital, Seoul, Korea. hkyang@snu.ac.kr. 9. Department of Surgery, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-Gu, Seoul, 110-744, Korea. hkyang@snu.ac.kr. 10. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. hkyang@snu.ac.kr.
Abstract
BACKGROUND: Limited by the accuracy of preoperative staging, some cases of gastric cancer invading the muscularis propria (pT2) are underestimated as early gastric cancer (EGC) in the preoperative assessment. The aim of this present study was to determine prognostic factors and to propose indications for limited lymph node dissection in patients with clinically EGC (cEGC). METHODS: Patients of cEGC (n = 2072) who were postoperatively diagnosed as pT1 (cT1pT1, n = 1858) and pT2 (cT1pT2, n = 214) from 2005 to 2009 at Seoul National University Hospital were retrospectively analyzed. RESULTS: There was no difference in 5-year survival rate between the cT1pT1 and cT1pT2 group (95.5 % vs. 92.5 %, P = 0.059), and both groups had better overall survival than pT2 patients who were preoperatively diagnosed as locally advanced gastric cancer (cT2-4pT2), whose 5-year survival rate was 78.0 % (P < 0.001). Multivariate analysis indicated lymph node metastasis (LNM) was the independent prognostic factor for cEGC (P < 0.001). In cEGC patients, three preoperative factors, including N stage by multidetector-row computed tomography (MDCT) (P < 0.001), preoperative histological type (P < 0.001), and tumor size (P < 0.001), were associated with LNM by multivariate analysis. Regarding the possibility of LNM, low-risk (4.4 %) and high-risk (17.3 %) groups were developed based on weighted scores of the aforementioned independent three variables. Among 52 patients in the low-risk group, the extension of LNM was limited to the perigastric area. CONCLUSIONS: Comprehensive evaluation based on MDCT, preoperative histological type, and tumor size is an effective method to predict LNM and guide tailored LN dissection for cEGC.
BACKGROUND: Limited by the accuracy of preoperative staging, some cases of gastric cancer invading the muscularis propria (pT2) are underestimated as early gastric cancer (EGC) in the preoperative assessment. The aim of this present study was to determine prognostic factors and to propose indications for limited lymph node dissection in patients with clinically EGC (cEGC). METHODS:Patients of cEGC (n = 2072) who were postoperatively diagnosed as pT1 (cT1pT1, n = 1858) and pT2 (cT1pT2, n = 214) from 2005 to 2009 at Seoul National University Hospital were retrospectively analyzed. RESULTS: There was no difference in 5-year survival rate between the cT1pT1 and cT1pT2 group (95.5 % vs. 92.5 %, P = 0.059), and both groups had better overall survival than pT2 patients who were preoperatively diagnosed as locally advanced gastric cancer (cT2-4pT2), whose 5-year survival rate was 78.0 % (P < 0.001). Multivariate analysis indicated lymph node metastasis (LNM) was the independent prognostic factor for cEGC (P < 0.001). In cEGCpatients, three preoperative factors, including N stage by multidetector-row computed tomography (MDCT) (P < 0.001), preoperative histological type (P < 0.001), and tumor size (P < 0.001), were associated with LNM by multivariate analysis. Regarding the possibility of LNM, low-risk (4.4 %) and high-risk (17.3 %) groups were developed based on weighted scores of the aforementioned independent three variables. Among 52 patients in the low-risk group, the extension of LNM was limited to the perigastric area. CONCLUSIONS: Comprehensive evaluation based on MDCT, preoperative histological type, and tumor size is an effective method to predict LNM and guide tailored LN dissection for cEGC.
Entities:
Keywords:
Early gastric cancer; Lymph node metastases; Lymphadenectomy; Prognosis
Authors: S P Mönig; T K Zirbes; W Schröder; S E Baldus; D G Lindemann; H P Dienes; A H Hölscher Journal: AJR Am J Roentgenol Date: 1999-08 Impact factor: 3.959
Authors: Sung Wook Hwang; Dong Ho Lee; Sang Hyub Lee; Young Soo Park; Jin Hyeok Hwang; Jin Wook Kim; Sook Hyang Jung; Na Young Kim; Young Hoon Kim; Kyoung Ho Lee; Hyung-Ho Kim; Do Joong Park; Hye Seung Lee; Hyun Chae Jung; In Sung Song Journal: J Gastroenterol Hepatol Date: 2010-03 Impact factor: 4.029
Authors: Anis Rassi; Anis Rassi; William C Little; Sérgio S Xavier; Sérgio G Rassi; Alexandre G Rassi; Gustavo G Rassi; Alejandro Hasslocher-Moreno; Andrea S Sousa; Maurício I Scanavacca Journal: N Engl J Med Date: 2006-08-24 Impact factor: 91.245