Naruhiko Ikoma1, Jeannelyn S Estrella2, Mariela Blum3, Prajnan Das4, Hsiang-Chun Chen5, Xuemei Wang5, Keith Fournier1, Paul Mansfield1, Jaffer Ajani3, Brian D Badgwell6. 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA. 2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA. bbadgwell@mdanderson.org.
Abstract
BACKGROUND: It is unclear how preoperative therapy for gastric cancer affects the metastasis rate of lymph nodes (LNs) and whether the location of positive LNs affects survival after preoperative therapy. Therefore, we determined the association between positive central lymph nodes (CnLNs) and disease stage and overall survival (OS). METHODS: We reviewed a prospectively maintained database to identify patients who had undergone resection of gastric adenocarcinoma at our institution from 2005 to 2015. CnLNs were defined as common hepatic, celiac, and proximal splenic artery LNs (stations no. 8, 9, and 11p). The frequency of CnLN metastases and risk factors affecting OS were examined. RESULTS: We identified 356 patients. Preoperative therapy was administered to 66% of patients. D2 LN dissection was performed in 80% of patients, and the median number of LNs examined was 25 (IQR, 18-34). In 243 patients (68%), CnLNs had undergone separate pathologic examination; the CnLN-positive rate was 9.1% (22 of 243; station no. 8, 4.5%; no. 9, 2.1%; and no. 11p, 4.8%). CnLN metastasis was associated with shorter 3-year OS in patients with pN2/3 disease (33 vs. 62%; p = 0.004). Among patients who had undergone preoperative therapy, ypT3-4 stage (HR 2.44; p = 0.01) and positive CnLNs (HR 5.44; p < 0.001) were negatively associated with OS by multivariate analysis. CONCLUSIONS: CnLN metastases are uncommon in gastric cancer and have an adverse effect on OS in patients who have undergone preoperative therapy. Larger multi-institutional studies are needed to determine whether CnLN positivity requires a separate staging category after preoperative therapy.
BACKGROUND: It is unclear how preoperative therapy for gastric cancer affects the metastasis rate of lymph nodes (LNs) and whether the location of positive LNs affects survival after preoperative therapy. Therefore, we determined the association between positive central lymph nodes (CnLNs) and disease stage and overall survival (OS). METHODS: We reviewed a prospectively maintained database to identify patients who had undergone resection of gastric adenocarcinoma at our institution from 2005 to 2015. CnLNs were defined as common hepatic, celiac, and proximal splenic artery LNs (stations no. 8, 9, and 11p). The frequency of CnLN metastases and risk factors affecting OS were examined. RESULTS: We identified 356 patients. Preoperative therapy was administered to 66% of patients. D2 LN dissection was performed in 80% of patients, and the median number of LNs examined was 25 (IQR, 18-34). In 243 patients (68%), CnLNs had undergone separate pathologic examination; the CnLN-positive rate was 9.1% (22 of 243; station no. 8, 4.5%; no. 9, 2.1%; and no. 11p, 4.8%). CnLN metastasis was associated with shorter 3-year OS in patients with pN2/3 disease (33 vs. 62%; p = 0.004). Among patients who had undergone preoperative therapy, ypT3-4 stage (HR 2.44; p = 0.01) and positive CnLNs (HR 5.44; p < 0.001) were negatively associated with OS by multivariate analysis. CONCLUSIONS:CnLN metastases are uncommon in gastric cancer and have an adverse effect on OS in patients who have undergone preoperative therapy. Larger multi-institutional studies are needed to determine whether CnLN positivity requires a separate staging category after preoperative therapy.
Authors: Naruhiko Ikoma; Hsiang-Chun Chen; Xuemei Wang; Mariela Blum; Jeannelyn S Estrella; Keith Fournier; Paul Mansfield; Jaffer Ajani; Brian D Badgwell Journal: Ann Surg Oncol Date: 2017-03-22 Impact factor: 5.344
Authors: Jaffer A Ajani; Thomas A D'Amico; Khaldoun Almhanna; David J Bentrem; Joseph Chao; Prajnan Das; Crystal S Denlinger; Paul Fanta; Farhood Farjah; Charles S Fuchs; Hans Gerdes; Michael Gibson; Robert E Glasgow; James A Hayman; Steven Hochwald; Wayne L Hofstetter; David H Ilson; Dawn Jaroszewski; Kimberly L Johung; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; Stephen Leong; Catherine Linn; A Craig Lockhart; Quan P Ly; Mary F Mulcahy; Mark B Orringer; Kyle A Perry; George A Poultsides; Walter J Scott; Vivian E Strong; Mary Kay Washington; Benny Weksler; Christopher G Willett; Cameron D Wright; Debra Zelman; Nicole McMillian; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2016-10 Impact factor: 11.908
Authors: Jaffer A Ajani; David J Bentrem; Stephen Besh; Thomas A D'Amico; Prajnan Das; Crystal Denlinger; Marwan G Fakih; Charles S Fuchs; Hans Gerdes; Robert E Glasgow; James A Hayman; Wayne L Hofstetter; David H Ilson; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; A Craig Lockhart; Kenneth Meredith; Mary F Mulcahy; Mark B Orringer; James A Posey; Aaron R Sasson; Walter J Scott; Vivian E Strong; Thomas K Varghese; Graham Warren; Mary Kay Washington; Christopher Willett; Cameron D Wright; Nicole R McMillian; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2013-05-01 Impact factor: 11.908
Authors: M Degiuli; M Sasako; A Ponti; A Vendrame; M Tomatis; C Mazza; A Borasi; L Capussotti; G Fronda; M Morino Journal: Br J Surg Date: 2014-01 Impact factor: 6.939
Authors: Naruhiko Ikoma; Jeannelyn S Estrella; Wayne L Hofstetter; Jaffer A Ajani; Keith F Fournier; Paul F Mansfield; John M Skibber; Brian D Badgwell Journal: J Gastrointest Surg Date: 2018-07-27 Impact factor: 3.452