A Tavares1,2, X Wen3,4,5, J Maciel6,7, F Carneiro3,4,8,9, M Dinis-Ribeiro10,11. 1. Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal. ameliassbtavares@gmail.com. 2. Faculty of Medicine, University of Porto, Porto, Portugal. ameliassbtavares@gmail.com. 3. Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal. 4. Institute for Research Innovation in Health (i3S), University of Porto, Porto, Portugal. 5. Department of Pathology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal. 6. Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal. 7. Faculty of Health Sciences, Universidade Fernando Pessoa, Porto, Portugal. 8. Department of Pathology, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal. 9. Department of Pathology, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal. 10. Department of Gastroenterology, Oncology Portuguese Institute of Porto, Porto, Portugal. 11. MEDCIDS/CINTESIS Faculty of Medicine, University of Porto, Porto, Portugal.
Abstract
INTRODUCTION: Regional lymph node metastasis is an important prognostic factor for patients with gastric cancer. Occult tumour cells (OTCs), including either micrometastases (MMs) or isolated tumour cells (ITCs), may be a key factor in the development of cancer recurrence in pN0 patients. AIMS: We aimed to determine the frequency and prognostic significance for disease recurrence of OTCs. MATERIALS AND METHODS: This retrospective cohort study included all consecutive patients with pN0 gastric adenocarcinoma between January 2000 and December 2011 (n = 73). Immunohistochemistry using the pan-cytokeratin antibody AE1/AE3 was used to detect OTCs in 1257 isolated lymph nodes. RESULTS: OTCs were identified in 30 patients (41%), including 20 cases with MMs (27%) and 10 cases with ITCs (14%). Disease recurrence and cancer-related death were observed in 24 (33%) and 20 patients (27%), respectively, and both were significantly associated with the detection of OTCs. A significant difference was also observed for the mean survival time between patients with OTCs and those without OTCs [100 vs 158 months (p = 0.015)]. The presence of OTCs was statistically significantly associated with the Lauren classification, tumour size and lymphatic permeation. Multivariate analyses revealed that only age, T stage and the presence of ITCs in lymph nodes were independent factors for recurrence. The presence of ITCs increased the risk for recurrence by 11.1-fold. CONCLUSIONS: In a significant proportion of patients diagnosed as stage pN0, OTCs may be identified in lymph nodes if carefully searched for, which can negatively affect their prognosis. The presence of ITCs was found to be an independent factor for recurrence and after proper validation should be considered during lymph node assessment for prognosis definition.
INTRODUCTION: Regional lymph node metastasis is an important prognostic factor for patients with gastric cancer. Occult tumour cells (OTCs), including either micrometastases (MMs) or isolated tumour cells (ITCs), may be a key factor in the development of cancer recurrence in pN0 patients. AIMS: We aimed to determine the frequency and prognostic significance for disease recurrence of OTCs. MATERIALS AND METHODS: This retrospective cohort study included all consecutive patients with pN0 gastric adenocarcinoma between January 2000 and December 2011 (n = 73). Immunohistochemistry using the pan-cytokeratin antibody AE1/AE3 was used to detect OTCs in 1257 isolated lymph nodes. RESULTS: OTCs were identified in 30 patients (41%), including 20 cases with MMs (27%) and 10 cases with ITCs (14%). Disease recurrence and cancer-related death were observed in 24 (33%) and 20 patients (27%), respectively, and both were significantly associated with the detection of OTCs. A significant difference was also observed for the mean survival time between patients with OTCs and those without OTCs [100 vs 158 months (p = 0.015)]. The presence of OTCs was statistically significantly associated with the Lauren classification, tumour size and lymphatic permeation. Multivariate analyses revealed that only age, T stage and the presence of ITCs in lymph nodes were independent factors for recurrence. The presence of ITCs increased the risk for recurrence by 11.1-fold. CONCLUSIONS: In a significant proportion of patients diagnosed as stage pN0, OTCs may be identified in lymph nodes if carefully searched for, which can negatively affect their prognosis. The presence of ITCs was found to be an independent factor for recurrence and after proper validation should be considered during lymph node assessment for prognosis definition.
Authors: A Nakajo; S Natsugoe; S Ishigami; M Matsumoto; S Nakashima; S Hokita; M Baba; S Takao; T Aikou Journal: Ann Surg Oncol Date: 2001-03 Impact factor: 5.344