高利雄,Xiankun Ren,Guiquan Li,Benhua Wu,Xuan Chen. Influence of lymph node micrometastasis on the staging system for gastric cance. Oncol Transl Med, 2020, 6: 266-271. |
Influence of lymph node micrometastasis on the staging system for gastric cance |
Received:May 12, 2020 Revised:July 09, 2020 |
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KeyWord:gastric cancer; lymph node micrometastasis; TNM stage |
Author Name | Affiliation | E-mail | 高利雄 | Department of Gastroenterology, Medical Center Hospital of Qionglai | xiangxiangxiaohu@163.com | Xiankun Ren | Department of Gastroenterology, Medical Center Hospital of Qionglai | | Guiquan Li | Department of Gastroenterology, Medical Center Hospital of Qionglai | | Benhua Wu | Department of Gastroenterology, Medical Center Hospital of Qionglai | | Xuan Chen | Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University | |
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Abstract: |
Objective The aim of this study was to investigate the effect of lymph node micrometastasis on the
prognosis of patients with gastric cancer and the necessity of integrating it into the gastric cancer staging
system.
Methods In total, 241 patients with gastric cancer were included. Hematoxylin and eosin staining of
lymph nodes was performed, and negative lymph nodes were evaluated by immunohistochemistry to detect
micrometastases. Differences in survival rates between stages were evaluated.
Results (1) A total of 78 patients (32.4%) had lymph node micrometastases. Compared with the group
without micrometastases, the overall recurrence rate, lymph infiltration, vascular invasion, and nerve
invasion rate in the micrometastasis group were significantly higher (P < 0.05). (2) According to the
standard N staging system, the rates of disease-free survival (DFS) for the N0, N1, N2, N3a, and N3b
groups were 96.0%, 84.0%, 67.6%, 59.0%, and 21.7%, respectively. There was no significant difference
in survival between N2 and N3a. The cumulative survival curves for N2 and N3a intersected. (3) The
N stage of 38 patients (15.8%) differed between the traditional system and the new N staging system
reflecting micrometastasis. The DFS for N0, N1, N2, N3a, and N3b were 97.0%, 86.3%, 74.2%, 65.4%,
and 29.2%, respectively. There was no significant difference in survival between N2 and N3a, but the
cumulative survival curves for N2 and N3a did not intersect. (4) Based on a Cox multivariate analysis,
various independent risk factors for recurrence were identified (P < 0.05).
Conclusion Lymph node micrometastasis is an important risk factor for gastric cancer recurrence.
Lymph node micrometastasis should be considered in TNM staging to determine prognosis and optimal
treatment strategies. |
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