Original Article

Langenbeck's Archives of Surgery

, Volume 394, Issue 1, pp 105-113

First online:

Occult disseminated tumor cells in lymph nodes of patients with gastric carcinoma. A critical appraisal of assessment and relevance

  • Peter ScheunemannAffiliated withDepartment of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Email author 
  • , Nikolas H. StoeckleinAffiliated withDepartment of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University
  • , Kai HermannAffiliated withDepartment of General Surgery, University Hospital Hamburg-Eppendorf
  • , Alexander RehdersAffiliated withDepartment of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University
  • , Claus F. EisenbergerAffiliated withDepartment of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University
  • , Wolfram T. KnoefelAffiliated withDepartment of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University
  • , Stefan B. HoschAffiliated withDepartment of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University

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Abstract

Background and aims

In gastric cancer, regional lymph node metastasis verified by histopathological examination is the most important prognostic factor after complete surgical tumor resection (R0). However, the prognostic value of immunohistochemically identifiable disseminated tumor cells in lymph nodes without histopathological tumor burden in patients with gastric cancer is still controversially discussed. The aim of the study was to assess the frequency and prognostic impact of minimal tumor cell spread to lymph nodes in these patients.

Patients–methods

One hundred sixty lymph nodes judged as “tumor free” on routine histopathology obtained from 58 patients with gastric adenocarcinoma were analyzed immunohistochemically using the monoclonal anti-EpCAM antibody Ber-EP4 for occult disseminated tumor cells.

Results

Tumor cells in lymph nodes were detected in 62 (38.8%) of the 160 “tumor-free” lymph nodes obtained from 39 (67.2%) patients. Multivariate Cox regression analysis confirmed the presence of disseminated tumor cells in “tumor-free” lymph nodes as an independent prognostic factor for both a significantly reduced relapse-free survival (p = 0.008) and overall survival (p = 0.009).

Conclusions

The frequent occurrence and prognostic impact of minimal disseminated tumor cells in lymph nodes of patients with gastric carcinoma support the need for a refined staging system of excised lymph nodes, which should include immunohistochemical examination.

Keywords

Disseminated tumor cells Micrometastasis Minimal residual disease Lymph nodes Gastric carcinoma