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Extranodal Extension of Nodal Metastases Is a Poor Prognostic Indicator in Gastric Cancer: a Systematic Review and Meta-analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The extranodal extension (ENE) of nodal metastases (the extension of neoplastic cells through the nodal capsule into the perinodal soft tissue) is a histological feature that has been considered a prognostic factor in several cancers, but the role in gastric cancer was not yet investigated. We aimed to investigate the prognostic role of ENE in patients affected by gastric cancer through a systematic review and meta-analysis.

Material and Methods

Two independent authors searched major databases until 09/30/2015 to identify studies providing data on gastric cancer patients’ prognostic parameters and comparing patients with ENE (ENE+) vs intra-nodal extension (ENE−). The data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) with 95 % confidence intervals (CI), adjusted for potential confounders.

Results

Nine studies followed up 3250 patients with gastric cancer (1064 ENE+ and 2186 ENE−). ENE+ was associated with a significantly higher risk of all-cause mortality (RR = 1.70; 95 % CI: 1.43–2.03, I 2 = 66 %; HR = 2.14; 95 % CI: 1.66–2.75, I 2 = 0 %), cancer-specific mortality (RR = 1.59; 95 % CI: 1.42–1.79; HR = 1.52; 95 % CI: 1.19–1.96), and disease recurrence (RR = 3.43, 95 % CI: 1.80–6.54, I 2 = 0 %).

Discussion

Judging from our results, ENE in gastric cancer patients should be considered for prognostic purposes from the gross sample to the pathology report.

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Acknowledgments

Mattia Barbareschi was supported by Trentino Biomolecular Oncologic Network—TreBiONet: “Fondazione Cassa di Risparmio di Trento e Rovereto.”

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Author notes

    Authors and Affiliations

    1. Department of Medicine, DIMED, University of Padua, Padua, Italy

      Nicola Veronese, Matteo Fassan, Giuseppe Sergi, Enzo Manzato & Sara Carraro

    2. Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA

      Laura D. Wood

    3. Health Service and Population Research Department, King’s College London, De Crespigny Park, London, UK

      Brendon Stubbs

    4. Department of Neuroscience, University of Padua, Padua, Italy

      Marco Solmi

    5. Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy

      Paola Capelli, Alessia Nottegar, Ivana Cataldo & Claudio Luchini

    6. Department of Surgery, University and Hospital trust of Verona, Verona, Italy

      Antonio Pea & Fabio Bagante

    7. Medical Oncology Unit, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy

      Marco Maruzzo

    8. Department of Pathology, Santa Chiara Hospital, Trento, Italy

      Mattia Barbareschi & Claudio Luchini

    9. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

      Liang Cheng

    10. Division of General and Upper GI Surgery, Department of Surgery, University and Hospital trust of Verona, Verona, Italy

      Maria Bencivenga & Giovanni de Manzoni

    11. ARC-NET Research Center, University and Hospital Trust of Verona, Verona, Italy

      Claudio Luchini

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    1. Nicola Veronese
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    Correspondence to Claudio Luchini.

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    Giovanni de Manzoni and Claudio Luchini share last Authorshop.

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    Veronese, N., Fassan, M., Wood, L.D. et al. Extranodal Extension of Nodal Metastases Is a Poor Prognostic Indicator in Gastric Cancer: a Systematic Review and Meta-analysis. J Gastrointest Surg 20, 1692–1698 (2016). https://doi.org/10.1007/s11605-016-3199-7

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    • DOI: https://doi.org/10.1007/s11605-016-3199-7

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