Skip to main content
SpringerLink
Log in

Extra-perigastric Extranodal Metastasis is a Significant Prognostic Factor in Node-Positive Gastric Cancer

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Extranodal metastasis is an isolated tumor nodule without a residual lymph node structure and has been reported as a poor prognostic factor in gastric cancer. The aim of this study is to assess the prognostic value of extranodal metastasis, especially from the viewpoint of its anatomical distribution.

Methods

A total of 139 consecutive gastric cancer patients who underwent curative surgery with lymph node metastasis between 2008 and 2009 were included. Clinicopathological features and patient survival outcomes were retrospectively assessed. Patients with extranodal metastasis were subdivided into two groups: perigastric extranodal metastasis, located near the perigastric area (#1–#7 according to the Japanese classification of gastric carcinoma 15th edition), and extra-perigastric extranodal metastasis, located alongside the major vessels (#8–#12).

Results

Extranodal metastasis was found in 51 patients (37%), and it was more frequent in those with bulky, ≥pT3, and pStage III tumors. All patients with extra-perigastric extranodal metastasis had recurrence, resulting in a 0% 5-year overall survival rate, which was significantly worse than that of patients with perigastric extranodal metastasis (59%), or those without extranodal metastasis (84%; P < 0.001). Multivariable analysis identified the presence of extra-perigastric extranodal metastasis as an independent poor prognostic factor.

Conclusions

Extranodal metastasis, especially extra-perigastric extranodal metastasis, was a pivotal poor prognostic factor in node-positive gastric cancer. Recognizing extra-perigastric extranodal metastasis would help provide optimal therapeutic options to these high-risk patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386

    Article  CAS  Google Scholar 

  2. Adachi Y, Kamakura T, Mori M et al (1994) Prognostic significance of the number of positive lymph nodes in gastric carcinoma. Br J Surg 81:414–416

    Article  CAS  Google Scholar 

  3. Nashimoto A, Akazawa K, Isobe Y et al (2013) Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 16:1–27

    Article  Google Scholar 

  4. Sobin LH, Gospodarowicz MK, Wittekind C (2009) Classification of malignant tumours, 7th edn. UICC, Geneva

    Google Scholar 

  5. Puppa G, Maisonneuve P, Sonzogni A et al (2007) Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging. Mod Pathol 20:843–855

    Article  Google Scholar 

  6. Ueno H, Mochizuki H, Hashiguchi Y et al (2007) Extramural cancer deposits without nodal structure in colorectal cancer: optimal categorization for prognostic staging. Am J Clin Pathol 127:287–294

    Article  Google Scholar 

  7. Ersen A, Unlu MS, Akman T et al (2014) Tumor deposits in gastric carcinomas. Pathol Res Pract 210:565–570

    Article  Google Scholar 

  8. Etoh T, Sasako M, Ishikawa K et al (2006) Extranodal metastasis is an indicator of poor prognosis in patients with gastric carcinoma. Br J Surg 93:369–373

    Article  CAS  Google Scholar 

  9. Lee HS, Lee HE, Yang HK et al (2013) Perigastric tumor deposits in primary gastric cancer: implications for patient prognosis and staging. Ann Surg Oncol 20:1604–1613

    Article  Google Scholar 

  10. Nakamura K, Ogoshi K, Makuuchi H (2010) Subclassification of extranodal involvement in gastric cancer patients. Hepatogastroenterology 57:968–974

    PubMed  Google Scholar 

  11. Sun Z, Wang ZN, Xu YY et al (2012) Prognostic significance of tumor deposits in gastric cancer patients who underwent radical surgery. 151:871–881

    Article  Google Scholar 

  12. Chen XL, Zhao LY, Xue L et al (2016) Prognostic significance and the role in TNM stage of extranodal metastasis within regional lymph nodes station in gastric carcinoma. Oncotarget 7:67047–67060

    PubMed  PubMed Central  Google Scholar 

  13. Bang Y-J, Kim Y-W, Yang H-K et al (2012) Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. The Lancet 379:315–321

    Article  CAS  Google Scholar 

  14. Sakuramoto S, Sasako M, Yamaguchi T et al (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820

    Article  CAS  Google Scholar 

  15. Sasako M, Sakuramoto S, Katai H et al (2011) Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 29:4387–4393

    Article  CAS  Google Scholar 

  16. Takahari D, Hamaguchi T, Yoshimura K et al (2014) Survival analysis of adjuvant chemotherapy with S-1 plus cisplatin for stage III gastric cancer. Gastric Cancer 17:383–386

    Article  CAS  Google Scholar 

  17. Yoon S, Yoo C, Ryu MH et al (2017) Phase 2 study of adjuvant chemotherapy with docetaxel, capecitabine, and cisplatin in patients with curatively resected stage IIIB-IV gastric cancer. Gastric Cancer 20:182–189

    Article  CAS  Google Scholar 

  18. He X, Wu W, Lin Z, et al (2018). Validation of the American Joint Committee on Cancer (AJCC) 8th edition stage system for gastric cancer patients: a population-based analysis. Gastric Cancer 21:391–400

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported in part by The National Cancer Center Research and Development Fund (28-A-11).

Author information

Authors and Affiliations

  1. Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Akiko Tonouchi, Masanori Tokunaga, Shizuki Sugita, Masahiro Watanabe, Reo Sato, Akio Kaito & Takahiro Kinoshita

  2. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan

    Masato Sugano, Atsushi Ochiai & Takeshi Kuwata

  3. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Akiko Tonouchi & Tetsuo Akimoto

  4. Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Masato Sugano, Atsushi Ochiai, Takahiro Kinoshita & Takeshi Kuwata

  5. Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan

    Tetsuo Akimoto

Authors
  1. Akiko Tonouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masato Sugano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masanori Tokunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shizuki Sugita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reo Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akio Kaito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tetsuo Akimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Atsushi Ochiai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takahiro Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takeshi Kuwata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeshi Kuwata.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Human Rights Statement

This study complied with the standards of the Declaration of Helsinki and current ethical guidelines and was approved by the institutional ethics board.

Informed Consent

Written informed consent for participation in this study was not obtained from the patients, because this study did not report on a clinical trial and the data were retrospective in nature and analyzed anonymously.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 132 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tonouchi, A., Sugano, M., Tokunaga, M. et al. Extra-perigastric Extranodal Metastasis is a Significant Prognostic Factor in Node-Positive Gastric Cancer. World J Surg 43, 2499–2505 (2019). https://doi.org/10.1007/s00268-019-05076-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05076-x

Search

Navigation