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Prognostic impact of lymph node micrometastasis in patients with gastric cancer

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Abstract

Purpose

The clinical significance of lymph node micrometastasis (LNMM) remains controversial in gastric cancer (GC). In this study, we investigated the prognostic impact of LNMM in patients with GC.

Methods

A total of 624 patients with pathologically lymph node metastasis-negative (pN0) and N1 status (pN1) who underwent gastrectomy between 2004 and 2018 were enrolled in this retrospective study. The diameter of tumor cell clusters in metastatic lymph nodes was measured in 120 patients with pN1 GC.

Results

Patients with lymph node tumors < 1500 μm in diameter (LNMM) had a significantly better prognosis than those with tumors ≥ 1500 μm in diameter (p = 0.012; log-rank test). Cox’s proportional hazards model revealed that LNMM (p = 0.016), several dissected lymph nodes (p = 0.049), and the provision of adjuvant chemotherapy (p = 0.002) were independent prognostic factors for the overall survival of patients with pN1 GC. There was no significant difference in the overall survival between patients with LNMM who received chemotherapy and those who did not (p = 0.332).

Conclusions

LNMM is associated with a favorable prognosis and maybe an independent prognostic marker in patients with pN1 GC. LNMM in GC may be considered a factor preventing adjuvant chemotherapy.

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Data availability

All data generated or analyzed during this article are included in this published article. The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Zhou J, Chen Q. Poor expression of microRNA-135b results in the inhibition of cisplatin resistance and proliferation and induces the apoptosis of gastric cancer cells through MST1-mediated MAPK signaling pathway. FASEB J. 2019;33:3420–36.

    Article  CAS  Google Scholar 

  2. Kodama Y, Sugimachi K, Soejima K, Matsusaka T, Inokuchi K. Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg. 1981;5:241–8.

    Article  CAS  Google Scholar 

  3. Ohgaki M, Toshio T, Akeo H, Yamasaki J, Togawa T. Effect of extensive lymph node dissection on the survival of early gastric cancer. Hepatogastroenterology. 1999;46:2096–9.

    CAS  PubMed  Google Scholar 

  4. Otsuji E, Kuriu Y, Ichikawa D, Okamoto K, Hagiwara A, Yamagishi H. Tumor recurrence and its timing following curative resection of early gastric carcinoma. Anticancer Res. 2003;23:3499–503.

    PubMed  Google Scholar 

  5. Maehara Y, Okuyama T, Moriguchi S, Orita H, Kusumoto H, Korenaga D, et al. Prophylactic lymph node dissection in patients with advanced gastric cancer promotes increased survival time. Cancer. 1992;70:392–5.

    Article  CAS  Google Scholar 

  6. Japanese gastric cancer treatment guidelines 2018. (5th ed.). Gastric Cancer. 2020.

  7. Sobin LH, Gospodarowicz MK, Wittekind C. International Union against cancer. TNM classification of malignant tumours Chichester West Sussex. Wiley-Blackwell; 2010.

    Google Scholar 

  8. Zhou Y, Zhang GJ, Wang J, Zheng KY, Fu W. Current status of lymph node micrometastasis in gastric cancer. Oncotarget. 2017;8:51963–9.

    Article  Google Scholar 

  9. Lee E, Chae Y, Kim I, Choi J, Yeom B, Leong AS-Y. Prognostic relevance of immunohistochemically detected lymph node micrometastasis in patients with gastric carcinoma. Cancer. 2002;94:2867–73.

    Article  Google Scholar 

  10. Yasuda K, Adachi Y, Shiraishi N, Inomata M, Takeuchi H, Kitano S. Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer. Ann Surg Oncol. 2002;9:771–4.

    Article  Google Scholar 

  11. Eguchi T, Kodera Y, Nakanishi H, Yokoyama H, Ohashi N, Ito Y, et al. The effect of chemotherapy against micrometastases and isolated tumor cells in lymph nodes: an in vivo study. Vivo. 2008;22:707–12.

    CAS  Google Scholar 

  12. Williams JR. The ethics activities of the World Medical Association. Sci Eng Ethics. 2005;11:7–12.

    Article  Google Scholar 

  13. Japanese classification of gastric carcinoma (3rd English ed.). Gastric Cancer. 2011;14:101–12.

  14. Fujiwara Y, Okada K, Hanada H, Tamura S, Kimura Y, Fujita J, et al. The clinical importance of a transcription reverse-transcription concerted (TRC) diagnosis using peritoneal lavage fluids in gastric cancer with clinical serosal invasion: a prospective, multicenter study. Surgery. 2014;3:417–23.

    Article  Google Scholar 

  15. Yaguchi Y, Sugasawa H, Tsujimoto H, Takata H, Nakabayashi K, Ichikura T, et al. One-step nucleic acid amplification (OSNA) for the application of sentinel node concept in gastric cancer. Am Surg Oncol. 2011;8:2289.

    Article  Google Scholar 

  16. Natsugoe S, Arigami T, Uenosono Y, Yanagita S. Novel surgical approach based on the sentinel node concept in patients with early gastric cancer. Ann Gastroenterol Surg. 2017;1:180–5.

    Article  Google Scholar 

  17. Wang J, Yu JC, Kang WM, Wang WZ, Liu YQ, Gu P. The predictive effect of cadherin-17 on lymph node micrometastasis in pN0 gastric cancer. Ann Surg Oncol. 2012;19:1529–34.

    Article  Google Scholar 

  18. Kim JJ, Song KY, Hur H, Hur JI, Park SM, Park CH. Lymph node micrometastasis in node negative early gastric cancer. Eur J Surg Oncol. 2009;35:409–14.

    Article  CAS  Google Scholar 

  19. Morgagni P, Saragoni L, Scarpi E, Zattini PS, Zaccaroni A, Morgagni D, et al. Lymph node micrometastases in early gastric cancer and their impact on prognosis. World J Surg. 2003;27:558–61.

    Article  Google Scholar 

  20. Ito S, Ohashi Y, Sasako M. Survival after recurrence in patients with gastric cancer who receive S-1 adjuvant chemotherapy: exploratory analysis of the ACTS-GC trial. BMC Cancer. 2018;18:449.

    Article  Google Scholar 

  21. Kim YJ, Chung WC, Youn GJ, Jun KH, Chin HM. The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer. Rev Esp Enferm Dig. 2019;111:537–42.

    Article  Google Scholar 

  22. Xu X, Zheng G, Zhang T, Zhao Y, Zheng Z. Is pathologic tumor regression grade after neo-adjuvant chemotherapy a promising prognostic indicator for patients with locally advanced gastric cancer? A cohort study evaluating tumor regression response. Cancer Chemother Pharmacol. 2019;84:635–46.

    Article  Google Scholar 

  23. Saka M, Katai H, Fukagawa T, Nijjar R, Sano T. Recurrence in early gastric cancer with lymph node metastasis. Gastric Cancer. 2008;11:214–8.

    Article  Google Scholar 

  24. Uchida M, Kondo Y, Suzuki S, Hosohata K. Evaluation of acute kidney injury associated with anticancer drugs used in gastric cancer in the Japanese adverse drug event report database. Ann Pharmacother. 2019;53:1200–6.

    Article  CAS  Google Scholar 

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Acknowledgements

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Funding

The authors declare that they have no funding.

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Authors and Affiliations

  1. First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan

    Atsushi Yamamoto, Katsutoshi Shoda, Yoshihiko Kawaguchi, Hidenori Akaike, Ryo Saito, Naoki Ashizawa, Koichi Takiguchi, Shinji Furuya, Naohiro Hosomura, Hidetake Amemiya, Hiromichi Kawaida, Makoto Sudo, Hiroshi Kono & Daisuke Ichikawa

  2. Department of Pathology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan

    Kunio Mochizuki

Authors
  1. Atsushi Yamamoto
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  2. Katsutoshi Shoda
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  3. Yoshihiko Kawaguchi
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  4. Hidenori Akaike
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  5. Ryo Saito
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  6. Naoki Ashizawa
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  8. Shinji Furuya
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  10. Hidetake Amemiya
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  11. Hiromichi Kawaida
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  12. Makoto Sudo
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  13. Hiroshi Kono
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  14. Kunio Mochizuki
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  15. Daisuke Ichikawa
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Contributions

AY and KS designed the research. KS performed the research. KS reviewed the surgical pathology. AY and KS analyzed the data. AY and KS wrote the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Katsutoshi Shoda.

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Conflicts of interest

None of the authors have any conflicts of interest to disclose.

Ethics approval

This study was approved by the Ethics Committee of the University of Yamanashi Hospital and was performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the patient for the publication of these findings and accompanying images.

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Yamamoto, A., Shoda, K., Kawaguchi, Y. et al. Prognostic impact of lymph node micrometastasis in patients with gastric cancer. Surg Today 52, 61–68 (2022). https://doi.org/10.1007/s00595-021-02302-9

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  • DOI: https://doi.org/10.1007/s00595-021-02302-9

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