Article

Prognostic value of lymph node staging in gastric cancer.

Department of Digestive Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachihirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Hepato-gastroenterology (Impact Factor: 0.91). 01/2003; 50(49):301-4.
Source: PubMed

ABSTRACT The latest TNM classification (5th edition) changed the definition of nodal staging from the anatomical localization to the total number of metastatic lymph nodes. This study was designed to evaluate and compare the prognostic significance of nodal staging between the two widely known staging systems, the TNM classification (TNM) and Japanese Classification for Gastric Cancer (JCGC).
A total of 582 patients who underwent curative gastrectomy with extended lymphadenectomy for gastric cancer were reviewed retrospectively from hospital records. Based on the localization of metastatic nodes according to the JCGC and the total positive node number according to TNM, the patients were divided into subgroups and their prognoses compared.
Lymph node metastasis was found in 189 of the 582 patients (32.5%). Both nodal staging systems were found to be significant prognostic factors by multivariate analysis. A prognostic analysis of the patients by subdivision with the two staging systems indicated that the nodal staging system in TNM was more homogenous than that of the JCGC.
The nodal staging system of the TNM classification is superior to that of the Japanese Classification of Gastric Cancer, because it is simple, reproducible and homogeneous.

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    • "The depth of invasion and the new nodal staging have emerged as more significant prognostic factors than the previous nodal staging method (Yoo et al., 1999). The new UICC classification of nodal involvement has also been considered superior to the Japanese classification (Ichikura et al., 1999; Ichikawa et al., 2003). "
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    ABSTRACT: The incidence of gastric cancer in the last decades has declined rapidly in the industrialised countries. Worldwide, however, gastric cancer is still the second most common cause of cancer death. Although surgery is currently the most effective treatment, the rapid progress in adjuvant chemotherapy and radiation therapy requires a re-evaluation of prognosis assessment. The TNM staging system of the UICC is ubiquitously used; it groups patients by decreasing survival times from stage I to stage IV based on the spread of disease, i.e. depth of tumour penetration (T), extent of spread to lymph nodes (N), and the presence or absence of distant (M) metastases. This is by far the most consistent prognostic classification system today. However, even within the stage groups there are patients that follow a varying course of disease. Our knowledge of the molecular differences between tumours of the same stage and morphology has been accumulating over the years and methods for a more accurate assessment of the phenotype of neoplasias are of value when evaluating the prognosis of individual patients with gastric cancer. In this study, the immunohistochemical expression of tumour markers involved in different phases in tumourigenesis was examined. The aim was to find new markers which could provide prognostic information in addition to what is provided by the TNM variables. A total of 337 specimens from the primary tumour of patients who underwent surgery for gastric cancer were collected and the immunohistochemical expression of seven different biomarkers was analysed. DNA ploidy and S-phase fraction (SPF) was assessed by flow cytometry. Finally, all biomarkers and clinicopathological prognostic factors were combined and evaluated by a multivariate Cox regression model to elucidate which specific factors provide independent prognostic information. By univariate survival analysis the following variables were significant prognostic factors: epithelial and stromal syndecan-1 expression, stromal tenascin-C expression, expression of tumour-associated trypsin inhibitor (TATI) in cancer cells, nuclear p53 expression, nuclear p21 expression, DNA ploidy, and SPF. By multivariate survival analysis adjusted for all available clinicopathological and biomolecular variables, p53 expression, p21 expression, and DNA ploidy emerged as independent prognostic biomarkers, together with penetration depth of the tumour, presence of nodal metastases, surgical cure of the cancer, and age of the patient at the time of diagnosis. Mahasyöpä on maailman toiseksi yleisin syöpämuoto. Vaikka mahasyövän esiintyvyys on huomattavasti laskenut viimeisten vuosikymmenten aikana todetaan Suomessa edelleen noin 800 uutta mahasyöpää vuosittain ja vuonna 2003 mahasyöpä oli miesten neljänneksi ja naisten kuudenneksi eniten kuolemia aiheuttava syöpä. Ainoa parantava hoito on mahasyövän täydellinen kirurginen poisto. Syövän ennusteellisia tekijöitä tutkimalla pyritään saamaan mahdollisimman tarkka käsitys taudin kulusta. Tärkein syövän ennustetta kuvaava tekijä on syövän levinneisyysaste, joka määritetään syövän tunkeutumissyvyydellä (T, tumor), levinneisyydellä paikallisiin imusolmukkeisiin (N, node) ja mahdollisten etäpesäkkeiden (M, metastasis) avulla. Potilaat luokitellaan eri ennusteryhmiin, joiden sisällä on kuitenkin huomattavaa vaihtelua potilaiden ennusteessa. Tulevaisuuden hoitomuotojen kehittyessä ja hoitomuotojen vaikutusten arvioinnissa on tärkeää parantaa ennusteen arviointitarkkuutta, jotta hoidot voidaan suunnata oikein. Tutkimuksen päämääränä oli tutkia mahasyöpään liittyvien biologisten merkkiaineiden pitoisuuksia mahasyöpäleikkeissä ja niiden yhteyttä ennusteeseen. Värjäsimme immunohistokemiallisin menetelmin syöpäkudosleikkeitä syövän eri osavaiheita kuvaavia merkkiaineita vastaan. Immunohistokemia perustuu vasta-aineiden reaktiokykyyn eri makromolekyylien, useimmiten proteiinien kanssa. Lisäksi tutkimme solusyklin vaiheita virtaussytometrian avulla. Tällä DNA-analyysimenetelmällä määritetään syöpäkudosten DNA pitoisuus (DNA ploiditeetti) ja DNA:n kahdentumisvaiheessa olevien syöpäsolujen osuus (SPF). Lupaaviksi ennusteeseen liittyviksi tekijöiksi osoittautuivat solukiinnitykseen osallistuva syndekan-1, soluvälitilan tenaskiini-C, solusykliin ja ohjattuun solukuolemaan (apoptoosiin) vaikuttavat p53 ja p21, sekä kudosten entsymaattista hajoamista estävä TATI (tumor-associated trypsin inhibitor). Kun nämä sekä kaikki muut ennustekijät kuten syövän levinneisyys, syövän koko, potilaiden ikä, sukupuoli, ja syövän sijainti vatsalaukussa lisättiin matemaattiseen monimuuttujamalliin osoittautuivat itsenäisiksi syövän ennustetta kuvaaviksi tekijöiksi p53, p21, DNA ploiditeetti, sekä potilaan ikä ja leikkauksen täydellisyys. Kaikkein vahvimpina ennustekijöinä säilyivät kuitenkin edelleen levinneisyysosatekijät tunkeutumissyvyys (T) ja imusolmukelevinneisyys (N).
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