Abstract
BackgroundTo assess the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma and establish an optimal classification in the staging system.Methodology/Principal FindingsA total of 1343 patients with gastric carcinoma who underwent surgical resection were recruited to determine the frequency and prognostic significance of EMs. EMs were divided into two groups (EM1 and EM2) and then incorporated into the 7th edition UICC TNM staging system. EMs was detected in 179 (13.3%) of 1343 patients who underwent radical resection. Multivariate analysis identified EMs as an independent prognostic factor (HR = 1.412, 95%CI = 1.151–1.731, P<0.001). After curative operation, the overall survival rate were worse in patients with ≥3 cases of EM (EM2) than those with the number of 1 and 2 cases (EM1) (P<0.001). Survival of patients with EM1 was found almost comparable to that of N3 stage (P = 0.437). Survival of patients with EM2 showed similar to that of stage IV patients (P = 0.896). By using the linear trend X2, likelihood ratio X2, and Akaike information criterion (AIC) test, EM1 treated as N3 stage and EM2 treated as M1 stage performed higher linear trend X2 scores, likelihood ratio X2 scores, and lower AIC value than the 7th edition UICC TNM staging system, which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability, and monotonicity of gradients.Conclusions/SignificanceEMs might be classified based on their number and prognostic information and should incorporate into the TNM staging system.
Highlights
Histological examination of dissected nodal structures may disclose the presence of nodules of tumors that are not contained with recognizable lymph node tissue
Consideration of the possible origin for extranodal metastasis (EM) excluded from implantation on peritoneal surfaces, we investigated the incidence of EMs for 1343 cases of patients with potential radical resection
We investigated the clinical parameters and the prognostic value of EMs in a group of patients who underwent potentially radical resection for gastric carcinoma, in which we found that the incidence of EMs was 179 (13.3%) in 1343 patients
Summary
Histological examination of dissected nodal structures may disclose the presence of nodules of tumors that are not contained with recognizable lymph node tissue. According to the 7th edition classification, this type of metastatic nodules in the fat adjacent to a gastric carcinoma, without evidence of residual lymph node tissue, are considered regional lymph node metastases, but nodules implanted on peritoneal surfaces are considered distant metastases [5]. While this type of definition is still comprehensive and ambiguous. To assess the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma and establish an optimal classification in the staging system
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