Abstract
(Background) The aim of this study was to investigate the prognostic impact of lymphatic invasion in gastric cancer, focusing on survival differences between N stage groups. (Methods) A total of 398 consecutive patients who underwent curative gastrectomy for primary gastric adenocarcinoma from January 2006 to December 2015 were analyzed retrospectively using data from a prospectively collected registry database. We compared various clinicopathological features and survival differences between lymphatic invasion-positive and -negative groups. (Results) Of the 398 patients, 141 (35.4%) showed lymphatic invasion. The lymphatic invasion-positive subgroup had poorer prognosis than the lymphatic invasion-negative subgroup in N0 (five-year survival rate: 87.8% vs. 73.6%, p = 0.048) and N1 (87.2% vs. 50%, p = 0.007) stage patients. The odds ratio (OR) of lymphatic invasion to five-year survival rate was 2.078 (95% confidence interval (CI), 1.103–3.916; p = 0.024). The presence of lymphatic invasion had worse effect on survival than age (OR, 1.807; 95% CI, 1.024–2.242; p = 0.029) or tumor depth (OR, 1.286; 95% CI, 1.078–1.897; p = 0.013) in N0 and N1 stage patients. The overall survival of patients with lymphatic invasion was not different from that of patients at a one-higher N stage without lymphatic invasion at any N stage. (Conclusions) The presence of lymphatic invasion may be the most important independent prognostic factor in N0 and N1 gastric cancer and might be an upstaging factor of N stage at any N stage. Therefore, in addition to the number of metastasized lymph nodes, the presence of lymphatic invasion should be included in N stage determination.
Highlights
TNM classification (depth of invasion of tumor (T), lymph node metastasis (N), and distant metastasis (M)) has been known to be an important indicator for prognosis such as survival and recurrence in gastric cancer [1,2]
We demonstrated that Lymphatic invasion (LI) was an independent prognostic factor for predicting survival, in N0 and N1 sWtagee dpeamtieonntsst.rTatheed5YthSaRts LwIerwe a9s0.8a%n iinndsteapgeenId, 7e0n.t9%priongsntaogsteicII,faanctdor51f.o9%r pinresdtaicgteinIgII survival, in our datap,airntiacgurleaerlmyeinntNw0itahndthNat1osftaogtheeprasttiuednites.sT[2h5e–52Y7S],Rwshweerereas9t0h.8e%5YinSRstsaogfetIh, e70p.9a%tieinntsstwagitehILI,Iand 51.9% were 79.2%ininstasgtaegIeIII,i5n6o.2u%r dinatsata, gine IaIg, raenedm4e8n.t6%wiitnh stthaagteoIfIIo
Igtaisstrpiocscsaibnlcyere)x.pHlaoinweedvethr,atthlyemrepwhenroedneomseutravsitvaasilsdsitfafteursenmceasy awciceolrdding to LI a strongersitnatfluuseinncethoenmpororegnaodsviasntcheadn NLIssttaagtue sgdrooueps.sTshuecrhefaosreN, 2LIoarffNe3ct.sItthise pporossginbolysiesxipnlaeianrelydNthat lymph stages indnepodenedmenettlays.tasis status may wield a stronger influence on prognosis than LI status does
Summary
TNM classification (depth of invasion of tumor (T), lymph node metastasis (N), and distant metastasis (M)) has been known to be an important indicator for prognosis such as survival and recurrence in gastric cancer [1,2]. Lymphatic channels play a pivotal role in the spread and recurrence of solid organ tumors. Lymphatic invasion (LI) of malignant tumors, acting as a micro-metastatic tumor focus, is one of the odds of metastatic lymph nodes (log of ratio of number of metastatic and negative nodes) were proposed [6,7,8]. Lymphatic invasion (LI) of malignant tumors, acting as a micro-metastatic tumor focus, is one of the useful predictive markers of lymph node metastasis and cancer recurrence in gastric cancer [9,10,11] as uwseelflualspirnedviacrtiivoue smtayrpkeesrsofocf alynmceprshsnuocdheams eetsaosptahsaigseaanldcacnacnecrer[1r2e]c,ucrorleonrceectianl gcaasntcreicr c[a1n3]c,emr [e9l–a1n1o]masa w[1e4l]l,ansoinn-vsmaraiollucsetlylpluesnogfccaanncceerrs[1s5u]c,hanasdeespopithhaeglieaallocvaanrciearn[1ca2n],cceorlo[1re6c]t.aHl coawnecevrer[1, 3th],emeeffleacntoomfaL[I1o4n], nsuonrv-sivmaallilnceglal slutrnicg ccaanncceerr [is15c]o, natnrdoveepristhiaell.iaMl oetvaasrtiaatnicclaynmceprh[1n6o].dHesoawreevfeoru, nthdeienffoenctlyofaLbIoount 5su%r–v1iv0a%l ionf gpaasttireinc tcsanwcietrhisLcIoinntreonvdeorssicaol.pMic erteassetacttiiocnly-tmrepahtendoedaerslyargeafsoturincdciannocenrly(EabGoCu)t. Lymphatic invasion (LI) of malignant tumors, acting as a micro-metastatic tumor focus, is one of the useful predictive markers of lymph node metastasis and cancer recurrence in gastric cancer [9,10,11] as uwseelflualspirnedviacrtiivoue smtayrpkeesrsofocf alynmceprshsnuocdheams eetsaosptahsaigseaanldcacnacnecrer[1r2e]c,ucrorleonrceectianl gcaasntcreicr c[a1n3]c,emr [e9l–a1n1o]masa w[1e4l]l,ansoinn-vsmaraiollucsetlylpluesnogfccaanncceerrs[1s5u]c,hanasdeespopithhaeglieaallocvaanrciearn[1ca2n],cceorlo[1re6c]t.aHl coawnecevrer[1, 3th],emeeffleacntoomfaL[I1o4n], nsuonrv-sivmaallilnceglal slutrnicg ccaanncceerr [is15c]o, natnrdoveepristhiaell.iaMl oetvaasrtiaatnicclaynmceprh[1n6o].dHesoawreevfeoru, nthdeienffoenctlyofaLbIoount 5su%r–v1iv0a%l ionf gpaasttireinc tcsanwcietrhisLcIoinntreonvdeorssicaol.pMic erteassetacttiiocnly-tmrepahtendoedaerslyargeafsoturincdciannocenrly(EabGoCu)t. 5I–n10fa%cto, fwpeatiheanvtse wenitchouLnI tinereenddogsacsotrpiicc rceasneccetironp-atrteieantetds esahrolywginagstrdicisccarnecpearn(cEyGCb)e.tIwnefeanct,LwIeshtaatvuesenacnodunltyemrepdhgansotrdice cmanetcaesrtapsaistie[1n7t,s18sh].oMwainngy dstiuscdrieepsahnacvye bceotnwsiesetnenLtlIysctaotnucsluadneddlythmatpLhIniosdaepmroegtnasotsatsicisfa[1c7to,1r8o].nlMy ainnya sstuubdsieetsohfanvoedceo-nnesgisatteinvtelygacostnricclucdanedcetrhsaatnLdI misaayphraovgenolistttliec pfarcotgonroosntilcy vinalauesuinbspeattoiefnntos dwei-tnhelgyamtipvhe gnaosdtericmceatnasctearssisa,nedvemnaayt Nha1vsetalgitetl[e1p9–ro2g2]n.oTshtiecrevfaolruee, iitnispnaeticeenstssarwyittho ildyemnptihfynaodddeitmioentaalstparseids,icetvoerns, aotthNer tshtaangeTN[1M9–2s2ta].tuTs,hfeorresftorraet,ifiytinisgnpeacteiessnatsryattorisikdefnortipfyooardpdritoigonnoaslips.rTedhiecsteoprsr,eodtihcteorrsthmanayThNaMve sgtraetautsc,lfionricsatlrsaitgifnyiifnicganpcaet,ieanidtsinagt irnispkaftoiernpt oseolrecptrioognnfoorsims.oTreheexsetepnrseivdeicstuorrgsemryayanhdafvuertghreeraat dcljuinviacnalt sthigenraifipciaesn,cteo, iamidpinrogvienspuarvtiievnatl.selection for more extensive surgery and further adjuvant therapies, to imTphroevreefosurerv, iwvael.assessed the clinicopathological features and prognosis of gastric cancer with lympThhaetircefionrvea,swioen,awssiethssaedsptehceifciclifnoiccuospaotnhsoulorgviivcaall dfeiaffteurreenscaens drelpartoegdntoostihseopf rgeassetnrcice acanndcaebrswenitche loyfmlypmhapthicaitnicviansvioansi,ownitihn aeascphecNifisctafogceugsroonupsu. rvival differences related to the presence and absence of lymphatic invasion in each N stage group
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