Minimal Node Affection in Gastric Carcinoma – Pilote Multicentric Study Results
Authors:
J. Šimša; J. Hoch 1; J. Leffler 1; D. Umlaufová 1; J. Schwarz 1; F. Bělina 2; M. Ryska 2; R. Doležel 2; J. Gatěk 3; J. Varga 4
Authors‘ workplace:
Chirurgické oddělení Oblastní nemocnice Kolín, a. s., primář: doc. MUDr. Jaromír Šimša, Ph. D.
; Chirurgická klinika 2. LF UK a FN Motol, Praha, přednosta: prof. MUDr. Jiří Hoch, CSc.
1; Chirurgická klinika 2. LF UK a ÚVN, Praha, přednosta: prof. MUDr. Miroslav Ryska, CSc.
2; Chirurgické oddělení Nemocnice Atlas Zlín, a. s., primář: MUDr. Jiří Gatěk, Ph. D.
3; Chirurgická klinika 1. LF UK a FN Bulovka, Praha, přednosta: doc. MUDr. Jan Fanta, CSc.
4
Published in:
Rozhl. Chir., 2011, roč. 90, č. 6, s. 333-338.
Category:
Monothematic special - Original
Overview
Introduction:
Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings.
Material and methods:
Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody.
Results:
In the period of two years (1st January 2009 – 31st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients’ survival data.
Conclusion:
Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.
Key words:
gastric cancer – lymphadenectomy – lymph node micrometastasis – isolated tumour cells
Sources
1. Zhoubné novotvary 2007, Národní onkologický registr ČR, ÚZIS, 2010.
2. Bonenkamp, J. J., Songun, I., Hermans, J., et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet, 1995, 345: 745–748.
3. Cuschieri, A., Fayers, P., Fielding, J., et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet, 1996, 347: 995–999.
4. Gatěk, J., Duben, J., Bakala, J., et al. Lymfadenektomie u časného karcinomu žaludku. Rozhl Chir, 2004, 83 (9): 428–435.
5. Maruyama, K., Sasako, M., Kinoshita, T., et al. Effectiveness of systematic lymph node dissection in gastric cancer surgery. European Surgery, 1995, 27(1): 23–27.
6. Dostalík, J., Martínek, L., Satinský, I., et al. Laparoskopická totální gastrektomie – naše první zkušenosti. Rozhl. Chir., 2003, 82 (7): 353–356.
7. Sobin, L. H., Wittekind, Ch. TNM Classification of Malignant Tumours. UICC 6th Edition, New York: John Wiley & Sons, Inc., 2002 (České vydání z r. 2004).
8. Kell, M. R., Winter, D. C., O’Sullivan, G. C., et al. Biological behaviour and clinical implications of micrometastases. Br. J. Surg., 2000, 87: 1629–1639.
9. Calaluce, R., Miedema, B. W., Yesus, Y. W. Micrometastasis in colorectal carcinoma: A review. J. Surg. Oncol., 1998, 67(3): 194–202.
10. Lee, E., Chae, Y., Kim, I., et al. Prognostic relevance of immunohistochemically detected lymph node micrometastasis in patients with gastric carcinoma. Cancer, 2002, 94(11): 2867–2873.
11. Yasuda, K., Adachi, Y., Shiraishi, N., et al. Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer. Ann. Surg. Oncol., 2002, 9(8): 771–774.
12. Harrison, L. E., Choe, J. K., Goldstein, M., et al. Prognostic significance of immunohistochemical micrometastases in node negative gastric cancer patients. J. Surg. Oncol., 2000, 73(3): 153–157.
13. Öberg, A., Stenling, R., Tavelin, B., et al. Are lymph node micrometastases of any clinical significance in Dukes‘ stages A and B colorectal cancer? Dis. Colon Rectum, 1998, 41: 1244–1249.
14. Isaka, N., Nozue, M., Doy, M., et al. Prognostic significance of perirectal lymph node micrometastases in Dukes‘ B rectal carcinoma: An immunohistochemical study by CAM 5.2. Clin. Cancer Res., 1999, 5: 2065–2068.
15. Yasuda, K., Adachi, Y., Shiraishi, N., et al. Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer. Ann. Surg. Oncol., 2001, 8(4): 300–304.
16. Čapov, I., a kol. Diagnostika kostních mikrometastáz u nemalobuněčné formy plicního karcinomu – první výsledky. Rozhl. Chir., 2003, 82 (3): 145–148.
17. Hejna, M., Raderer, M., Zielinski, C. C. Multimodality treatment of gastric cancer European Surgery, 2002, 34(1): 29–31.
18. Roder, J. D., Bottcher, K., Etter, M., et al. Chirurgische und multimodale Behandlung des pT4-Magenkarzinoms. European Surgery, 1999, 31(1): 22–25.
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Perspectives in Surgery
2011 Issue 6
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