He Yulong

Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy.

The log odds of positive lymph nodes (LODDS) was defined as the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes, which is a novel and promising nodal staging system for gastric cancer. Here, we aimed to compare the prognostic effect of pN, lymph node ratio (LNR) and LODDS. The association between overall survival and pN, LNR and LODDS was retrospectively analysed. The discriminatory ability and monotonicity of gradients (linear trend χ2 score), homogeneity ability (likelihood ratio test) and prognostic stratification ability (Akaike information criterion [AIC] and receiver operating characteristic [ROC] curve) were compared among three lymph node staging systems. The pN, LNR and LODDS were all identified as independent prognostic factors for gastric cancer patients in the multivariate analysis. LODDS showed the best prognostic performance (linear trend χ2 score 266.743, likelihood ratio χ2 test score 427.771, AIC value 5670.226, area under the curve (AUC) 0.793), followed by LNR and pN. In patients with different levels of retrieved lymph nodes (≤10, 11–14, 15–25 and >25), LODDS was the most powerful for prognostic prediction and discrimination of the heterogeneity among the subgroups. Significant differences in survival were observed among patients in different LODDS subgroups after being classified according to the pN and LNR classifications. LODDS appears to be a more powerful system for predicting the overall survival of gastric cancer patients, as compared to LNR and pN, and may serve as an alternative nodal staging system for gastric cancer.

CD44, Sonic Hedgehog, and Gli1 Expression Are Prognostic Biomarkers in Gastric Cancer Patients after Radical Resection.

Aim. CD44 and Sonic Hedgehog (Shh) signaling are important for gastric cancer (GC). However, the clinical impact, survival, and recurrence outcome of CD44, Shh, and Gli1 expressions in GC patients following radical resection have not been elucidated. Patients and Methods. CD44, Shh, and Gli1 protein levels were quantified by immunohistochemistry (IHC). The association between CD44, Shh, and Gli1 expression and clinicopathological features or prognosis of GC patients was determined. The biomarker risk score was calculated by the IHC staining score of CD44, Shh, and Gli1 protein. Results. The IHC positive staining of CD44, Shh, and Gli1 proteins was correlated with larger tumour size, worse gross type and histological type, and advanced TNM stage, which also predicted shorter overall survival (OS) and disease-free survival (DFS) after radical resection. Multivariate analysis indicated the Gli1 protein and Gli1, CD44 proteins were predictive biomarkers for OS and DFS, respectively. If biomarker risk score was taken into analysis, it was the independent prognostic factor for OS and DFS. Conclusions. CD44 and Shh signaling are important biomarkers for tumour aggressiveness, survival, and recurrence in GC.

Survival of Proper Hepatic Artery Lymph Node Metastasis in Patients with Gastric Cancer: Implications for D2 Lymphadenectomy

Background and Aims There is a discrepancy between the American Joint Committee on Cancer (AJCC) guidelines (7th edition) and the Japanese treatment guidelines (3rd edition) with regard to the extent of D2 lymphadenectomy for gastric cancer. In the AJCC, hepatic artery station (No.12a) lymph node (LN) metastasis is classified as distant metastasis, whereas in the Japanese guidelines, this classified is regional metastasis. This study aimed to evaluate whether it is appropriate to reclassify No.12a LN metastasis as distant metastasis in consideration of survival outcome. Methods In this retrospective analysis, data from patients with gastric cancer who underwent regular D2 or greater lymphadenectomy between 1996 and 2006 were evaluated to determine any association between the clinicopathological features of hepatic artery LNs and survival prognosis. Results Among the 247 patients with gastric cancer who underwent No.12 LN harvest, 45 (18.2%) were positive for No.12a LN metastasis. No.12a LN metastasis was significantly associated with poor clinicopathological features, advanced tumor stage, and poor overall survival. The 5-year survival rate of patients with No.12a LN metastasis was significantly better than that of patients with distant metastasis (P < 0.05), but was similar to that of patients with LN involvement in the D2 lymphadenectomy region (P > 0.05). No.12a LN metastasis was shown to significantly influence survival outcome in univariate analysis, but was not identified as a significant independent predictor in multivariate analysis. In logistic multivariate regression analysis, T stage, N stage, and station No.3, 5, and 6 LN metastasis were independent predictors of No.12a LN involvement. Conclusions It is inappropriate to reclassify No.12a LN metastasis as distant metastasis. We propose that this be considered as regional metastasis and be included in the extent of D2 lymphadenectomy to improve survival outcomes in patients with gastric cancer.

A New pN Staging System Based on Both the Number and Anatomic Location of Metastatic Lymph Nodes in Gastric Cancer

BackgroundOur aim was to establish a new pN staging system for gastric cancer based on the number and location of metastatic lymph nodes (MLNs) and to compare it with other systems.MethodsWe retrospectively analyzed the prognostic data of 521 gastric cancer patients who underwent curative resection. Survival analyses were used to establish a pN staging system that considers both the number and location of MLNs and to compare discriminatory ability and monotonicity of gradients (linear trend χ2 score), homogeneity ability (likelihood ratio test), and prognostic stratification ability (Akaike information criterion) between Japanese Gastric Cancer Association (JGCA) and Union for International Cancer Control (UICC) systems.ResultsCut-point survival analysis divided pN+ patients into two groups: Nxn1~6 and Nxn≥7. N0, N1, N2, and N3 (the previous classifications) were replaced by N0, N1n1~6, N2n1~6, and N1n≥7 + N2n≥7 + N3n1~6 + N3n≥7, respectively. Compared with two widely used staging systems, the new system had the highest likelihood ratio test [106.06 (new) vs 95.09 (JGCA) vs 94.33 (UICC)] and linear trend χ2 scores [102.30 (new) vs 89.12 (JGCA) vs 86.97(UICC)] and the lowest Akaike information criterion (AIC) score [2,283.88 (new) vs 2,285.31 (JGCA) vs 2,299.88 (UICC)].ConclusionA new pN staging system based on the number and location of MLNs is an efficient prognostic indicator of the survival of patients with gastric cancer following radical surgery.

Comparison of clinicopathological features of gastric carcinoma, between 2 times periods, at a single institute in China.

PURPOSES This study aims to compare the clinicopathological features of gastric carcinoma between two different time periods, and to investigate the prognostic factors for gastric carcinoma. PATIENTS AND METHODS One thousand sixteen consecutive gastric cancer patients were divided into two groups according to the operation date, period I (1994-1999) and period II (2000-2006). The clinicopathological features and prognosis were compared between the two periods. RESULTS There were significant differences in the proportions of early gastric carcinoma, different tumor node metastasis (TNM) staged patients, specialized operation and adjuvant chemotherapy between the two periods. The 5-year survival rate after curative resection within period II, were significantly higher than those within period I. Stratification analysis revealed that the survival rates of the patients with curative resection, lymph node metastasis, advanced disease, different TNM stages, specialized operations, without adjuvant chemotherapy within period II, were significantly higher than those within period I. Multivariate regression analysis revealed that Borrmann type, histologic type, depth of invasion, lymph node metastasis, curative resection, adjuvant chemotherapy, and different time periods were independent prognostic factors for gastric carcinoma. CONCLUSIONS The treatment efficacy of gastric carcinoma within the recent period improved highly when compared with that within the early period. It was the elevated diagnostic rate of early gastric cancer, standardized radical operation, and adjuvant chemotherapy that contributed to such improvement.