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Extracapsular lymph node spread: a new prognostic factor in gastric cancer
Hakan Alakus1, Arnulf H Hölscher, Guido Grass
1Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
Cancer
|December 2, 2009
Summary
Extracapsular lymph node involvement in gastric cancer is a significant negative prognostic factor, independent of current staging. This finding suggests its inclusion in future gastric cancer staging systems for improved accuracy.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Lymphatic spread is a key prognostic factor in gastric carcinoma.
- Current staging systems (UICC pN) rely on lymph node count, not node characteristics.
- Extracapsular lymph node involvement (ECNI) is a characteristic not currently assessed.
Purpose of the Study:
- To evaluate the prognostic value of ECNI in gastric cancer.
- To correlate ECNI with clinicopathological parameters.
Main Methods:
- Retrospective analysis of 159 gastric cancer patients undergoing gastrectomy with D2-lymphadenectomy.
- Quantification of resected lymph nodes, metastatic lymph nodes, and nodes with ECNI.
- Definition of ECNI as cancer cell infiltration beyond the lymph node capsule.
Main Results:
- 60.4% of patients had lymph node metastasis; 35.8% of these showed ECNI.
- ECNI correlated significantly with higher pN, pM categories, and UICC stages.
- ECNI was a significant predictor of poor survival (P=.001) and an independent prognostic factor in multivariate analysis, unlike UICC pN-category.
Conclusions:
- ECNI is associated with advanced tumor stages in gastric cancer.
- ECNI is an independent negative prognostic factor for gastric cancer survival.
- ECNI should be considered for inclusion in future gastric cancer staging systems.