ASO Author Reflections: Extracapsular Extension of Lymph Node: An Important Consideration for Gastric Cancer
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Extracapsular Extension of Lymph Node: An Important Consideration for Gastric Cancer Bofei Li, MD1, Anthony W. I. Lo, MBChB (CUHK), PhD (Melbourne), FHKCPath2, and Simon Law, MBBChir (Cantab), MA, MS (HK), PhD (HK), FRCSEd, FCSHK, FHKAM (Surgery), FACS1 1
Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China; 2Division of Anatomical Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
Gastric cancer is still highly prevalent worldwide, and proper stratification of patients based on survival outcome is important following radical surgery. The American Joint Committee on Cancer (AJCC) stratifies N stage based purely on the number of metastatic regional lymph nodes. Although several previous studies have indicated that extracapsular extension (ECE) was an independent poor prognostic factor in gastric cancer,1,2 this feature is currently still neglected in the staging system and prognostic models. The finer distinctions into different grades of ECE have not been discussed for gastric cancer, and the impact of ECE and its interaction with other prognostic factors are not clearly documented. ECE is defined as tumor extending through the nodal capsule into the perinodal fatty tissue. It has also been termed extranodal extension (ENE), extracapsular spread, and extranodal spread in previous reports. It is better studied in other cancers, being incorporated into nodal staging in head and neck cancer, and has strong prognostic value in esophageal cancer, where it is encountered more frequently in adenocarcinoma than squamous cell carcinoma.3 Our data on ECE in gastric cancer are published in this issue of Annals of Surgical Oncology.4 We included 187 patients who underwent D2 gastrectomy. All patients were
Ó Society of Surgical Oncology 2020 First Received: 20 April 2020 S. Law, MBBChir (Cantab), MA, MS (HK), PhD (HK), FRCSEd, FCSHK, FHKAM (Surgery), FACS e-mail: [email protected]
neoadjuvant therapy-naı¨ve and had positive lymph nodes on pathological examination. ECE was identified in over two-thirds of patients and was shown to be a strong prognostic factor, with significantly worse 3-year overall survival and disease-free survival in ECE(?) patients when compared with ECE(-) patients. ECE grade based on the Lewis criteria5 added limited value in stratification or prognosis. Subserosal tumor deposits, which were classified as ECE grade 4, were therefore recommended to be grouped under one morphology of ECE(?). ECE(?) represented high risk of not only peritoneal recurrence but also lymph node and hematogenous recurrences. A prognostic nomogram model including ECE could provide better individual prediction of survival for lymph node-positive gastric cancer patients. We also emphasized the importance of rework on slides review for any further studies involving pathology data. Our data warrant wider use of ECE, as well as the prognostic model and incorporation
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