Impact of Extracapsular Extension of Lymph Node in Adenocarcinoma of the Stomach
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ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Impact of Extracapsular Extension of Lymph Node in Adenocarcinoma of the Stomach Bofei Li, MD1, Ian Yu-Hong Wong, MBBS(HK), FCSHK, FRCSEd(GEN), FHKAM(Surgery)1, Fion Siu-Yin Chan, MBBS(HK), FRCSEd, FCSHK, FHKAM(Surgery)1, Kwan Kit Chan, MBBS(HK), FCSHK, FRCSEd(GEN), FHKAM(Surgery)1, Claudia Lai-Yin Wong, MBChB, FCSHK, FRCSEd(GEN), FHKAM(Surgery)1, Tsz-Ting Law, MBBS(HK), FCSHK, FRCSEd(GEN), FHKAM(Surgery)1, Jeanette Yat-Yin Kwok, BN, RN, MStat1, Anthony Wing Ip Lo, MBChB(CUHK), PhD(Melbourne), FHKCPath2, and Simon Law, MBBChir(Cantab), MA, MS(HK), PhD(HK), FRCSEd, FCSHK, HKAM(Surgery), FACS1 1
Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China; 2Division of Anatomical Pathology, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
ABSTRACT Background. Extracapsular extension (ECE) of lymph node may have important prognostic impact for patients with adenocarcinoma of the stomach, but it generally is ignored in staging systems and prognostic models. This study aimed to examine the impact that ECE of lymph node has on prognosis for patients with adenocarcinoma of the stomach. Methods. The study analyzed 321 consecutive patients with gastric cancer who underwent radical gastrectomy between January 2008 and December 2015. None of these patients had distant metastases. Lymph node metastases were found in 187 patients. The ECE grade was evaluated according to the previously described system used in head and neck cancers. Deposits of cancer cells in sub-serosal fat
Preliminary results of this work presented at Korea International Gastric Cancer Week 2019 (KINGCA WEEK 2019), 11–13 April 2019, Seoul, South Korea.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08541-3) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 23 February 2020 S. Law, MBBChir(Cantab), MA, MS(HK), PhD(HK), FRCSEd, FCSHK, HKAM(Surgery), FACS e-mail: [email protected]
without a recognizable lymph node were classified as ECE grade 4. Survival outcomes were compared using Kaplan– Meier and Cox regression analyses. A nomogram was constructed using identified significant prognostic factors. The predictive accuracy and model performance were measured by the concordance index (C-index). Results. Patients with ECE(?) showed significantly worse 3-year overall survival (OS) and disease-free survival (DFS) than those without ECE. In the sensitivity analysis, ECE had independent prognostic value for both 3-year OS and 3-year DFS, whereas ECE grading showed little impact on mortality trend or disease progression trend. The ECEbased nomogram showed a significantly higher C-index than the pathological tumor and node staging (pTN) staging system. Conclusions. The adverse prognostic impact of ECE was validated. Sub-serosal tumor deposits without recognizable lymph node tissue are recomm
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