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Article: Impact of Extracapsular Extension of Lymph Node in Adenocarcinoma of the Stomach

TitleImpact of Extracapsular Extension of Lymph Node in Adenocarcinoma of the Stomach
Authors
Keywordsaged
cancer cell
cancer grading
cancer mortality
cancer prognosis
Issue Date2020
PublisherSpringer for American Society of Breast Surgeons and Society of Surgical Oncology. The Journal's web site is located at http://www.annalssurgicaloncology.org
Citation
Annals of Surgical Oncology, 2020, v. 27 n. 11, p. 4225-4232 How to Cite?
AbstractBackground: 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 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 ECE-based 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 recommended for inclusion in the ECE definition. A nomogram involving ECE could provide better individual prediction of survival for patients with lymph node-positive gastric cancer.
Persistent Identifierhttp://hdl.handle.net/10722/294170
ISSN
2023 Impact Factor: 3.4
2023 SCImago Journal Rankings: 1.037
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLI, B-
dc.contributor.authorWong, IYH-
dc.contributor.authorChan, FSY-
dc.contributor.authorChan, KK-
dc.contributor.authorWong, CLY-
dc.contributor.authorLaw, TT-
dc.contributor.authorKwok, JYY-
dc.contributor.authorLo, AWI-
dc.contributor.authorLaw, S-
dc.date.accessioned2020-11-23T08:27:22Z-
dc.date.available2020-11-23T08:27:22Z-
dc.date.issued2020-
dc.identifier.citationAnnals of Surgical Oncology, 2020, v. 27 n. 11, p. 4225-4232-
dc.identifier.issn1068-9265-
dc.identifier.urihttp://hdl.handle.net/10722/294170-
dc.description.abstractBackground: 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 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 ECE-based 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 recommended for inclusion in the ECE definition. A nomogram involving ECE could provide better individual prediction of survival for patients with lymph node-positive gastric cancer.-
dc.languageeng-
dc.publisherSpringer for American Society of Breast Surgeons and Society of Surgical Oncology. The Journal's web site is located at http://www.annalssurgicaloncology.org-
dc.relation.ispartofAnnals of Surgical Oncology-
dc.rightsThis is a post-peer-review, pre-copyedit version of an article published in [insert journal title]. The final authenticated version is available online at: https://doi.org/[insert DOI]-
dc.subjectaged-
dc.subjectcancer cell-
dc.subjectcancer grading-
dc.subjectcancer mortality-
dc.subjectcancer prognosis-
dc.titleImpact of Extracapsular Extension of Lymph Node in Adenocarcinoma of the Stomach-
dc.typeArticle-
dc.identifier.emailWong, IYH: iyhwong@hku.hk-
dc.identifier.emailChan, FSY: fsychan@hku.hk-
dc.identifier.emailWong, CLY: wongcly@hku.hk-
dc.identifier.emailLaw, TT: ttlaw@HKUCC-COM.hku.hk-
dc.identifier.emailKwok, JYY: jyykwok@hkucc.hku.hk-
dc.identifier.emailLaw, S: slaw@hku.hk-
dc.identifier.authorityWong, IYH=rp02293-
dc.identifier.authorityLaw, S=rp00437-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1245/s10434-020-08541-3-
dc.identifier.pmid32372311-
dc.identifier.scopuseid_2-s2.0-85085044594-
dc.identifier.hkuros320255-
dc.identifier.volume27-
dc.identifier.issue11-
dc.identifier.spage4225-
dc.identifier.epage4232-
dc.identifier.isiWOS:000530603600001-
dc.publisher.placeUnited States-
dc.identifier.issnl1068-9265-

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