J Gastric Cancer.  2020 Mar;20(1):41-49. 10.5230/jgc.2020.20.e3.

Association between Lymphovascular Invasion and Recurrence in Patients with pT1N+ or pT2–3N0 Gastric Cancer: a Multi-institutional Dataset Analysis

Affiliations
  • 1Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan. innocentworld0hinata@yahoo.co.jp
  • 2Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
  • 3Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan.
  • 4Department of Surgery, Komaki Municipal Hospital, Komaki, Japan.
  • 5Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan.
  • 6Department of Surgery, Konan Kosei Hospital, Konan, Japan.
  • 7Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
  • 8Department of Surgery, Okazaki City Hospital, Okazaki, Japan.
  • 9Department of Surgery, Tosei General Hospital, Seto, Japan.
  • 10Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan.

Abstract

PURPOSE
Patients with pathological stage T1N+ or T2-3N0 gastric cancer may experience disease recurrence following curative gastrectomy. However, the current Japanese Gastric Cancer Treatment Guidelines do not recommend postoperative adjuvant chemotherapy for such patients. This study aimed to identify the prognostic factors for patients with pT1N+ or pT2-3N0 gastric cancer using a multi-institutional dataset.
MATERIALS AND METHODS
We retrospectively analyzed the data obtained from 401 patients with pT1N+ or pT2-3N0 gastric cancer who underwent curative gastrectomy at 9 institutions between 2010 and 2014.
RESULTS
Of the 401 patients assessed, 24 (6.0%) experienced postoperative disease recurrence. Multivariate analysis revealed that age ≥70 years (hazard ratio [HR], 2.62; 95% confidence interval [CI], 1.09-7.23; P=0.030) and lymphatic and/or venous invasion (lymphovascular invasion (LVI): HR, 7.88; 95% CI, 1.66-140.9; P=0.005) were independent prognostic factors for poor recurrence-free survival. There was no significant association between LVI and the site of initial recurrence.
CONCLUSIONS
LVI is an indicator of poor prognosis in patients with pT1N+ or pT2-3N0 gastric cancer.

Keyword

Gastric cancer; Recurrence; Risk factor

MeSH Terms

Asian Continental Ancestry Group
Chemotherapy, Adjuvant
Dataset*
Gastrectomy
Humans
Multivariate Analysis
Prognosis
Recurrence*
Retrospective Studies
Risk Factors
Stomach Neoplasms*

Figure

  • Fig. 1 Flow diagram of the study.

  • Fig. 2 Association between LVI and disease recurrence. (A) Recurrence-free survival of patients with pT1N+ or pT2–3 N0 gastric cancer according to the LVI status. (B) Distribution of initial recurrence sites.LVI = lymphovascular invasion.*Two patients had multiple sites of first recurrence.


Reference

1. Van Cutsem E, Sagaert X, Topal B, Haustermans K, Prenen H. Gastric cancer. Lancet. 2016; 388:2654–2664. PMID: 27156933.
Article
2. Shum H, Rajdev L. Multimodality management of resectable gastric cancer: a review. World J Gastrointest Oncol. 2014; 6:393–402. PMID: 25320655.
Article
3. Kanda M, Murotani K, Kobayashi D, Tanaka C, Yamada S, Fujii T, et al. Postoperative adjuvant chemotherapy with S-1 alters recurrence patterns and prognostic factors among patients with stage II/III gastric cancer: a propensity score matching analysis. Surgery. 2015; 158:1573–1580. PMID: 26120068.
Article
4. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017; 20:1–19.
5. Shen L, Shan YS, Hu HM, Price TJ, Sirohi B, Yeh KH, et al. Management of gastric cancer in Asia: resource-stratified guidelines. Lancet Oncol. 2013; 14:e535–e547. PMID: 24176572.
Article
6. Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer. 2018; 21:144–154. PMID: 28417260.
Article
7. Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, Murai T, et al. Multi-institutional analysis of the prognostic significance of postoperative complications after curative resection for gastric cancer. Cancer Med. 2019; 8:5194–5201. PMID: 31353821.
Article
8. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14:101–112. PMID: 21573743.
9. Liu JY, Peng CW, Yang XJ, Huang CQ, Li Y. The prognosis role of AJCC/UICC 8th edition staging system in gastric cancer, a retrospective analysis. Am J Transl Res. 2018; 10:292–303. PMID: 29423014.
10. Kanda M, Mizuno A, Fujii T, Shimoyama Y, Yamada S, Tanaka C, et al. Tumor infiltrative pattern predicts sites of recurrence after curative gastrectomy for stages 2 and 3 gastric cancer. Ann Surg Oncol. 2016; 23:1934–1940. PMID: 26847679.
Article
11. Tokunaga M, Ito S, Yoshikawa T, Nunobe S, Fukagawa T, Misawa K, et al. Prognostic factors for survival in patients with pT1 N+ or T2–3 N0 gastric cancer in Japan. Br J Surg. 2017; 104:885–890. PMID: 28240355.
Article
12. Kunisaki C, Makino H, Kimura J, Takagawa R, Kosaka T, Ono HA, et al. Impact of lymphovascular invasion in patients with stage I gastric cancer. Surgery. 2010; 147:204–211. PMID: 19878963.
Article
13. Du CY, Chen JG, Zhou Y, Zhao GF, Fu H, Zhou XK, et al. Impact of lymphatic and/or blood vessel invasion in stage II gastric cancer. World J Gastroenterol. 2012; 18:3610–3616. PMID: 22826628.
Article
14. del Casar JM, Corte MD, Alvarez A, García I, Bongera M, González LO, et al. Lymphatic and/or blood vessel invasion in gastric cancer: relationship with clinicopathological parameters, biological factors and prognostic significance. J Cancer Res Clin Oncol. 2008; 134:153–161. PMID: 17628829.
Article
15. Dicken BJ, Graham K, Hamilton SM, Andrews S, Lai R, Listgarten J, et al. Lymphovascular invasion is associated with poor survival in gastric cancer: an application of gene-expression and tissue array techniques. Ann Surg. 2006; 243:64–73. PMID: 16371738.
16. Lu J, Dai Y, Xie JW, Wang JB, Lin JX, Chen QY, et al. Combination of lymphovascular invasion and the AJCC TNM staging system improves prediction of prognosis in N0 stage gastric cancer: results from a high-volume institution. BMC Cancer. 2019; 19:216. PMID: 30857518.
Article
17. Zhao B, Huang X, Zhang J, Luo R, Lu H, Xu H, et al. Clinicopathologic factors associated with recurrence and long-term survival in node-negative advanced gastric cancer patients. Rev Esp Enferm Dig. 2019; 111:111–120. PMID: 30404528.
Article
Full Text Links
  • JGC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr