Mide kanseri nedeniyle D2 lenf nodu diseksiyonu yapılan hastalarda metastatik lenf nodu oranının prognostik değeri

Amaç: Bu çalışmanın amacı, küratif D2 lenf nodu diseksiyonu uygulanan mide kanseri hastalarında metastatik lenf nodu oranı (MLNR) evrelemesinin prognostik değerini araştırmaktır. Yöntemler: Ocak 2012 ile Nisan 2021 arasında klinik olarak lokal ileri mide kanseri nedeniyle küratif gastrektomi ve D2 lenf nodu diseksiyonu uygulanan 171 hastanın kayıtları geriye dönük olarak incelendi. Metastatik lenf nodu oranı (MLNR) ve Tümör Lenf Nodu Metastazı (TNM) evreleme sistemine göre lenf nodu (N) evrelemesi değerlendirildi. Genel sağ kalım (OS), hastalıksız sağkalım (DFS), klinikopatolojik özellikler ve prognostik faktörler değerlendirildi. MLNR, lenf nodu metastazı sayısı ile karşılaştırıldı. Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 60.7 idi (erkek: N = 118; kadın: N = 53). TNM, N evrelemesine göre, 62 hasta N0, 25 hasta N1, 35 hasta N2 ve 49 hasta N3 idi. MLNR evrelemesine göre MLNR 0 62 hasta, MLNR 1 35 hasta, MLNR 2 35 hasta ve MLNR 3 grubunda 39 hasta vardı. MLNR evrelemesine göre 32 hastada (% 18,7) evre kayması görüldü. Cox regresyon sağkalım analizi, MLNR'nin bağımsız bir prognostik faktör olduğunu gösterdi. (p =0,0001, 95% CI 81.31-101.04) Sonuç: Nodal değerlendirmede pozitif lenf nodu sayısı yerine MLNR evrelemesinin kullanılması, evre kayması sorununu azaltmaya yardımcı olabileceği bulunmuştur. MLNR, hem OS hem de DFS için önemli bir prognostik faktördür.

Prognostic value of metastatic lymph node ratio in patients undergoing D2 gastrectomy for gastric cancer

Aim: Aim of this study was to investigate the prognostic value of metastatic lymph node ratio (MLNR) staging in gastric cancer patients who underwent curative D2 lymph node dissection. Methods: Place and Duration of Study: Department of General Surgery, University of Health Sciences Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey, from January 2012 to April 2021. Medical records of 171 patients undergoing D2 curative gastrectomy for locally advanced gastric cancer between January 2012 and April 2021 were reviewed retrospectively. Metastatic lymph node ratio (MLNR) and TNM staging system node ( Ns )staging was evaluated. Prognostic factors on overall and disease-free survival (DFS) were evaluated. MLNR was compared with number of lymph node metastasis. Results: Mean age of patients included in present study was 60.7 (male: N = 118; female: N = 53). Based on TNM N staging, 62 patients N0, 25 patients N1, 35 patients N2, and 49 were N3 patients. According to classification based on metastatic lymph node ratio (MLNR), 62 patients MLNR 0, 35 patients MLNR 1, 35 patients MLNR 2 and 39 patients were in the MLNR 3 group. Stage migration were seen in 32 patients (% 18,7) in the classification of MLNR. Cox regression survival analysis showed MLNR is an independent prognostic factor. (p =0.0001, 95% CI 81.31-101.04) Conclusions: It has been found that using MLNR staging instead of number of positive lymph nodes in nodal evaluation can help to reduce the problem of stage migration. MLNR is an important prognostic factor for both OS and DFS.

PDF

___

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.
2. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24:1–21.
3. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:v38–49.
4. Alatengbaolide, Lin D, Li Y, Xu H, Chen J, Wang B, et al. Lymph node ratio is an independent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol Cancer Clin Trials. 2013;36:325–30.
5. Sun W, Deng J, Zhang N, Liu H, Liu J, Gu P, et al. Prognostic impact of D2-plus lymphadenectomy and optimal extent of lymphadenectomy in advanced gastric antral carcinoma: Propensity score matching analysis; Chin J Cancer Res. 2020;32:51-61.
6. Ajani JA, In H, Sano T, Gaspar LE, Erasmus JJ, Thang LH, et al. Stomach. In: Amin MB, editor. AJCC Cancer Staging Manual. Chicago: Springer; 2018.:203-20.
7. Komatsu S, Ichikawa D, Nishimura M, Kosuga T, Okamoto K, Konishi H, et al. Evaluation of prognostic value and stage migration effect using positive lymph node ratio in gastric cancer. Eur J Surg Oncol. 2017;43:203–9.
8. Kong SH, Lee HJ, Ahn HS, Kim JW, Kim WH, Lee KU, et al. Stage migration effect on survival in gastric cancer surgery with extended lymphadenectomy: The reappraisal of positive lymph node ratio as a proper N-staging. Ann Surg. 2012;255:50–8.
9. Gu P, Deng J, Wang W, Wang Z, Zhou Z, Xu H, et al. Impact of the number of examined lymph nodes on stage migration in node-negative gastric cancer patients: a Chinese multi-institutional analysis with propensity score matching. Ann Transl Med. 2020;8:938–8.
10. Szczepanik AM, Paszko A, Szura M, Scully-Horner T, Kulig J. Alternative staging of regional lymph nodes in gastric cancer. Vol. 11, Przeglad Gastroenterologiczny. Termedia Publishing House Ltd.; 2016. p. 145–9.
11. Rawicz-Pruszyński K, Ciseł B, Mlak R, Mielko J, Skórzewska M, Kwietniewska M, Pikuła A, Gęca K, Sędłak K, Kurylcio A, Polkowski WP. The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy. Cancers (Basel). 2019;11:1914.
12. Zhu K, Jin H, Li Z, Gao Y, Zhang Q, Liu X, et al. The Prognostic Value of Lymph Node Ratio after Neoadjuvant Chemotherapy in Patients with Locally Advanced Gastric Adenocarcinoma. J Gastric Cancer. 2021;21:49.
13. Agnes A, Biondi A, Cananzi FM, Rausei S, Reddavid R, Laterza V, et al. Ratio-based staging systems are better than the 7th and 8th editions of the TNM in stratifying the prognosis of gastric cancer patients: A multicenter retrospective study. J Surg Oncol. 2019;119:948–57.
14. Medina-Franco H, Cabrera-Mendoza F, Almaguer-Rosales S, Guillén F, Suárez-Bobadilla YL, Sánchez-Ramón A. Lymph node ratio as a predictor of survival in gastric carcinoma. Am Surg. 2013;79:284–9.
15. Isik A, Peker K, Firat D, Yilmaz B, Sayar I, Idiz O, et al. Importance of metastatic lymph node ratio in non-metastatic, lymph node-invaded colon cancer: A clinical trial. Med Sci Monit. 2014;20:1369–75.
16. Zhou J, Lin Z, Lyu M, Chen N, Liao H, Wang Z, et al. Prognostic value of lymph node ratio in non-small-cell lung cancer: A meta-Analysis. Jpn J Clin Oncol. 2019;50:44–57.
17. Abdeyrim A, He S, Zhang Y, Mamtali G, Asla A, Yusup M, et al. Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: A systematic review and meta-analysis. Vol. 49, Journal of Otolaryngology - Head and Neck Surgery. BioMed Central Ltd.; 2020.
18. Marchet A, Mocellin S, Ambrosi A, de Manzoni G, Di Leo A, Marrelli D, et al. The prognostic value of N-ratio in patients with gastric cancer: Validation in a large, multicenter series. Eur J Surg Oncol. 2008;34:159–65.
19. Asoglu O, Matlim T, Kurt A, Onder SY, Kunduz E, Karanlik H, Sam B, Kapran Y, Bugra D. Guidelines for extended lymphadenectomy in gastric cancer: a prospective comparative study. Ann Surg Oncol. 2013;20:218–25.
20. Jian-hui C, Shi-rong C, Hui W, Si-le C, Jian-bo X, Er-tao Z, et al. Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy. Tumour Biol. 2016;37:11105.
21. Espín F, Bianchi A, Llorca S, Feliu J, Palomera E, García O, et al. Metastatic lymph node ratio versus number of metastatic lymph nodes as a prognostic factor in gastric cancer. Eur J Surg Oncol. 2012;38:497– 502.
22. Tokgoz S, Basal FB. The prognostic effect of metastatic lymph node ratio in operated gastric cancer patients. J Coll Physicians Surg Pakistan. 2020; 30:1035–40.
23. Bilici A, Selcukbiricik F, Seker M, Oven BB, Olmez OF, Yildiz O, et al. Prognostic Significance of Metastatic Lymph Node Ratio in Patients with pN3 Gastric Cancer Who Underwent Curative Gastrectomy. Oncol Res Treat. 2019;42:204–11.
24. Yasuda K , Adachi Y, Shiraishi N, Inomata M, Takeuchi H, Kitano S. Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer. Ann Surg Oncol. 2002;9:771–4.
25. Ravishankaran P, Krishnamurthy A. Prognostic value of metastatic lymph nodal ratio in squamous cell carcinoma of esophagus: A threestep extrapolative study. South Asian J Cancer. 2014;3:213–6.