Prognostic significance and the role in TNM stage of extranodal metastasis within regional lymph nodes station in gastric carcinoma
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Xiao-Long Chen1,2,*, Lin-Yong Zhao1,2,*, Lian Xue1,2, Yu-Hui Xu3, Wei-Han Zhang1,2, Kai Liu1,2, Xin-Zu Chen1,2, Kun Yang1,2, Bo Zhang1, Zhi-Xin Chen1, Jia-Ping Chen1, Zong-Guang Zhou1,4, Jian-Kun Hu1,2
1Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
2Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
3West China School of Medicine, Sichuan University, Chengdu 610041, China
4Institution of Digestive Surgery, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
*These authors have contributed equally to this work and should be considered as the co-first authors
Jian-Kun Hu, email: [email protected]
Keywords: gastric carcinoma, extranodal metastasis, prognosis, TNM stage, C-index
Received: April 4, 2016 Accepted: August 10, 2016 Published: August 22, 2016
The role of extranodal metastasis (ENM) in TNM stage in gastric carcinoma (GC) is controversial. This study was aimed to make a detailed investigation of the prognostic significance and the role in TNM stage of ENM in GC. The patients with primary GC, who underwent gastrectomy with curative intention in West China Hospital from January 2005 to December 2011, were retrospectively enrolled. The prognosis and clinicopathological traits were compared between ENM positive (ENMP) and negative (ENMN) groups in all patients, TNM I-II, III and IV stages, respectively. The significance of the number and the role in TNM stage of ENM were also assessed. In our study, 1457 patients were enrolled, with 1324 (90.9%) in ENMN group and 133 (9.1%) in ENMP group. ENMP group had significantly more advanced GC and worse prognosis (all p<0.05) than ENMN group in all patients, TNM I-II stages and TNM III stage. ENM>2 subgroup had remarkably larger tumor size (p=0.002) and more advanced N stage (p=0.016) than ENM=1-2 subgroup. The number of ENM was an independent prognostic factor in ENMP group (p=0.029). The prognosis of ENM>2 in TNM I-III stages was significantly worse than ENMN patients in TNM III stage. The C-index of TNM stage plus the number of ENM was significantly higher than that of current TNM stage alone (p=0.005). In conclusion, the patients in ENMP subgroup had more advanced GC and worse prognosis than those in ENMN subgroup. It might be more reasonable to categorize ENM>2 into TNM IV stage.
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