Risk Factors of Hepatoduodenal Lymph Node Metastasis in Advanced Gastric Cancer and The Impact on Prognosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 JINXin ¹ , FENGLi ² , LIFu-guang ¹

1. Department of General Surgery, Ankang Central Hospital, Ankang 725000, Shannxi Province, China;
2. Department of Anorectal Surgery, Ankang Central Hospital, Ankang 725000, Shannxi Province, China;

Corresponding author：

JINXin, Email: dingcf115@163.com

Keywords：

Advanced gastric cancer; Hepatoduodenal lymph node; Metastasis

DOI：

10.7507/1007-9424.20160217

Video：

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Objective To investigate the risk factors of hepatoduodenal lymph node (HDLN) metastasis in patients with advanced gastric cancer and its effect on prognosis. Methods Clinical datas of patients with advanced gastric cancer who underwent D2 radical gastrectomy for gastric cancer and HDLN dissection between Jan 2011 and Nov 2013 in department of general surgery of Ankang Central Hospital were retrospectively reviewed. Multivariate logistic regression analysis was performed to identify the independent risk factors associated with HDLN metastasis. Survival curves were performed to compare the survival rate of patients with or without HDLN metastasis and of patients with HDLN metastasis or with other lymph node metastasis. A Cox proportional hazards model was used for the multivariate analysis of risk factors for death in advanced gastric cancer. Results The incidence of HDLN metastasis was 10.7% in patients with advanced gastric cancer. Multivariate logistic regression analyses revealed that the middle or lower stomach cancer (OR=6.014, P=0.002) and stage T3 or T4 (OR=5.133, P=0.021) were independent risk factors for HDLN metastasis. The 2-year overall survival (OS) rate was 36.7% in patients with HDLN metastasis. It was lower in patients with HDLN metastasis compared with those without (P=0.002). Limited to node-positive patients, patients with HDLN metastasis demonstrated decreased 2-year OS rate compared with node-positive patients without HDLN metastasis (P=0.027). Cox proportional hazard analysis identified poorly differentiated or undifferentiated cancer, stage of T3 or T4, and HDLN metastasis were independent poor prognostic factors in the patients with advanced gastric cancer (P < 0.05). Conclusions Cancer located in the middle or lower stomach, and stage T3 or T4 were independent risk factors for HDLN metastasis in patients with advanced gastric cancer. HDLN metastasis demonstrated a poor prognosis.

Citation： JINXin, FENGLi, LIFu-guang. Risk Factors of Hepatoduodenal Lymph Node Metastasis in Advanced Gastric Cancer and The Impact on Prognosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(7): 838-842. doi: 10.7507/1007-9424.20160217 Copy

1.	Guo DJ, Yang K, Zhang WH, et al. Prognostic value of metastatic No.8p LNs in patients with gastric cancer. Gastroenterol Res Pract, 2015, 2015: 937682.
2.	Attaallah W, Uprak K, Gunal O, et al. Prognostic impact of the metastatic lymph node ratio on survival in gastric cancer. Indian J Surg Oncol, 2016, 7(1): 67-72.
3.	Ikeguchi M, Miyatani K, Takaya S, et al. Role of surgery in the management for gastric cancer with synchronous distant metastases. Indian J Surg Oncol, 2016, 7(1): 32-36.
4.	Tas F, Karabulut S, Tastekin D, et al. Clinical significance of serum protease-activated receptor-1 levels in gastric cancer patients. Biomed Rep, 2016, 4(4): 489-492.
5.	Spychala A, Nowaczyk P, Murawa D. Comparison of lymphatic system staging classifications in patients with gastric cancer. Pol Przegl Chir, 2015, 87(11): 551-557.
6.	Fujiwara Y, Omori T, Demura K, et al. A Multidisciplinary approach for advanced gastric cancer with paraaortic lymph node metastasis. Anticancer Res, 2015, 35(12): 6739-6745.
7.	郭东明, 李川, 文天夫, 等.肝十二指肠韧带原发肿块诊治分析(附16例报道).中国普外基础与临床杂志, 2014, 21(7): 841-845.
8.	Alatengbaolide, Lin D, Li Y, et al. Lymph node ratio is an indepen-dent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol, 2013, 36(4): 325-330.
9.	Coccolini F, Montori G, Ceresoli M, et al. Advanced gastric cancer: what we know and what we still have to learn. World J Gastroenterol, 2016, 22(3): 1139-1159.
10.	Japanese Gastric Cancer Association. Japanese gastric cancer treat-ment guidelines 2010 (ver. 3). Gastric Cancer, 2011, 14(2): 113-123.
11.	Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: current status of lymph node dissection. World J Gastroenterol, 2016, 22(10): 2875-2893.
12.	Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol, 2010, 17(12): 3077-3079.
13.	Yoshikawa K, Shimada M, Higashijima J, et al. Limited lymph node dissection in elderly patients with gastric cancer. J Med Invest, 2016, 63(1-2): 91-95.
14.	Yamashita K, Hosoda K, Ema A, et al. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol, 2016 Mar 15. [Epub ahead of print].
15.	Digklia A, Wagner AD. Advanced gastric cancer: current treatment landscape and future perspectives. World J Gastroenterol, 2016, 22(8): 2403-2414.
16.	Li Q, Li G, Palmer JD, et al. Lymph node burden as a predictive factor for selective chemoradiotherapy in patients with locally advanced gastric cancer after a D2 dissection: a retrospective study. Am J Clin Oncol, 2014 Dec 10. [Epub ahead of print].
17.	Kawaguchi T, Komatsu S, Ichikawa D, et al. Prognostic influence of the extent of lymph node dissection and perioperative comorbidities in patients with gastric cancer. Anticancer Res, 2016, 36(4): 1917-1922.
18.	Khan MK, Syed AA, Khattak S, et al. Surgical management of gastric cancer: single center experience from a developing country. South Asian J Cancer, 2015, 4(3): 127-129.
19.	He H, Shen Z, Wang X, et al. Survival benefit of greater number of lymph nodes dissection for advanced node-negative gastric cancer patients following radical gastrectomy. Jpn J Clin Oncol, 2016, 46(1): 63-70.
20.	Choi YY, An JY, Katai H, et al. A lymph node staging system for gastric cancer: a hybrid type based on topographic and numeric systems. PLoS One, 2016, 11(3): e0149555.
21.	陆宏伟, 张亚飞, 吉鸿, 等.腹腔镜胃癌D2根治术治疗进展期胃癌的疗效与安全性.中国普外基础与临床杂志, 2015, 22(3): 317-321.
22.	Wang Y. The predictive factors for lymph node metastasis in early gastric cancer: A clinical study. Pak J Med Sci, 2015, 31(6): 1437-1440.
23.	Shirong C, Jianhui C, Chuangqi C, et al. Survival of proper hepatic artery lymph node metastasis in patients with gastric cancer: impli-cations for D2 lymphadenectomy. PLoS One, 2015, 10(3): e0118953.
24.	Lee SL, Lee HH, Ko YH, et al. Relevance of hepatoduodenal ligament lymph nodes in resectional surgery for gastric cancer. Br J Surg, 2014, 101(5): 518-522.
25.	Imamura T, Komatsu S, Ichikawa D, et al. Clinical characteristics of hepatoduodenal Lymph node metastasis in gastric cancer. World J Gastroenterol, 2015, 21(38): 10866-10873.

1. Guo DJ, Yang K, Zhang WH, et al. Prognostic value of metastatic No.8p LNs in patients with gastric cancer. Gastroenterol Res Pract, 2015, 2015: 937682.
2. Attaallah W, Uprak K, Gunal O, et al. Prognostic impact of the metastatic lymph node ratio on survival in gastric cancer. Indian J Surg Oncol, 2016, 7(1): 67-72.
3. Ikeguchi M, Miyatani K, Takaya S, et al. Role of surgery in the management for gastric cancer with synchronous distant metastases. Indian J Surg Oncol, 2016, 7(1): 32-36.
4. Tas F, Karabulut S, Tastekin D, et al. Clinical significance of serum protease-activated receptor-1 levels in gastric cancer patients. Biomed Rep, 2016, 4(4): 489-492.
5. Spychala A, Nowaczyk P, Murawa D. Comparison of lymphatic system staging classifications in patients with gastric cancer. Pol Przegl Chir, 2015, 87(11): 551-557.
6. Fujiwara Y, Omori T, Demura K, et al. A Multidisciplinary approach for advanced gastric cancer with paraaortic lymph node metastasis. Anticancer Res, 2015, 35(12): 6739-6745.
7. 郭东明, 李川, 文天夫, 等.肝十二指肠韧带原发肿块诊治分析(附16例报道).中国普外基础与临床杂志, 2014, 21(7): 841-845.
8. Alatengbaolide, Lin D, Li Y, et al. Lymph node ratio is an indepen-dent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol, 2013, 36(4): 325-330.
9. Coccolini F, Montori G, Ceresoli M, et al. Advanced gastric cancer: what we know and what we still have to learn. World J Gastroenterol, 2016, 22(3): 1139-1159.
10. Japanese Gastric Cancer Association. Japanese gastric cancer treat-ment guidelines 2010 (ver. 3). Gastric Cancer, 2011, 14(2): 113-123.
11. Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: current status of lymph node dissection. World J Gastroenterol, 2016, 22(10): 2875-2893.
12. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol, 2010, 17(12): 3077-3079.
13. Yoshikawa K, Shimada M, Higashijima J, et al. Limited lymph node dissection in elderly patients with gastric cancer. J Med Invest, 2016, 63(1-2): 91-95.
14. Yamashita K, Hosoda K, Ema A, et al. Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer. Eur J Surg Oncol, 2016 Mar 15. [Epub ahead of print].
15. Digklia A, Wagner AD. Advanced gastric cancer: current treatment landscape and future perspectives. World J Gastroenterol, 2016, 22(8): 2403-2414.
16. Li Q, Li G, Palmer JD, et al. Lymph node burden as a predictive factor for selective chemoradiotherapy in patients with locally advanced gastric cancer after a D2 dissection: a retrospective study. Am J Clin Oncol, 2014 Dec 10. [Epub ahead of print].
17. Kawaguchi T, Komatsu S, Ichikawa D, et al. Prognostic influence of the extent of lymph node dissection and perioperative comorbidities in patients with gastric cancer. Anticancer Res, 2016, 36(4): 1917-1922.
18. Khan MK, Syed AA, Khattak S, et al. Surgical management of gastric cancer: single center experience from a developing country. South Asian J Cancer, 2015, 4(3): 127-129.
19. He H, Shen Z, Wang X, et al. Survival benefit of greater number of lymph nodes dissection for advanced node-negative gastric cancer patients following radical gastrectomy. Jpn J Clin Oncol, 2016, 46(1): 63-70.
20. Choi YY, An JY, Katai H, et al. A lymph node staging system for gastric cancer: a hybrid type based on topographic and numeric systems. PLoS One, 2016, 11(3): e0149555.
21. 陆宏伟, 张亚飞, 吉鸿, 等.腹腔镜胃癌D2根治术治疗进展期胃癌的疗效与安全性.中国普外基础与临床杂志, 2015, 22(3): 317-321.
22. Wang Y. The predictive factors for lymph node metastasis in early gastric cancer: A clinical study. Pak J Med Sci, 2015, 31(6): 1437-1440.
23. Shirong C, Jianhui C, Chuangqi C, et al. Survival of proper hepatic artery lymph node metastasis in patients with gastric cancer: impli-cations for D2 lymphadenectomy. PLoS One, 2015, 10(3): e0118953.
24. Lee SL, Lee HH, Ko YH, et al. Relevance of hepatoduodenal ligament lymph nodes in resectional surgery for gastric cancer. Br J Surg, 2014, 101(5): 518-522.
25. Imamura T, Komatsu S, Ichikawa D, et al. Clinical characteristics of hepatoduodenal Lymph node metastasis in gastric cancer. World J Gastroenterol, 2015, 21(38): 10866-10873.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk Factors of Hepatoduodenal Lymph Node Metastasis in Advanced Gastric Cancer and The Impact on Prognosis

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