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World Journal of Surgery

, Volume 43, Issue 10, pp 2499–2505 | Cite as

Extra-perigastric Extranodal Metastasis is a Significant Prognostic Factor in Node-Positive Gastric Cancer

  • Akiko Tonouchi
  • Masato Sugano
  • Masanori Tokunaga
  • Shizuki Sugita
  • Masahiro Watanabe
  • Reo Sato
  • Akio Kaito
  • Tetsuo Akimoto
  • Atsushi Ochiai
  • Takahiro Kinoshita
  • Takeshi KuwataEmail author
Original Scientific Report

Abstract

Background

Extranodal metastasis is an isolated tumor nodule without a residual lymph node structure and has been reported as a poor prognostic factor in gastric cancer. The aim of this study is to assess the prognostic value of extranodal metastasis, especially from the viewpoint of its anatomical distribution.

Methods

A total of 139 consecutive gastric cancer patients who underwent curative surgery with lymph node metastasis between 2008 and 2009 were included. Clinicopathological features and patient survival outcomes were retrospectively assessed. Patients with extranodal metastasis were subdivided into two groups: perigastric extranodal metastasis, located near the perigastric area (#1–#7 according to the Japanese classification of gastric carcinoma 15th edition), and extra-perigastric extranodal metastasis, located alongside the major vessels (#8–#12).

Results

Extranodal metastasis was found in 51 patients (37%), and it was more frequent in those with bulky, ≥pT3, and pStage III tumors. All patients with extra-perigastric extranodal metastasis had recurrence, resulting in a 0% 5-year overall survival rate, which was significantly worse than that of patients with perigastric extranodal metastasis (59%), or those without extranodal metastasis (84%; P < 0.001). Multivariable analysis identified the presence of extra-perigastric extranodal metastasis as an independent poor prognostic factor.

Conclusions

Extranodal metastasis, especially extra-perigastric extranodal metastasis, was a pivotal poor prognostic factor in node-positive gastric cancer. Recognizing extra-perigastric extranodal metastasis would help provide optimal therapeutic options to these high-risk patients.

Notes

Acknowledgements

This work was supported in part by The National Cancer Center Research and Development Fund (28-A-11).

Compliance with Ethical Standards

Conflict of interest

The authors declare that there is no conflict of interest.

Human Rights Statement

This study complied with the standards of the Declaration of Helsinki and current ethical guidelines and was approved by the institutional ethics board.

Informed Consent

Written informed consent for participation in this study was not obtained from the patients, because this study did not report on a clinical trial and the data were retrospective in nature and analyzed anonymously.

Supplementary material

268_2019_5076_MOESM1_ESM.docx (132 kb)
Supplementary file1 (DOCX 132 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Akiko Tonouchi
    • 1
    • 3
  • Masato Sugano
    • 2
    • 4
  • Masanori Tokunaga
    • 1
  • Shizuki Sugita
    • 1
  • Masahiro Watanabe
    • 1
  • Reo Sato
    • 1
  • Akio Kaito
    • 1
  • Tetsuo Akimoto
    • 3
    • 5
  • Atsushi Ochiai
    • 2
    • 4
  • Takahiro Kinoshita
    • 1
    • 4
  • Takeshi Kuwata
    • 2
    • 4
    Email author
  1. 1.Department of Gastric SurgeryNational Cancer Center Hospital EastKashiwaJapan
  2. 2.Department of Pathology and Clinical LaboratoriesNational Cancer Center Hospital EastKashiwaJapan
  3. 3.Course of Advanced Clinical Research of CancerJuntendo University Graduate School of MedicineTokyoJapan
  4. 4.Exploratory Oncology Research & Clinical Trial Center (EPOC)National Cancer CenterKashiwaJapan
  5. 5.Department of Radiation Oncology and Particle TherapyNational Cancer Center Hospital EastKashiwaJapan

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