Retrospective study of lymph node metastasis and pathological characteristics of gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yanwu ¹ ,  ZHANG Youcheng ^1,2

1. Gansu University of Chinese Medicine, Lanzhou 730000, P.R.China;
2. Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730000, P.R.China;

Corresponding?author：

ZHANG Youcheng, Email: zhangychmd@126.com

Keywords：

gastric neoplasm; lymph node metastasis; clinicopathologic feature; immunohistochemical marker

DOI：

10.7507/1007-9424.201610049

Video：

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Objective To explore regularity of lymph node metastasis and analyze its relation between lymph node metastasis and histological features and its immunohistochemical markers of gastric cancer, and to provide evidence for selection of reasonable operation. Method The clinical data of 160 patients with gastric cancer who underwent D2, D3 or D3⁺ from August 2013 to May 2016 in the Second Hospital of Lanzhou University were retrospectively studied, and the relation between the lymph node metastasis and the pathological features and the immunohistochemical markers in the different location of gastric cancer was analyzed. Results ① The rate of lymph node metastasis in the early gastric cancer was significantly lower than that in the advanced gastric cancer (P<0.05), which in the T4 stage was significantly higher than that in the T1–T3 stages (P<0.05), in the poorly differentiated gastric cancer was significantly higher than that in the well differentiated gastric cancer (P<0.05), or in the Borrmann type Ⅲ+Ⅳ (infiltrative type) was significantly higher than that in the Borrmann type Ⅰ+Ⅱ (topical type,P<0.05), but which wasn’t associated with the gender, tumor location, or tumor diameter (P>0.05). ② The lymph node metastasis occurred mainly in the first and the second stations for the well differentiated gastric cardia cancer, which not only occurred in the first and the second stations, but also occurred in the No.13 lymph node for the poorly differentiated gastric cardia cancer; which occurred mainly in the first and the second stations and occasionally occurred in the No.12 lymph node for the well differentiated gastric body cancer, which not only occurred in the first and the second stations, but also occurred in the No.12, No.13 and No.14 lymph nodes for the poorly differentiated gastric body cancer; which occurred in the No.11, No.12 and No.13 lymph nodes for the part of well differentiated gastric antrum cancer, which even occurred in the No.15 and No.16 lymph nodes for the part of poorly differentiated gastric antrum cancer. ③ The expression positive rates of the TopoⅡα, Villin, Ki-67, CK-8, and CK-18 proteins in the poorly differentiated gastric cancer were significantly higher than those in the well differentiated gastric cancer (P<0.05), which of the P-gp, GST-π, and c-erbB-2 proteins in the poorly differentiated gastric cancer were significantly lower than those in the well differentiated gastric cancer (P<0.05). The expression positive rates of the TopoⅡα, P-gp, Villin, Ki-67, CK-8, and CK-18 proteins in the gastric cancer with lymph node metastasis were significantly higher than those in the gastric cancer without lymph node metastasis (P<0.05), whereas there were no relation between the expression positive rates of the GST-π and c-erbB-2 proteins and the lymph node metastasis of gastric cancer (P>0.05). ④ The different location of gastric cancer wasn’t associated with the gender, gross type, clinical stage, T stage, degree of differentiation, Borrmann type, or tumor diameter. Conclusions In advanced gastric cancer, depth of tumor invasion reached T4, poor degree of differentiation, and Borrmann infiltration type of gastric cancer, lymph node metastasis rates are higher. For gastric cardia cancer patients with well differentiation, standard D2 should be performed, D2+No.13 should be performed for poor differentiation. For gastric body cancer patients with well differentiation, D2+No.12 should be performed, D3 should be performed for poor differentiation. For gastric antrum cancer patients with differentiation degree or not, D3 should be performed, selective dissection of No.15 or No.16 lymph node should be performed for poor differentiation. Combined detection of TopoⅡα, Villin, Ki-67, CK-8, CK-18, P-gp, GST-π, and c-erbB-2 immunohistochemical markers might be helpful to improve accuracy of lymph node metastasis and evaluate degree of malignancy and prognosis of patients with gastric cancer.

Citation： LI Yanwu, ZHANG Youcheng. Retrospective study of lymph node metastasis and pathological characteristics of gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(5): 572-579. doi: 10.7507/1007-9424.201610049 Copy

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2.	Piazuelo MB, Correa P. Gastric cáncer: Overview. Colomb Med (Cali), 2013, 44(3): 192-201.
3.	Noguchi M, Miyazaki I. Prognostic significance and surgical management of lymph node metastasis in gastric cancer. Br J Surg, 1996, 83(2): 156-161.
4.	Ren G, Cai R, Zhang WJ, et al. Prediction of risk factors for lymph node metastasis in early gastric cancer. World J Gastroenterol, 2013, 19(20): 3096-3107.
5.	萬遠廉, 潘義生, 劉玉村, 等. 胃癌淋巴轉移規律與淋巴結清掃范圍的分析 (附 326 例報告). 中華外科雜志, 2000, 38(10): 752-755.
6.	Kodera Y, Yamamura Y, Kanemitsu Y, et al. Lymph node metastasis in cancer of the middle-third stomach: criteria for treatment with a pylorus-preserving gastrectomy. Surg Today, 2001, 31(3): 196-203.
7.	陳峻青. 胃癌外科基礎研究與擴大切除術的進展. 中國普外基礎與臨床雜志, 2004, 11(2): 97-99.
8.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 2017, 20(1): 1-19.
9.	畦倉薫, 有馬一城, 高橋利通, 等. 72 腫瘤浸潤型胃癌 (Borrmann V 型) の検討 (<特集>第 25 回日本消化器外科學會総會). 日本消化器外科學會雑誌, 1985, 18(2): 334.
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11.	李宇, 周巖冰. 胃癌的淋巴結轉移規律研究. 齊魯醫學雜志, 2007, 22(4): 309-311.
12.	鞠振煜. 胃癌腫瘤部位與區域淋巴結轉移及對術式選擇的臨床分析. 吉林大學, 2012: 27-40.
13.	Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med, 1999, 340(12): 908-914.
14.	Maruyama K, Sasako M, Kinoshita T, et al. Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg, 1995, 19(4): 532-536.
15.	Sasako M, Saka M, Fukagawa T, et al. Surgical treatment of advanced gastric cancer: Japanese perspective. Dig Surg, 2007, 24(2): 101-107.
16.	Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol, 2004, 30(3): 303-308.
17.	Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol, 2006, 7(4): 309-315.
18.	Aihara R, Mochiki E, Ohno T, et al. Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer. Surg Endosc, 2010, 24(9): 2343-2348.
19.	Hiki N, Shimoyama S, Yamaguchi H, et al. Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg, 2006, 203(2): 162-169.
20.	彭根, 揭志剛. 進展期胃癌胰頭后淋巴結組 (NO.13 LN) 清掃 67 例分析//首屆江西省科協學術年會第二十二分會場暨江西省第十一次中西醫結合普通外科學術年會, 2010: 20-24.
21.	劉兵. 胃癌 No.12、No.13 淋巴結清掃的臨床意義. 內蒙古醫科大學, 2015: 11-17.
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23.	吳宏培, 李俊海, 張遠, 等. P-gp、GST-π、TopoⅡ在胃癌組織中的表達及意義. 現代腫瘤醫學, 2010, 18(9): 1788-1791.
24.	關云艷, 歐希龍, 郭慶明, 等. P-gp, ToPoⅡ和 GST-π在胃癌組織中的表達及與預后的關系. 世界華人消化雜志, 2006, 14(35): 3371-3376.
25.	王啓名, 張慶玲. 細胞角蛋白免疫組化染色對胃癌淋巴結轉移的診斷意義. 廣東醫學院學報, 2011, 29(4): 367-369.
26.	李增波, 張志偉, 湯國輝, 等. CK-8 蛋白在胃癌組織中的表達及意義. 中南醫學科學雜志, 2012, 40(6): 555-558.
27.	柴軍輝, 張占東, 馬奇, 等. CK18 在胃癌及區域轉移淋巴結中的表達及意義. 河南醫學研究, 2014, 23(9): 1-4.
28.	李秋元. 胃癌組織中 c-erbB-2、c-met、nm23 的表達及意義. 汕頭大學, 2007: 19-31.
29.	王齊敏, 王莉芬, 于香莉, 等. 胃癌組織中 EGFR、C-erbB-2、TopoⅡα 及 P-gp 的表達及意義. 現代腫瘤醫學, 2013, 21(4): 834-837.
30.	蔡穎, 藺玉昌. 胃癌 P53 和 Ki-67 表達與淋巴結轉移的相關性. 齊齊哈爾醫學院學報, 2001, 22(11): 1236-1237.
31.	侯寶洲, 孫劍經, 趙秀芳, 等. 胃癌中 β-catenin、ki67 與 Her-2/Neu 的關系及臨床意義. 安徽醫科大學學報, 2014, 49(2): 258-261.

1. Layke JC, Lopez PP. 胃癌: 診斷和治療方案的選擇. 中國全科醫學, 2015, 18(3): 248-249.
2. Piazuelo MB, Correa P. Gastric cáncer: Overview. Colomb Med (Cali), 2013, 44(3): 192-201.
3. Noguchi M, Miyazaki I. Prognostic significance and surgical management of lymph node metastasis in gastric cancer. Br J Surg, 1996, 83(2): 156-161.
4. Ren G, Cai R, Zhang WJ, et al. Prediction of risk factors for lymph node metastasis in early gastric cancer. World J Gastroenterol, 2013, 19(20): 3096-3107.
5. 萬遠廉, 潘義生, 劉玉村, 等. 胃癌淋巴轉移規律與淋巴結清掃范圍的分析 (附 326 例報告). 中華外科雜志, 2000, 38(10): 752-755.
6. Kodera Y, Yamamura Y, Kanemitsu Y, et al. Lymph node metastasis in cancer of the middle-third stomach: criteria for treatment with a pylorus-preserving gastrectomy. Surg Today, 2001, 31(3): 196-203.
7. 陳峻青. 胃癌外科基礎研究與擴大切除術的進展. 中國普外基礎與臨床雜志, 2004, 11(2): 97-99.
8. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 2017, 20(1): 1-19.
9. 畦倉薫, 有馬一城, 高橋利通, 等. 72 腫瘤浸潤型胃癌 (Borrmann V 型) の検討 (<特集>第 25 回日本消化器外科學會総會). 日本消化器外科學會雑誌, 1985, 18(2): 334.
10. 李濤, 徐惠綿, 徐巖, 等. 不同部位胃癌臨床病理特征、淋巴結轉移規律及預后的對比研究. 中國當代醫藥, 2013, 20(25): 4-8.
11. 李宇, 周巖冰. 胃癌的淋巴結轉移規律研究. 齊魯醫學雜志, 2007, 22(4): 309-311.
12. 鞠振煜. 胃癌腫瘤部位與區域淋巴結轉移及對術式選擇的臨床分析. 吉林大學, 2012: 27-40.
13. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med, 1999, 340(12): 908-914.
14. Maruyama K, Sasako M, Kinoshita T, et al. Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg, 1995, 19(4): 532-536.
15. Sasako M, Saka M, Fukagawa T, et al. Surgical treatment of advanced gastric cancer: Japanese perspective. Dig Surg, 2007, 24(2): 101-107.
16. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol, 2004, 30(3): 303-308.
17. Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol, 2006, 7(4): 309-315.
18. Aihara R, Mochiki E, Ohno T, et al. Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer. Surg Endosc, 2010, 24(9): 2343-2348.
19. Hiki N, Shimoyama S, Yamaguchi H, et al. Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg, 2006, 203(2): 162-169.
20. 彭根, 揭志剛. 進展期胃癌胰頭后淋巴結組 (NO.13 LN) 清掃 67 例分析//首屆江西省科協學術年會第二十二分會場暨江西省第十一次中西醫結合普通外科學術年會, 2010: 20-24.
21. 劉兵. 胃癌 No.12、No.13 淋巴結清掃的臨床意義. 內蒙古醫科大學, 2015: 11-17.
22. 胡建昆, 陳心足. 進展期胃癌治療方式合理選擇及評價. 中國實用外科雜志, 2011, 31(8): 720-722.
23. 吳宏培, 李俊海, 張遠, 等. P-gp、GST-π、TopoⅡ在胃癌組織中的表達及意義. 現代腫瘤醫學, 2010, 18(9): 1788-1791.
24. 關云艷, 歐希龍, 郭慶明, 等. P-gp, ToPoⅡ和 GST-π在胃癌組織中的表達及與預后的關系. 世界華人消化雜志, 2006, 14(35): 3371-3376.
25. 王啓名, 張慶玲. 細胞角蛋白免疫組化染色對胃癌淋巴結轉移的診斷意義. 廣東醫學院學報, 2011, 29(4): 367-369.
26. 李增波, 張志偉, 湯國輝, 等. CK-8 蛋白在胃癌組織中的表達及意義. 中南醫學科學雜志, 2012, 40(6): 555-558.
27. 柴軍輝, 張占東, 馬奇, 等. CK18 在胃癌及區域轉移淋巴結中的表達及意義. 河南醫學研究, 2014, 23(9): 1-4.
28. 李秋元. 胃癌組織中 c-erbB-2、c-met、nm23 的表達及意義. 汕頭大學, 2007: 19-31.
29. 王齊敏, 王莉芬, 于香莉, 等. 胃癌組織中 EGFR、C-erbB-2、TopoⅡα 及 P-gp 的表達及意義. 現代腫瘤醫學, 2013, 21(4): 834-837.
30. 蔡穎, 藺玉昌. 胃癌 P53 和 Ki-67 表達與淋巴結轉移的相關性. 齊齊哈爾醫學院學報, 2001, 22(11): 1236-1237.
31. 侯寶洲, 孫劍經, 趙秀芳, 等. 胃癌中 β-catenin、ki67 與 Her-2/Neu 的關系及臨床意義. 安徽醫科大學學報, 2014, 49(2): 258-261.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Retrospective study of lymph node metastasis and pathological characteristics of gastric cancer

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