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

Yıl 2021, Cilt: 6 Sayı: 3, 112 - 116, 09.12.2021

Öz

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.
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.

Kaynakça

  • 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 [Internet]. 2018 Nov [cited 2021 Mar 30];68(6):394–424. Available from: https://pubmed.ncbi.nlm.nih.gov/30207593/
  • 2. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer [Internet]. 2021 Jan 1 [cited 2021 Mar 30];24(1):1–21. Available from: https://pubmed.ncbi.nlm.nih.gov/32060757/
  • 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 [Internet]. 2016 Sep 1 [cited 2021 May 1];27:v38–49. Available from: www.springer.com.
  • 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 [Internet]. 2013 Aug [cited 2021 May 1];36(4):325–30. Available from: https://pubmed.ncbi.nlm.nih.gov/22547011/
  • 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. [cited 2021 May 1]; Available from: https://doi.org/10.21147/j.issn.1000-9604.2020.01.07
  • 6. AJCC Cancer Staging Manual | Mahul B. Amin | Springer [Internet]. [cited 2021 Mar 30]. Available from: https://www.springer.com/gp/book/9783319406176
  • 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 [Internet]. 2017 Jan 1 [cited 2021 May 1];43(1):203–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27595506/
  • 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 [Internet]. 2012 Jan [cited 2021 May 2];255(1):50–8. Available from: https://pubmed.ncbi.nlm.nih.gov/21577089/
  • 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 [Internet]. 2020 Aug [cited 2021 May 2];8(15):938–938. Available from: http://atm.amegroups.com/article/view/48843/html
  • 10. Szczepanik AM, Paszko A, Szura M, Scully-Horner T, Kulig J. Alternative staging of regional lymph nodes in gastric cancer [Internet]. Vol. 11, Przeglad Gastroenterologiczny. Termedia Publishing House Ltd.; 2016 [cited 2021 May 2]. p. 145–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27713774/
  • 11. Rawicz-Pruszy´nski K, Pruszy´nski P, Ciseł B, Mlak R, Mielko J, Skórzewska M, et al. The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy. 2019 [cited 2021 May 2]; Available from: www.mdpi.com/journal/cancers
  • 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 [Internet]. 2021 [cited 2021 May 2];21(1):49. Available from: https://pubmed.ncbi.nlm.nih.gov/33854813/
  • 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 [Internet]. 2019 Jun 1 [cited 2021 May 2];119(7):948–57. Available from: https://pubmed.ncbi.nlm.nih.gov/30742308/
  • 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 Mar;79(3):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 [Internet]. 2014 Aug 4 [cited 2021 May 2];20:1369–75. Available from: https://pubmed.ncbi.nlm.nih.gov/25087904/
  • 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 [Internet]. 2019 Dec 23 [cited 2021 May 2];50(1):44–57. Available from: https://pubmed.ncbi.nlm.nih.gov/31735973/
  • 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 [Internet]. 2008 Feb [cited 2021 May 2];34(2):159–65. Available from: https://pubmed.ncbi.nlm.nih.gov/17566691/
  • 19. Oktar Asoglu , Tugba Matlim, Atilla Kurt, Semen Yesil Onder, Enver Kunduz, Hasan Karanlik, Bulent Sam, Yersu Kapran, Dursun Bugra. Guidelines for extended lymphadenectomy in gastric cancer: a prospective comparative study. Ann Surg Oncol [Internet]. 2013 Jan [cited 2021 Jul 16];20(1):218–25. Available from: https://pubmed.ncbi.nlm.nih.gov/22851047/
  • 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 [Internet]. 2016 Aug 1 [cited 2021 Jul 16];37(8):11105. Available from: /pmc/articles/PMC4999458/
  • 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 Jun;38(6):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 Oct 1;30(10):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 Apr 1;42(4):204–11.
  • 24. Kazuhiro Yasuda , Yosuke Adachi, Norio Shiraishi, Masafumi Inomata, Hiroaki Takeuchi, Seigo Kitano. Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer. Ann Surg Oncol [Internet]. 2002 Oct [cited 2021 Jul 16];9(8):771–4. Available from: https://pubmed.ncbi.nlm.nih.gov/12374660/
  • 25. Praveen Ravishankaran , Arvind Krishnamurthy. Prognostic value of metastatic lymph nodal ratio in squamous cell carcinoma of esophagus: A three-step extrapolative study. South Asian J cancer [Internet]. 2014 Oct 1 [cited 2021 Jul 16];3(4):213–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25422807/

Prognostic Value of Metastatic Lymph Node Ratio (MLNR) in Patients Undergoing D2 Gastrectomy for GastricCancer

Yıl 2021, Cilt: 6 Sayı: 3, 112 - 116, 09.12.2021

Öz

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.
Place and Duration of Study: Department of General Surgery, University of Health Sciences, Prof Dr Cemil Tascıoğlu City Hospital, Istanbul, Turkey, from January 2012 to April 2021.
Methods: 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.

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.

Kaynakça

  • 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 [Internet]. 2018 Nov [cited 2021 Mar 30];68(6):394–424. Available from: https://pubmed.ncbi.nlm.nih.gov/30207593/
  • 2. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer [Internet]. 2021 Jan 1 [cited 2021 Mar 30];24(1):1–21. Available from: https://pubmed.ncbi.nlm.nih.gov/32060757/
  • 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 [Internet]. 2016 Sep 1 [cited 2021 May 1];27:v38–49. Available from: www.springer.com.
  • 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 [Internet]. 2013 Aug [cited 2021 May 1];36(4):325–30. Available from: https://pubmed.ncbi.nlm.nih.gov/22547011/
  • 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. [cited 2021 May 1]; Available from: https://doi.org/10.21147/j.issn.1000-9604.2020.01.07
  • 6. AJCC Cancer Staging Manual | Mahul B. Amin | Springer [Internet]. [cited 2021 Mar 30]. Available from: https://www.springer.com/gp/book/9783319406176
  • 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 [Internet]. 2017 Jan 1 [cited 2021 May 1];43(1):203–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27595506/
  • 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 [Internet]. 2012 Jan [cited 2021 May 2];255(1):50–8. Available from: https://pubmed.ncbi.nlm.nih.gov/21577089/
  • 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 [Internet]. 2020 Aug [cited 2021 May 2];8(15):938–938. Available from: http://atm.amegroups.com/article/view/48843/html
  • 10. Szczepanik AM, Paszko A, Szura M, Scully-Horner T, Kulig J. Alternative staging of regional lymph nodes in gastric cancer [Internet]. Vol. 11, Przeglad Gastroenterologiczny. Termedia Publishing House Ltd.; 2016 [cited 2021 May 2]. p. 145–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27713774/
  • 11. Rawicz-Pruszy´nski K, Pruszy´nski P, Ciseł B, Mlak R, Mielko J, Skórzewska M, et al. The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy. 2019 [cited 2021 May 2]; Available from: www.mdpi.com/journal/cancers
  • 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 [Internet]. 2021 [cited 2021 May 2];21(1):49. Available from: https://pubmed.ncbi.nlm.nih.gov/33854813/
  • 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 [Internet]. 2019 Jun 1 [cited 2021 May 2];119(7):948–57. Available from: https://pubmed.ncbi.nlm.nih.gov/30742308/
  • 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 Mar;79(3):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 [Internet]. 2014 Aug 4 [cited 2021 May 2];20:1369–75. Available from: https://pubmed.ncbi.nlm.nih.gov/25087904/
  • 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 [Internet]. 2019 Dec 23 [cited 2021 May 2];50(1):44–57. Available from: https://pubmed.ncbi.nlm.nih.gov/31735973/
  • 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 [Internet]. 2008 Feb [cited 2021 May 2];34(2):159–65. Available from: https://pubmed.ncbi.nlm.nih.gov/17566691/
  • 19. Oktar Asoglu , Tugba Matlim, Atilla Kurt, Semen Yesil Onder, Enver Kunduz, Hasan Karanlik, Bulent Sam, Yersu Kapran, Dursun Bugra. Guidelines for extended lymphadenectomy in gastric cancer: a prospective comparative study. Ann Surg Oncol [Internet]. 2013 Jan [cited 2021 Jul 16];20(1):218–25. Available from: https://pubmed.ncbi.nlm.nih.gov/22851047/
  • 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 [Internet]. 2016 Aug 1 [cited 2021 Jul 16];37(8):11105. Available from: /pmc/articles/PMC4999458/
  • 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 Jun;38(6):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 Oct 1;30(10):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 Apr 1;42(4):204–11.
  • 24. Kazuhiro Yasuda , Yosuke Adachi, Norio Shiraishi, Masafumi Inomata, Hiroaki Takeuchi, Seigo Kitano. Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer. Ann Surg Oncol [Internet]. 2002 Oct [cited 2021 Jul 16];9(8):771–4. Available from: https://pubmed.ncbi.nlm.nih.gov/12374660/
  • 25. Praveen Ravishankaran , Arvind Krishnamurthy. Prognostic value of metastatic lymph nodal ratio in squamous cell carcinoma of esophagus: A three-step extrapolative study. South Asian J cancer [Internet]. 2014 Oct 1 [cited 2021 Jul 16];3(4):213–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25422807/
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Orjinal Makale
Yazarlar

Ali Alemdar 0000-0002-1354-7887

Selma Şengiz Erhan 0000-0001-8810-8806

Yayımlanma Tarihi 9 Aralık 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 6 Sayı: 3

Kaynak Göster

Vancouver Alemdar A, Şengiz Erhan S. Prognostic Value of Metastatic Lymph Node Ratio (MLNR) in Patients Undergoing D2 Gastrectomy for GastricCancer. Arch Clin Exp Med. 2021;6(3):112-6.