Minimal Node Affection in Gastric Carcinoma – Pilote Multicentric Study Results

Česká verzia

Authors: J. Šimša; J. Hoch ¹; J. Leffler ¹; D. Umlaufová ¹; J. Schwarz ¹; F. Bělina ²; M. Ryska ²; R. Doležel ²; J. Gatěk ³ ; J. Varga ⁴
Authors place of work: Chirurgické oddělení Oblastní nemocnice Kolín, a. s., primář: doc. MUDr. Jaromír Šimša, Ph. D. ; Chirurgická klinika 2. LF UK a FN Motol, Praha, přednosta: prof. MUDr. Jiří Hoch, CSc. ¹; Chirurgická klinika 2. LF UK a ÚVN, Praha, přednosta: prof. MUDr. Miroslav Ryska, CSc. ²; Chirurgické oddělení Nemocnice Atlas Zlín, a. s., primář: MUDr. Jiří Gatěk, Ph. D. ³; Chirurgická klinika 1. LF UK a FN Bulovka, Praha, přednosta: doc. MUDr. Jan Fanta, CSc. ⁴
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 6, s. 333-338.
Category: Monothematic special - Original

Summary

Introduction:
Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings.

Material and methods:
Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody.

Results:
In the period of two years (1^st January 2009 – 31^st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients’ survival data.

Conclusion:
Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.

Key words:
gastric cancer – lymphadenectomy – lymph node micrometastasis – isolated tumour cells

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