Short- and long-term outcomes of single-port versus multiport laparoscopic radical gastrectomy for gastric cancer: a meta-analysis of propensity score-matched studies and randomized controlled trials.

BACKGROUND: At present, there is no convincing evidence-based medical basis for the efficacy of single-port laparoscopic gastrectomy. To make a high-quality comparison of the short- and long-term outcomes of single-port laparoscopic gastrectomy versus multiport laparoscopic gastrectomy, we performed this meta-analysis, which only included propensity score-matched studies and randomized controlled trials comparing single-port laparoscopic gastrectomy with multiport laparoscopic gastrectomy for patients with gastric cancer. METHODS: Data were retrieved from the electronic databases PubMed, EMBASE, Medline, Cochrane Library, CNKI, Wanfang and VIP up to January 2023, and the data included the outcomes of treatment after single-port laparoscopic gastrectomy and multiport laparoscopic gastrectomy. The primary outcomes were early complications, survival rate after surgery at 1 year, and survival rate after surgery at 5 years. The secondary outcomes were number of pain medications, mean operation time, estimated blood loss, hospital mortality, time to first soft fluid diet, time to first flatus, hospital stay after surgery, and retrieved number of lymph nodes. The Jadad score and Newcastle‒Ottawa scale were used to assess the quality of the included studies. RESULTS: After screening, 9 studies were finally included, including 988 patients. The meta-analysis results showed that estimated blood loss (MD=-29.35, 95% CI: -42.95-15.75, P < 0.0001), hospital stay (MD=-0.99, 95% CI:-1.82~-0.17, P = 0.02), and number of pain medications(MD=-0.65, 95% CI:-1.07~-0.23, P = 0.002) in the single-port laparoscopic gastrectomy group were better than those in the multiport laparoscopic gastrectomy group. There is no significant difference between the single-port laparoscopic gastrectomy group and the multiport laparoscopic gastrectomy group in mean operation time(MD = 5.23,95% CI:-16.58~27.04,P = 0.64), time to first soft fluid diet(MD=-0.06,95% CI: -0.30~0.18,P = 0.63), time to first flatus(MD=-0.18,95% CI:-0.43~0.07,P = 0.16), early complication(OR = 0.73,95% CI:0.50~1.09,P = 0.12), hospital mortality(OR = 1.00,95% CI:0.09~11.16,P = 1.00), retrieved number of lymph nodes(MD=-1.15, 95% CI:-2.71~0.40, P = 0.15), survival rate after surgery 1 year(OR = 2.14,95% CI:0.50~9.07,P = 0.30), and survival rate after surgery 5 year(93.7 vs. 87.6%; p = 0.689). CONCLUSION: This meta-analysis showed that single-port laparoscopic gastrectomy is both safe and feasible for laparoscopic radical gastrectomy for gastric cancer, with similar operation times and better short-term outcomes than multiport laparoscopic gastrectomy in terms of hospital stay, postoperative pain, and estimated blood loss. There was no significant difference in long-term outcomes between single-port laparoscopic gastrectomy and multiport laparoscopic gastrectomy.

Rare metastasis of gastric cancer to the axillary lymph node: A case report.

Lymph node metastasis of gastric cancer is more common, metastatic lymph nodes are often around the stomach, and metastasis is carried out in a certain order, but gastric cancer metastasis to axillary lymph nodes is very rare. Due to the small number of patients with this kind of metastasis, its clinical features and treatment are not very clear. We initially thought that the enlarged axillary lymph nodes were inflammatory lesions. Axillary lymph node biopsy was later diagnosed as gastric cancer metastases to axillary lymph nodes. The patient refused further treatment and died 11 months after the second operation because of multiple systemic metastases. We believe that metastasis of gastric cancer to axillary lymph nodes is rare and the prognosis is poor. In clinical work, the possibility of metastatic lymph nodes should be considered in patients with a history of gastric cancer with enlarged axillary lymph nodes.

Intrahepatic cholangiocarcinoma with gastric metastasis misdiagnosed as primary gastric cancer: A case report and literature review.

We describe a case of intrahepatic cholangiocarcinoma with gastric metastasis misdiagnosed as primary gastric cancer. In addition, combined with the literature, we summarized the clinical and imaging features of gastric metastasis of intrahepatic cholangiocarcinoma in order to improve the understanding of the preoperative diagnosis. Positron emission tomography/computed tomography (PET/CT) is accurate in evaluating the primary tumor, lymph node metastasis, and distant metastasis of patients. In addition, immunohistochemical staining can determine the primary site of metastatic adenocarcinoma. For patients who can not determine the location of the primary tumor, the rigorous preoperative examination is necessary, it can improve the accuracy of diagnosis and avoid excessive treatment of patients.

Laparoscopic Subtotal Gastrectomy and Sigmoidectomy Combined With Natural Orifice Specimen Extraction Surgery (NOSES) for Synchronous Gastric Cancer and Sigmoid Colon Cancer: A Case Report.

Background: Gastric cancer and colon cancer are rarely seen in clinic, but there are still related reports. For gastric cancer and simultaneous colon cancer, surgical resection is the main treatment. Traditional surgery requires an incision from xiphoid process to pubic symphysis. With the progress of minimally invasive technology, laparoscopic surgery is also used in the treatment of gastric cancer, but also in the abdominal incision to remove specimens and in vitro anastomosis of digestive tract. Taking specimens through the natural cavity as a new surgical method can not only reduce the abdominal incision, but also reduce the occurrence of wound-related complications. Here, we report a patient with gastric cancer and colon cancer who was treated in our hospital. Case Summary: We report a series of patients with gastric cancer and colon cancer. upper abdominal pain was treated in our hospital for 6 months. electronic gastroscopy showed large irregular ulcers on the lesser curvature of the gastric antrum and biopsy showed poorly differentiated adenocarcinoma of the gastric antrum. The enhanced CT of abdomen and pelvis showed irregular thickening of gastric antrum wall, irregular thickening of sigmoid colon wall and no obvious enlarged lymph nodes around. Further electronic enteroscopy showed that the sigmoid colon showed cauliflower protuberance, the intestinal cavity was slightly narrow, the intestinal wall was stiff, and the biopsy pathology showed moderately differentiated adenocarcinoma of the sigmoid colon. No obvious abnormality was found in serological tumor indexes. We diagnosed gastric cancer with sigmoid colon cancer and the patient received Laparoscopic subtotal gastrectomy and sigmoidectomy combined with natural orifice specimen extraction surgery. At present, 12 months after operation, no clear tumor recurrence was found in the metastasis. Conclusion: We should improve the understanding of gastric cancer and sigmoid cancer and combine examination with pathology to avoid misdiagnosis as metastatic cancer. Laparoscopic subtotal gastrectomy should be performed for tumors with no serosa invasion, body mass index <30 and tumor diameter <6.5 cm. Sigmoidectomy combined with natural nostril sampling is feasible.

Effects of Preoperative Pyloric Stenosis on Outcomes and Nutritional Status in 73 Patients Following Curative Gastrectomy for Gastric Cancer: A Retrospective Study from a Single Center.

BACKGROUND The aim of this study was to explore the potential impact of pyloric stenosis (PS) on the nutritional status, the incidence of postoperative complications, and the long-term prognosis of distal gastric cancer (GC) patients after curative resection. MATERIAL AND METHODS We retrospectively analyzed the data of 343 GC patients who underwent curative gastrectomy for gastric cancer between January 2010 and December 2013. All patients were divided into 2 groups according to the status of PS. Their clinical and pathological features, nutritional indicators, and incidence of postoperative complications were compared and potential prognostic factors were analyzed using the propensity score matching analysis (PSM). RESULTS Seventy-four (21.6%) patients had PS. Patients with PS had worse survival outcomes than those without PS (χ²=21.369, P<0.001). Multivariate survival analysis demonstrated that PS, depth of invasion, and lymph node metastasis (all P<0.05) were the independent predictors of overall survival (OS). Patients with PS had significantly higher lymph node metastasis in No. 3, 4sb, 4d, 6, 8a, 9, and 14v lymph nodes. Patients with PS had significantly lower preoperative BMI, more weight loss, and lower prealbumin than those without PS. There were no significant differences between the 2 groups in postoperative complications, morbidity, or mortality. CONCLUSIONS Distal GC patients with PS have poor clinicopathological and nutritional status and poor prognosis. However, PS does not increase surgery-related morbidity and mortality.

Recurrence pattern and its predictors for advanced gastric cancer after total gastrectomy.

ABSTRACT: This study aimed to investigate the recurrence patterns of advanced gastric cancer (AGC) after curative total gastrectomy and further explore predictors for each pattern of recurrence.Data of 299 AGC patients between 2010 and 2014 were retrospectively analyzed to investigate the clinicopathologic factors affecting the recurrence pattern of AGC patients underwent curative total gastrectomy.Sixty-eight (22.7%) AGC patients had recurrence after total gastrectomy. Distant metastasis (DM) was the most prevalent pattern with 29 (42.6%) cases, followed by peritoneal recurrence (PR) with 25 (36.8%) patients, and locoregional recurrence (LR) occurred in 23 (33.8%) patients. The recurrence rates within 2 and 5 years were 77.9% and 97.1%. Extent of lymphadenectomy (P < .001, χ2 = 17.366), depth of tumor invasion (P < .001, χ2 = 21.638), lymph node metastasis (P = .046, χ2 = 9.707), and number of negative lymph nodes (P = .017, χ2 = 2.406) were associated with tumor recurrence by univariate analysis. Multivariate analyses revealed that the extent of lymphadenectomy (P = .034, 95% CI: 1.074-6.414) and T4b status (P = .015, 95% CI: 0.108-0.785) were independent predictors for LR; histological type (P = .041, 95% CI: 0.016-0.920) and T4b status (P = .007, 95% CI: 0.102-0.690) for PR; and pN status (P = .032) for DM.In AGC patients following total gastrectomy, recurrent predictors various among locoregional, peritoneal, and distant recurrence. Recurrent predictors of tumor invasion, lymph node metastasis, and histological type could guide follow-up and risk-oriented adjuvant treatment, extended lymphadenectomy was considered to reduce LR of AGC patients after curative total gastrectomy.

Tumor size as a recommendable variable for accuracy of the prognostic prediction of gastric cancer: a retrospective analysis of 1,521 patients.

BACKGROUND: It is still controversial whether tumor size (Ts) should be considered an important indicator for evaluation the prognosis of gastric cancer (GC). The purpose of this study was to elucidate the prognostic prediction superiority of Ts in the large-scale cohort of GC patients. METHODS: Data from 1,521 patients who underwent the curative resection were analyzed for demonstration the prognostic value of Ts. In addition, a tumor size-node-metastasis (TsNM) classification system was proposed to evaluate the comparative superiorities of the prognostic prediction of GC patients. RESULTS: With the univariate and multivariate analyses, Ts was identified as an independently prognostic predictor of GC patients, as was T stage. Ts was demonstrated to have smaller Akaike information criterion and Bayesian Information Criterion values within the Cox regression analyses than shown by T stage, which represented the optimum prognostic stratification. TsNM classification was also found to be competent for accurately prognostic evaluation of GC patients. The matched case-control logistic regression showed that TsNM classification could provide very powerful discriminations of patients' overall survival, compared with TNM classification. Additionally, Ts stage was found to enhance the survival discriminations in patients with certain clinicopathological characteristics, including male gender, T4a stage, N0 stage, diffuse type of Lauren classification, or age ≤60 years. CONCLUSIONS: Ts should be recommended as an important clinicopathologic variable to enhance the accuracy of the prognostic prediction of GC clinical patients.

[Analysis of clinicopathological characteristics and prognosis of 91 patients with familial gastric cancer].

OBJECTIVE: To explore the clinicopathological characteristics and prognosis of familial gastric cancer(FGC) and to provide clinical evidence for rational treatment program. METHODS: Clinicopathological data of 91 patients with FGC and 293 patients with sporadic gastric cancer(SGC) in our department from March 2003 to October 2007 were retrospectively analyzed and compared between the two groups. RESULTS: Tumors with a diameter of less than or equal to 5 cm were more common in FGC patients than SGC patients [65.9%(60/91) vs. 52.6%(154/293), P=0.025]. Proportion of FGC patients with poor differentiation was significantly higher as compared to SGC patients [68.1%(62/91) vs. 55.6%(163/293), P=0.034]. The 5-year overall survival rate in FGC patients was significantly lower than that in SGC patients(25.6% vs. 38.9%, P=0.001). Further stratified analysis revealed that the 5-year survival rates of T4 FGC and T4 SGC patients were 14.5% and 30.5% respectively, the 5-year survival rates of N3 FGC and N3 SGC patients were 10.4% and 17.3% respectively, and the differences were statistically significant(all P<0.05), while other T stage and N stage between the two groups were not significantly different(all P>0.05). Univarite analysis showed that tumor size, tumor location, pathological type, operation method, infiltration depth and lymph node metastasis were influencing factors of prognosis of FGC. Multivariate analysis showed that tumor size(HR=2.271), pathology types(HR=1.449), lymph node metastasis(HR=1.748) and the infiltration depth(HR=1.487) were independent risk factors affecting the prognosis of patients with FGC. CONCLUSION: Compared with SGC, FGC is associated with poor differentiation and poor prognosis.

[Variation and research progress of celiac trunk branch].

Celiac trunk is a wide and short ventral branch. It originates from the anterior abdominal artery at the level of L1 vertebra, and divides into three branches: the left gastric, common hepatic and splenic arteries, supplying the upper abdominal organs such as stomach, liver, spleen, pancreas, and duodenum. However, there are many types of branches variations. The branches of celiac trunk are classified into several types. We establish a classification of variation type according to the origin of left gastric, common hepatic and splenic arteries, which includes hepatogastrosplenic trunk type, hepatosplenic trunk type, hepatogastric trunk type, gastrosplenic trunk type, and the others include hepatosplenomesentery trunk type, hepatogastrospleno-mesentery trunk type, hepatogastrosplenocolonic trunk type, hepatogastrosplenopancreatic trunk type, gastrospenic trunk plus hepatomesentery trunk type, hepatogastrosplenoic left liver trunk type, hepatogastro-splenopancreatoduodenal trunk type, hepatogastric trunk plus hepatosplenic trunk type. Development of celiac trunk variation type was introduced based on the classification of Lipshutz, Adachi, Michels and Zhang Nianjia. Mastering the types of branches variations is necessary for us to perform the upper abdominal operations safely and effectively.

Comparison of the staging of regional lymph nodes using the sixth and seventh editions of the tumor-node-metastasis (TNM) classification system for the evaluation of overall survival in gastric cancer patients: findings of a case-control analysis involving a single institution in China.

BACKGROUND: It has recently been reported that the sixth edition of the tumor-node-metastasis (TNM) classification system for gastric cancer involving the staging of regional lymph nodes (N) has inappropriate cut-offs with regard to counts of metastatic lymph nodes. It remains controversial, however, as to whether the seventh edition of this classification system is completely accurate in staging N for the prediction of the prognosis of gastric cancer. Our aim was to determine which of these two editions of the TNM classification system was superior with regard to the prediction of the prognosis of Chinese patients with gastric cancer. METHODS: We analyzed relevant clinicopathological data statistically from 1,563 patients with gastric cancer who had undergone curative resection to evaluate the sixth and seventh editions of the TNM classification system for N staging with regard to the prediction of overall survival (OS). RESULTS: Our survival analyses demonstrated that N staging via use of both the sixth and seventh editions of the TNM classification system was correlated with OS. Furthermore, case-control analysis indicated that the seventh edition was significantly superior to the sixth edition in predicting the OS of patients, regardless of the extent of lymphadenectomy (D1 or D2) and the number of dissected lymph nodes (<16 or ≥16). By taking into consideration both the extent of lymphadenectomy and the number of dissected lymph nodes simultaneously, we determined that the seventh edition of the TNM classification system was superior to the sixth edition regarding the evaluation of the OS in the various subgroups of gastric cancer patients. CONCLUSION: The seventh edition proved more reliable and accurate than the sixth edition of the TNM classification system in categorizing the number of metastatic lymph nodes for the purpose of predicting the OS of patients with gastric cancer after curative resection.

Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer.

AIM: To elucidate the potential impact of examined lymph nodes (eLNs) on long-term survival of node-negative gastric cancer patients after curative surgery. METHODS: A total of 497 node-negative gastric cancer patients who underwent curative gastrectomy between January 2000 and December 2008 in our center were enrolled in this study. Patients were divided into 4 groups according to eLNs through cut-point analysis. Clinicopathological features were compared between ≤ 15 eLNs group and > 15 eLNs group and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified using the Cox proportional hazards regression model. Stratified analysis was performed to investigate the impact of eLNs on patient survival in each stage. Overall survival was also compared among the four groups. Finally, we explored the recurrent sites associated with eLNs. RESULTS: Patients with eLNs > 15 had a better survival compared with those with eLNs ≤ 15 for the entire cohort. By the multivariate survival analysis, we found that the depth of invasion and the number of eLNs were the independent predictors of overall survival (OS) of patients with node-negative gastric cancer. According to the cut-point analysis, T2-T4 patients with 11-15 eLNs had a significantly longer mean OS than those with 4-10 eLNs or 1-3 eLNs. Patients with ≤ 15 eLNs were more likely to experience locoregional and peritoneal recurrence than those with > 15 eLNs. CONCLUSION: Number of eLNs could predict the prognosis of node-negative gastric cancer, and dissection of > 15 eLNs is recommended during lymphadenectomy so as to improve the long-term survival.

Lymph node metastasis is mediated by suppressor of cytokine signaling-3 in gastric cancer.

Suppressor of cytokine signaling-3 (SOCS-3), a multifunctional cytokine, is able to inhibit cell growth and migration by blocking the Janus kinase signal transducers and activators of transcription signaling (JAK/STAT) activation in oncogenesis. Although the STAT-3 expression was associated with lymph node metastasis from gastric cancer (GC), the implication of SOCS-3 expression in GC is not clearly elucidated. In this study, SOCS-3, STAT-3, and pSTAT-3 were evaluated in GC tissues and adjacent non-tumor tissues of 107 patients who underwent curative surgery by immunohistochemistry. Further, SOCS-3 and STAT-3 mRNA levels were also detected simultaneously. In addition, survival analysis was performed between clinicopathologic variables and prognosis of GC patients. Finally, correlative analysis was adopted for demonstration the best predicator of the survival independent factor. From the results, we demonstrated that only the lymph node metastasis was the independent predictor of the overall survival (OS) of GC patients, although SOCS-3, STAT-3, and other variables were significantly relative to OS. With multivariate logistical regression analysis, SOCS-3, STAT-3, and the status of extragastric nodal metastasis were identified to be the independent factors of the lymph node metastasis from GC. Ultimately, the SOCS-3 was the best predicator of lymph node metastasis from GC identified with the nominal regression analysis. Therefore, SOCS-3 should be considered as a potential indicator for prediction the lymph node metastasis from GC.

[The prognostic analysis of tumor size in T4a stage gastric cancer].

OBJECTIVE: To investigate the impact of tumor size in the prognosis of T4a stage gastric cancer. METHODS: The best cut-off point depending on tumor size was selected by Kaplan-Meier. Compare cliniclópathological characteristics between small size gastric cancer (SSG) and large size gastric cancer (LSG). Univariate analysis was done by Log-rank test and multivariate analysis was performed using the Cox proportional hazard regression model. The independent prognostic factors of patients were performed subgroup analysis. RESULTS: Eight centimetre was the optimal cut-off of tumor size for T4a stage gastric cancer. There were significantly differences between SSG and LSG in tumor location (χ² = 15.695), histological grade (χ² = 4.393), macroscopic type (χ² = 5.629) and early recurrence (χ² = 4.292). Univariate analysis showed age (χ² = 4.463), tumor size (χ² = 9.057), macroscopic type (χ² = 6.679), histological grade (χ² = 5.122), location of tumor (χ² = 8.707) and N stage (χ² = 132.954) are related to survival (P < 0.05). Among them, tumor size (HR = 1.339), histological grade (HR = 1.169) and N stage (HR = 1.876) were independent risk factor for survival (P = 0.05). For SSG, N stage (HR = 2.014) and histological grade (HR = 1.192) were independent risk factor for survival (P = 0.05), and for LSG, N stage (HR = 1.876) was independent risk factor for survival (P = 0.000). Further stratified analysis indicated that the 5-year survival rate of LSG is significantly lower than that of SSG in T4a stage patients of gastric cancer without lymph nodes metastasis or poorly differentiated (HR = 0.182 and 0.653, P < 0.01). CONCLUSIONS: Tumor size is an independent prognostic factor in patients of T4a stage gastric cancer. Tumor size cut-off point of 8 cm can exert significant impact on the prognosis of T4a stage gastric cancer without lymph nodes metastasis or poorly differentiated.

[The significance of No.13 lymph node dissection in D2 gastrectomy for lower-third advanced gastric cancer].

OBJECTIVE: To evaluate the feasibility and necessity of No.13 lymph node dissection in D2 radical gastrectomy for lower-third advanced gastric cancer (AGC). METHODS: Data of 379 cases who were diagnosed as TNM II-III stage AGC were collected from January 2001 to June 2007. One hundred cases who undergone No.13 lymph node dissection during D2 gastrectomy for lower-third AGC were selected as study group. Other 279 cases (control group) received only D2 gastrectomy. The differences in clinicopathologic and intraoperative and postoperative parameters and 5-years survival rate were compared using the SPSS 17.0 software. RESULTS: There were no significant differences between the two groups in patients' gender, age, tumor size, histologic type, Borrmann type, duodenum invasion, tumor depth, lymph node metastasis, TNM classification, operative time, blood loss and the incidence of postoperative complications (P > 0.05). In the study group, there were 9 patients with positive No. 13 lymph node, and its 5-year survival rate (46.0%) was higher than the control group (36.5%, χ² = 4.452, P < 0.05). The Univariate analysis showed that age (χ² = 7.539), No.13 lymph node dissection (χ² = 4.452), tumor size (χ² = 7.100), duodenum invasion (χ² = 9.106), tumor depth (χ² = 7.428), lymph node metastasis (χ² = 45.046), TNM classification (χ² = 57.008) are associated with prognosis of lower-third AGC (P < 0.05). Multivariate analysis identified age (HR = 0.500, 95% CI: 0.343 - 0.730), tumor size (HR = 0.545, 95%CI: 0.339 - 0.876), duodenum invasion (HR = 5.821, 95%CI: 2.326 - 14.572), and tumor depth (T4: HR = 2.087, 95% CI: 1.283 - 3.394) as independent prognostic factors (P < 0.05). CONCLUSION: No. 13 lymph node dissection for TNM II-III stage lower-third advanced gastric cancer is feasible and necessary.

[Significance of No.14v lymph node dissection for advanced gastric cancer undergoing D2 lymphadenectomy].

OBJECTIVE: To elucidate the necessity of No.14v lymph node dissection in D2 lymphadenectomy for advanced gastric cancer. METHODS: Clinicopathological data of 131 cases of advanced gastric cancer receiving D2 or D2+ plus No.14v lymph node dissection were reviewed retrospectively. Clinicopathological factors associated with No.14v lymph node metastasis were analyzed and prognostic value of No.14v lymph node metastasis was evaluated. RESULTS: Of the 131 patients, 24 (18.3%) had positive No.14v lymph node. The incidence of 14v metastasis was associated with tumor location, tumor size, depth of invasion, N staging, TNM staging, No.1, No.6, and No.8a lymph nodes metastasis. Tumor location and N staging were independent risk factors for No.14v metastasis (all P<0.05). The 5-year survival rate was 8.3% and 37.8% in patients with and without No.14v metastasis respectively. The difference was statistically significant (P<0.01). Multivariate analysis revealed that metastasis of No.14v was an independent prognostic factor for advanced gastric cancer after D2 lymphadenectomy (P=0.029, RR=1.807, 95%CI:1.064-3.070). CONCLUSIONS: For advanced middle and lower gastric cancers, especially those with larger size, serosa invasion and possibility of No.6 lymph node metastasis, it is necessary and feasible to remove the No.14v lymph node.

[The value of negative lymph node count in prediction of prognosis of advanced gastric cancer].

OBJECTIVE: To evaluate the value of negative lymph node count (NLNC) in prediction of prognosis of advanced gastric cancer after radical resection. METHODS: The 544 cases of radical gastrectomy patients with complete clinical and follow-up data between January 2011 and July 2007 were collected. Survival was determined by the Kaplan-Merier method and univariate analysis was done by Log-rank test, Multivariate analysis was performed using the Cox proportional hazard regression model. RESULTS: Univariate analysis showed age (χ(2) = 4.449), T stage (χ(2) = 30.482), N stage (χ(2) = 205.452), location of tumor (χ(2) = 16.649), tumor size (χ(2) = 35.117), macroscopic type (χ(2) = 4.750), histological grade (χ(2) = 6.130), NLNC stage (χ(2) = 150.369) and type of gastrectomy (χ(2) = 25.605) were related to survival. Among them, T stage, N stage, tumor size and NLNC stage were independent risk factors for survival (P < 0.05). The prognostic factors of patients were performed subgroup analysis, NLNC > 15 group can prolong the survival than NLNC ≤ 15 group in the T2 stage (HR = 0.315), T4 stage (HR = 0.401), the same classification of location of tumor (HR = 0.286-0.493), tumor size (HR = 0.336, 0.465), macroscopic type (HR = 0.306, 0.418), histological grade (HR = 0.411, 0.365) and type of gastrectomy (HR = 0.444, 0.358 and 0.356, all P < 0.05). More NLNC can prolong Disease-Free Survival for patient of early recurrence (χ(2) = 8.648, P = 0.003). CONCLUSIONS: Sufficient negative lymph node count can prolong the survival and decrease the risk of early recurrence.

[Analysis of clinicopathologic characteristics and prognosis on mixed histology type of gastric cancer].

OBJECTIVE: To evaluate the clinicopathologic characteristics and prognosis of mixed histological type (MHT) gastric cancer. METHODS: Clinical and follow-up data of 1108 gastric cancer patients undergoing radical operation in Tianjin Cancer Hospital between 2003 and 2006 were analyzed retrospectively. Clinicopathologic characteristics of MHT gastric cancer were summarized and the prognosis was analyzed by Kaplan-Meier analysis and COX regression. RESULTS: Among the 1108 patients, 144 (13.0%) had mixed histology type of gastric cancer. Compared to the unitary histological type (UHT), MHT gastric cancer had bigger tumor size, higher proportion of T4 tumor, and was easier for lymph node and distant metastasis (all P<0.05). The 3- and 5-year survival rates of patients with MHT were 26.5% and 10.8% respectively, which were lower than those with UHT (58.8% and 35.0%, P<0.01). Univariate and multivariate analyses showed TNM classification was an independent prognostic factor (P<0.01). CONCLUSIONS: MHT gastric cancer shows worse prognosis than UHT gastric cancer. There is no difference in prognosis among various combination of MHT gastric cancer. TNM classification is an independent prognostic factor of MHT gastric cancer.

[Prognostic value of metastatic lymph node ratio for gastric cancer patients with less than 15 lymph nodes dissection].

OBJECTIVE: To evaluate the prognostic value of metastatic lymph node ratio (MLR) for gastric cancer patients with less than 15 lymph nodes dissected. METHODS: Clinical data of 610 gastric cancer patients undergoing operation in Tianjin Cancer Hospictal from January 2003 to July 2007 were analyzed retrospectively. Patients were divided into two groups: <15 lymph nodes dissected group (n=320) and ≥ 15 lymph nodes dissected group (n=290). MLR was classified based on the following intervals: rN1 ≤ 10%, rN2 10%-30%, rN3 30%-60% and rN4 >60%. Survival was determined by Kaplan-Meier method and difference was assessed by Log-rank test. Multivariate analysis was performed using Cox proportional hazard regression model. Survival rates were compared between two groups in pN and rN stages respectively. RESULTS: In <15 nodes group, all the survival differences among various rN stages were not significant (all P>0.05), while in same rN stage, all the survival differences among various pN stages were not significant (all P>0.05). Significant differences of 5-year cumulative survival rates were found between the two groups in pN2 and pN3a stage patients (both P<0.05) while no significant differences were found among different rN stages (all P>0.05). Multivariate analysis demonstrated rN stage was an independent prognostic factor for gastric cancer patients with <15 lymph nodes dissected (P=0.012, RR=1.617, 95%CI:1.111-2.354). CONCLUSION: The rN staging system based on MLR can predict the prognosis of gastric cancer patients with less than 15 lymph nodes dissected.

[The prognostic influence of D2 lymphadenectomy with para-aortic lymph nodal dissection for gastric cancer in N3 stage].

OBJECTIVE: To elucidate the necessity of para-aortic lymph nodal dissection in D2 lymphadenectomy for gastric cancer in N3 stage. METHODS: A total of 278 gastric cancer patients staged N3 who underwent gastrectomy between January 2003 and December 2007 were enrolled. There were 180 male and 98 female patients, and the patients' age were 26-93 years (median was 61 years). All patients had undergone surgical treatment. There were R0 resection in 246 cases and R1 resection in 32 cases. Lymph node dissection included D1 lymphadenectomy with 125 cases, D2 lymphadenectomy with 109 cases and D2+para-aortic lymph nodal dissection(PAND) with 44 cases. The surgical approach were total gastrectomy (98 cases) and subtotal gastrectomy (180 cases). Potential prognostic factors were analyzed. RESULTS: The lymph node metastasis of each station was high in gastric cancer patients staged N3 and 34.1% patients had the para-aortic lymph nodal metastasis. Borrmann type (HR = 1.350, 95%CI: 1.018-1.790, P = 0.037), curability (HR = 1.580, 95%CI: 1.076-2.322, P = 0.020), depth of invasion (HR = 1.697, 95%CI: 1.005-2.864, P = 0.048), metastatic lymph node ratio (HR = 1.631, 95%CI: 1.261-2.111, P = 0.000), extranodal metastasis (HR = 1.336, 95%CI: 1.027-1.738, P = 0.031), postoperative adjuvant chemotherapy (HR = 1.312, 95%CI: 1.015-1.696, P = 0.038), extent of lymphadenectomy (HR = 1.488 and 2.114, P = 0.054 and 0.000) and number of retrieved lymph node (HR = 1.503 and 2.112, P = 0.025 and 0.000) were found to be factors correlated to overall survival. In multivariate analysis, only Borrmann type (HR = 1.399, 95%CI: 1.050-1.863, P = 0.022), metastatic lymph node ratio (HR = 1.353, 95%CI: 1.016-1.802, P = 0.039) and extent of lymphadenectomy (HR = 1.725, 95%CI: 1.111-2.678, P = 0.015) were independent prognostic factors for gastric cancer patients in N3 stage. CONCLUSIONS: Patients in N3 stage should at least have 30 lymph node examined. D2 lymph node dissection plus PAND may improve the overall survival for gastric cancer patients in N3 stage.