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  • 1
    Electronic Resource
    Electronic Resource
    Nodal abdominal spread in adenocarcinoma of the cardia. Results of a multicenter prospective study (1998)
    Springer
    Gastric cancer 1 (1998), S. 146-151 
    Details
    ISSN: 1436-3305
    Keywords: Key words: cardia cancer, lymph node metastasis, surgery, extended lymphadenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Background. Precise knowledge of the abdominal nodal spread of cardia adenocarcinoma in relation to the depth of invasion of the tumor and its longitudinal extension may be very important for the surgeon as a guide in choosing the type of resection and lymphadenectomy. Methods. The frequency of node metastases in each abdominal station of the first and second tier was prospectively studied in 101 patients with type II and III cardia cancer (defined as approved by the consensus conference held during the second International Gastric Cancer Conference in Munich in April, 1997) who underwent total gastrectomy with D2 lymphadenectomy during the period January 1994 to April 1998. Lymph nodes were retrieved immediately after operation by the surgeon and assigned to the appropriate station according to the classification of the Japanese Research Society for Gastric Cancer. Results. In early gastric cancer, of both type II and type III, lymph node involvement was limited to the perigastric nodes of the upper half of the stomach and to the lymph node station of the celiac trunk. In advanced cancers, whether of type II or type III, there was a fairly high frequency of metastases to the perigastric nodes of the lower half of the stomach; there was also high frequency of metastases at N2 stations, without differences in frequency between pT2 and pT3 tumors (staged according to the classification of the Japanese Research Society for Gastric Cancer). Conclusions. The results of our study provide evidence for the need to perform a total gastrectomy with D2 lymphadenectomy in all patients with advanced cardia cancer type II or type III. In early cancers, a less extensive resection (proximal gastrectomy) with D2 lymphadenectomy may be indicated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101200050009
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  • 2
    Electronic Resource
    Electronic Resource
    Perigastric lymph node metastases in gastric cancer: comparison of different staging systems (1999)
    Springer
    Gastric cancer 2 (1999), S. 201-205 
    Details
    ISSN: 1436-3305
    Keywords: Key words: gastric cancer, perigastric node metastases, surgery, staging systems, UICC-TNM and JRSGC classifications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Background. Perigastric lymph node metastases in gastric cancer are classified differently by different staging systems: the distance of positive nodes from the primary tumor is considered by the 1987 International Union Against Cancer (UICC)-TNM system, but not by the Japanese staging system (of the Japanese Research Society for Gastric Cancer [JRSGC]); the new UICC-TNM system of 1997 is based on the number of involved nodes without differentiating perigastric from regional nodes. The aim of the present study was to assess which classification was more useful to predict prognosis in gastric cancer patients with metastases to the perigastric nodes. Methods. The results for 107 patients with lymph node metastases to the first and second tiers who underwent curative gastrectomy for gastric cancer from March 1988 to October 1997 were analyzed. In particular, we compared the clinical characteristics and the survival probabilities of: (1) patients with metastases to perigastric nodes located within 3 cm from the primary tumor, classified as N1; (2) patients with metastases to perigastric nodes located 3 cm beyond the primary tumor (N2 in the UICC-TNM and N1 in the Japanese classification), classified by us as N1–N2; and (3) patients with metastases to the second tier (classified by us as N2). We also assessed the number of positive nodes dividing the patients into groups according to the 1997 UICC TNM system. Results. On multivariate survival analysis, the mortality risks in the N1 and N1–N2 patients were comparable (relative risk [RR], N1–N2 versus N1, 1.32; 95% confidence interval [CI], 0.53–3.51) and were half the mortality risk in N2 patients (RR, N2 versus N1, 2.52; 95% CI, 1.33–4.79). The N1 and N1–N2 categories, while presenting markedly different distributions in the number of metastatic nodes (patients with more than seven metastatic nodes constituted less than 20% of the N1 group and more than 60% of the N1–N2 group), showed similar prognostic significance. Conclusion. In the present series, the distance of perigastric nodes from the primary tumor did not seem to exert a significant effect on prognosis, and the use of a combined classification based on anatomical location (JRSGC) and number of node metastases (UICC-TNM 1997) could be more useful than either system alone for prognostic purposes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101200050063
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  • 3
    Electronic Resource
    Electronic Resource
    Classification of Lymph Node Metastases from Carcinoma of the Stomach: Comparison of the Old (1987) and New (1997) TNM Systems (1999)
    Springer
    World journal of surgery 23 (1999), S. 664-669 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The pN classification of gastric cancer is currently based on the distance of metastatic nodes from the primary tumor (TNM—1987). The UICC (Union Internationale Contre le Cancer) has recently proposed a new classification system based on the number of the involved nodes (TNM—1997). The present prospective study is aimed at verifying whether the two classifications (1) assign approximately a similar rank to individual patients and (2) give comparable prognostic information. The Cox regression model was used to evaluate the prognostic significance of either the distance or the number of positive nodes, controlling for sex, age, site, histology and depth of tumor invasion, in a group of 175 patients who underwent curative surgery for gastric cancer from March 1988 to October 1997. Among the patients classified as N1 and N2 according to TNM—1987, 81.8% (36/44) and 35.8% (19/53), respectively, were coded as N1 and N2 by the new classification. The survival probabilities of N1 and N2 categories were similar in both classifications. The N2 category of TNM—1987 comprised also 10 cases with 〉15 positive nodes (N3 category of TNM—1997), who presented a large excess mortality (RR = 35.14 with respect to N0). When the site and number of positive nodes are combined in a new variable, both appear to be important from a prognostic point of view. Both anatomic location and number of nodes with metastasis are important predictors of survival in gastric cancer patients. Caution should be used when replacing the old classification with the new one, as they group patients in a different way.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00012365
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