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

1.	Layke JC, Lopez PP. 胃癌: 诊断和治疗方案的选择. 中国全科医学, 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.	万远廉, 潘义生, 刘玉村, 等. 胃癌淋巴转移规律与淋巴结清扫范围的分析 (附 326 例报告). 中华外科杂志, 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.	陈峻青. 胃癌外科基础研究与扩大切除术的进展. 中国普外基础与临床杂志, 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 回日本消化器外科学会総会). 日本消化器外科学会雑誌, 1985, 18(2): 334.
10.	李涛, 徐惠绵, 徐岩, 等. 不同部位胃癌临床病理特征、淋巴结转移规律及预后的对比研究. 中国当代医药, 2013, 20(25): 4-8.
11.	李宇, 周岩冰. 胃癌的淋巴结转移规律研究. 齐鲁医学杂志, 2007, 22(4): 309-311.
12.	鞠振煜. 胃癌肿瘤部位与区域淋巴结转移及对术式选择的临床分析. 吉林大学, 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, 揭志刚. 进展期胃癌胰头后淋巴结组 (NO.13 LN) 清扫 67 例分析//首届江西省科协学术年会第二十二分会场暨江西省第十一次中西医结合普通外科学术年会, 2010: 20-24.
21.	刘兵. 胃癌 No.12、No.13 淋巴结清扫的临床意义. 内蒙古医科大学, 2015: 11-17.
22.	胡建昆, 陈心足. 进展期胃癌治疗方式合理选择及评价. 中国实用外科杂志, 2011, 31(8): 720-722.
23.	吴宏培, 李俊海, 张远, 等. P-gp、GST-π、TopoⅡ在胃癌组织中的表达及意义. 现代肿瘤医学, 2010, 18(9): 1788-1791.
24.	关云艳, 欧希龙, 郭庆明, 等. P-gp, ToPoⅡ和 GST-π在胃癌组织中的表达及与预后的关系. 世界华人消化杂志, 2006, 14(35): 3371-3376.
25.	王啓名, 张庆玲. 细胞角蛋白免疫组化染色对胃癌淋巴结转移的诊断意义. 广东医学院学报, 2011, 29(4): 367-369.
26.	李增波, 张志伟, 汤国辉, 等. CK-8 蛋白在胃癌组织中的表达及意义. 中南医学科学杂志, 2012, 40(6): 555-558.
27.	柴军辉, 张占东, 马奇, 等. CK18 在胃癌及区域转移淋巴结中的表达及意义. 河南医学研究, 2014, 23(9): 1-4.
28.	李秋元. 胃癌组织中 c-erbB-2、c-met、nm23 的表达及意义. 汕头大学, 2007: 19-31.
29.	王齐敏, 王莉芬, 于香莉, 等. 胃癌组织中 EGFR、C-erbB-2、TopoⅡα 及 P-gp 的表达及意义. 现代肿瘤医学, 2013, 21(4): 834-837.
30.	蔡颖, 蔺玉昌. 胃癌 P53 和 Ki-67 表达与淋巴结转移的相关性. 齐齐哈尔医学院学报, 2001, 22(11): 1236-1237.
31.	侯宝洲, 孙剑经, 赵秀芳, 等. 胃癌中 β-catenin、ki67 与 Her-2/Neu 的关系及临床意义. 安徽医科大学学报, 2014, 49(2): 258-261.

1. Layke JC, Lopez PP. 胃癌: 诊断和治疗方案的选择. 中国全科医学, 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. 万远廉, 潘义生, 刘玉村, 等. 胃癌淋巴转移规律与淋巴结清扫范围的分析 (附 326 例报告). 中华外科杂志, 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. 陈峻青. 胃癌外科基础研究与扩大切除术的进展. 中国普外基础与临床杂志, 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 回日本消化器外科学会総会). 日本消化器外科学会雑誌, 1985, 18(2): 334.
10. 李涛, 徐惠绵, 徐岩, 等. 不同部位胃癌临床病理特征、淋巴结转移规律及预后的对比研究. 中国当代医药, 2013, 20(25): 4-8.
11. 李宇, 周岩冰. 胃癌的淋巴结转移规律研究. 齐鲁医学杂志, 2007, 22(4): 309-311.
12. 鞠振煜. 胃癌肿瘤部位与区域淋巴结转移及对术式选择的临床分析. 吉林大学, 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, 揭志刚. 进展期胃癌胰头后淋巴结组 (NO.13 LN) 清扫 67 例分析//首届江西省科协学术年会第二十二分会场暨江西省第十一次中西医结合普通外科学术年会, 2010: 20-24.
21. 刘兵. 胃癌 No.12、No.13 淋巴结清扫的临床意义. 内蒙古医科大学, 2015: 11-17.
22. 胡建昆, 陈心足. 进展期胃癌治疗方式合理选择及评价. 中国实用外科杂志, 2011, 31(8): 720-722.
23. 吴宏培, 李俊海, 张远, 等. P-gp、GST-π、TopoⅡ在胃癌组织中的表达及意义. 现代肿瘤医学, 2010, 18(9): 1788-1791.
24. 关云艳, 欧希龙, 郭庆明, 等. P-gp, ToPoⅡ和 GST-π在胃癌组织中的表达及与预后的关系. 世界华人消化杂志, 2006, 14(35): 3371-3376.
25. 王啓名, 张庆玲. 细胞角蛋白免疫组化染色对胃癌淋巴结转移的诊断意义. 广东医学院学报, 2011, 29(4): 367-369.
26. 李增波, 张志伟, 汤国辉, 等. CK-8 蛋白在胃癌组织中的表达及意义. 中南医学科学杂志, 2012, 40(6): 555-558.
27. 柴军辉, 张占东, 马奇, 等. CK18 在胃癌及区域转移淋巴结中的表达及意义. 河南医学研究, 2014, 23(9): 1-4.
28. 李秋元. 胃癌组织中 c-erbB-2、c-met、nm23 的表达及意义. 汕头大学, 2007: 19-31.
29. 王齐敏, 王莉芬, 于香莉, 等. 胃癌组织中 EGFR、C-erbB-2、TopoⅡα 及 P-gp 的表达及意义. 现代肿瘤医学, 2013, 21(4): 834-837.
30. 蔡颖, 蔺玉昌. 胃癌 P53 和 Ki-67 表达与淋巴结转移的相关性. 齐齐哈尔医学院学报, 2001, 22(11): 1236-1237.
31. 侯宝洲, 孙剑经, 赵秀芳, 等. 胃癌中 β-catenin、ki67 与 Her-2/Neu 的关系及临床意义. 安徽医科大学学报, 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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