Skip lymph node metastasis in gastric cancer: is it skipping or skipped?

Yoon Young Choi; Ji Yeong An; Ali Guner; Dae Ryong Kang; In Cho; In Gyu Kwon; Hyun Beak Shin; Woo Jin Hyung; Sung Hoon Noh

doi:10.1007/s10120-015-0472-5

Skip lymph node metastasis in gastric cancer: is it skipping or skipped?

Yoon Young Choi, Ji Yeong An, Ali Guner, Dae Ryong Kang, In Cho, In Gyu Kwon, Hyun Beak Shin, Woo Jin Hyung, Sung Hoon Noh

Department of Surgery

Research output: Contribution to journal › Article › peer-review

29 Citations (Scopus)

Abstract

Background: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. Methods: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. Results: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95 % confidence interval 1.13–2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95 % confidence interval 0.92–2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). Conclusions: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.

Original language	English
Pages (from-to)	206-215
Number of pages	10
Journal	Gastric Cancer
Volume	19
Issue number	1
DOIs	https://doi.org/10.1007/s10120-015-0472-5
Publication status	Published - 2016 Jan 1

Bibliographical note

Funding Information:
This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1320360, 1020390). The authors are grateful to Dong-Su Jang, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the illustrations.

Publisher Copyright:
© 2015, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

All Science Journal Classification (ASJC) codes

Oncology
Gastroenterology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s10120-015-0472-5

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title = "Skip lymph node metastasis in gastric cancer: is it skipping or skipped?",

abstract = "Background: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. Methods: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. Results: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95 % confidence interval 1.13–2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95 % confidence interval 0.92–2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). Conclusions: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.",

author = "Choi, {Yoon Young} and An, {Ji Yeong} and Ali Guner and Kang, {Dae Ryong} and In Cho and Kwon, {In Gyu} and Shin, {Hyun Beak} and Hyung, {Woo Jin} and Noh, {Sung Hoon}",

note = "Funding Information: This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1320360, 1020390). The authors are grateful to Dong-Su Jang, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the illustrations. Publisher Copyright: {\textcopyright} 2015, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.",

year = "2016",

month = jan,

day = "1",

doi = "10.1007/s10120-015-0472-5",

language = "English",

volume = "19",

pages = "206--215",

journal = "Gastric Cancer",

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T1 - Skip lymph node metastasis in gastric cancer

T2 - is it skipping or skipped?

AU - Choi, Yoon Young

AU - An, Ji Yeong

AU - Guner, Ali

AU - Kang, Dae Ryong

AU - Cho, In

AU - Kwon, In Gyu

AU - Shin, Hyun Beak

AU - Hyung, Woo Jin

AU - Noh, Sung Hoon

N1 - Funding Information: This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1320360, 1020390). The authors are grateful to Dong-Su Jang, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the illustrations. Publisher Copyright: © 2015, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. Methods: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. Results: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95 % confidence interval 1.13–2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95 % confidence interval 0.92–2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). Conclusions: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.

AB - Background: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. Methods: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. Results: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95 % confidence interval 1.13–2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95 % confidence interval 0.92–2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). Conclusions: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.

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IS - 1

ER -

Skip lymph node metastasis in gastric cancer: is it skipping or skipped?

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

UN SDGs

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