This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Extranodal metastasis is an indicator of poor prognosis in patients with gastric carcinoma. BJS 2006; 93: 369-373.
Published: 3rd January 2006
Authors: T. Etoh, M. Sasako, K. Ishikawa, H. Katai, T. Sano, T. Shimoda et al.
Background
The aim of this study was to determine the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma.
Method
The study included 1023 patients who underwent gastrectomy with lymphadenectomy for primary gastric carcinoma between January 1993 and December 1996. EM was defined as the presence of tumour cells in extramural soft tissue that was discontinuous with either the primary lesion or locoregional lymph nodes.
Results
EM was detected in 146 (14·3 per cent) of the 1023 patients and in 1060 (3·0 per cent) of the 35 811 nodules that were retrieved as ‘lymph nodes’ from adipose connective tissues. The incidence of EM was significantly higher in patients with tumours that were large (diameter 10 cm or more), infiltrative, deeply invading or undifferentiated and in those with lymph node, peritoneal or liver metastases, or lymphatic or vascular involvement. After curative operation overall survival was significantly worse for patients with EM than those without (P < 0·001). Multivariate analysis identified EM as an independent prognostic factor (hazard ratio 1·82 (95 per cent confidence interval 1·23 to 2·71); P = 0·003).
Conclusion
EM is an independent prognostic factor and should therefore be included in the tumour node metastasis (TNM) staging system. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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