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Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node

BACKGROUND: Resectable gastric cancer (GC) patients with small para-aortic lymph node (smaller than 10mm in diameter, sPAN) were seldom reported, and existing guidelines did not provide definite treatment recommendation for them. METHODS: A total of 667 consecutive resectable GC patients were enroll...

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Autores principales: Yao, Zhendan, Yang, Hong, Cui, Ming, Xing, Jiadi, Zhang, Chenghai, Zhang, Nan, Chen, Lei, Tan, Fei, Xu, Kai, Liu, Maoxing, Su, Xiangqian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10009175/
https://www.ncbi.nlm.nih.gov/pubmed/36923426
http://dx.doi.org/10.3389/fonc.2023.1131725
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author Yao, Zhendan
Yang, Hong
Cui, Ming
Xing, Jiadi
Zhang, Chenghai
Zhang, Nan
Chen, Lei
Tan, Fei
Xu, Kai
Liu, Maoxing
Su, Xiangqian
author_facet Yao, Zhendan
Yang, Hong
Cui, Ming
Xing, Jiadi
Zhang, Chenghai
Zhang, Nan
Chen, Lei
Tan, Fei
Xu, Kai
Liu, Maoxing
Su, Xiangqian
author_sort Yao, Zhendan
collection PubMed
description BACKGROUND: Resectable gastric cancer (GC) patients with small para-aortic lymph node (smaller than 10mm in diameter, sPAN) were seldom reported, and existing guidelines did not provide definite treatment recommendation for them. METHODS: A total of 667 consecutive resectable GC patients were enrolled. 98 patients were in the sPAN group, and 569 patients without enlarged para-aortic lymph node were in the nPAN group. Standard D2 lymphadenectomy was performed. Neoadjuvant and adjuvant chemotherapy were administrated according to the cTNM and pTNM stage, respectively. Clinicopathological features and prognosis were compared between these two groups. RESULTS: The median size of sPAN was 6 (range, 2−9) mm and the distribution was prevalent in No. 16b1. cN stage (p=0.001) was significantly related to the presence of sPAN. sPAN was both independent risk factor for OS (p=0.031) and RFS (p=0.046) of all patients. The prognosis of patients with sPAN was significantly worse than that of patients with nPAN (OS: p=0.008; RFS: p=0.007). Preoperative CEA and CA19-9 were independent risk factors for prognosis of patients with sPAN. Furthermore, patients in the sPAN group with normal CEA and CA19-9 exhibited acceptable prognosis (5-year OS: 67%; RFS: 64%), while those with elevated CEA or CA19-9 suffered significantly poorer prognosis (5-year OS: 17%; RFS: 17%) than patients in the nPAN group (5-year OS: 64%; RFS 62%) (both p < 0.05). CONCLUSIONS: Standard D2 lymphadenectomy should be considered a valid approach for GC patients with sPAN associate to normal preoperative CEA and CA19-9 levels. Patients with sPAN associated to elevated CEA or CA19-9 levels could benefit from a multimodal approach: neoadjuvant chemotherapy; radical surgery with D2 plus lymph nodal dissection extended to No. 16 station.
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spelling pubmed-100091752023-03-14 Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node Yao, Zhendan Yang, Hong Cui, Ming Xing, Jiadi Zhang, Chenghai Zhang, Nan Chen, Lei Tan, Fei Xu, Kai Liu, Maoxing Su, Xiangqian Front Oncol Oncology BACKGROUND: Resectable gastric cancer (GC) patients with small para-aortic lymph node (smaller than 10mm in diameter, sPAN) were seldom reported, and existing guidelines did not provide definite treatment recommendation for them. METHODS: A total of 667 consecutive resectable GC patients were enrolled. 98 patients were in the sPAN group, and 569 patients without enlarged para-aortic lymph node were in the nPAN group. Standard D2 lymphadenectomy was performed. Neoadjuvant and adjuvant chemotherapy were administrated according to the cTNM and pTNM stage, respectively. Clinicopathological features and prognosis were compared between these two groups. RESULTS: The median size of sPAN was 6 (range, 2−9) mm and the distribution was prevalent in No. 16b1. cN stage (p=0.001) was significantly related to the presence of sPAN. sPAN was both independent risk factor for OS (p=0.031) and RFS (p=0.046) of all patients. The prognosis of patients with sPAN was significantly worse than that of patients with nPAN (OS: p=0.008; RFS: p=0.007). Preoperative CEA and CA19-9 were independent risk factors for prognosis of patients with sPAN. Furthermore, patients in the sPAN group with normal CEA and CA19-9 exhibited acceptable prognosis (5-year OS: 67%; RFS: 64%), while those with elevated CEA or CA19-9 suffered significantly poorer prognosis (5-year OS: 17%; RFS: 17%) than patients in the nPAN group (5-year OS: 64%; RFS 62%) (both p < 0.05). CONCLUSIONS: Standard D2 lymphadenectomy should be considered a valid approach for GC patients with sPAN associate to normal preoperative CEA and CA19-9 levels. Patients with sPAN associated to elevated CEA or CA19-9 levels could benefit from a multimodal approach: neoadjuvant chemotherapy; radical surgery with D2 plus lymph nodal dissection extended to No. 16 station. Frontiers Media S.A. 2023-02-27 /pmc/articles/PMC10009175/ /pubmed/36923426 http://dx.doi.org/10.3389/fonc.2023.1131725 Text en Copyright © 2023 Yao, Yang, Cui, Xing, Zhang, Zhang, Chen, Tan, Xu, Liu and Su https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Yao, Zhendan
Yang, Hong
Cui, Ming
Xing, Jiadi
Zhang, Chenghai
Zhang, Nan
Chen, Lei
Tan, Fei
Xu, Kai
Liu, Maoxing
Su, Xiangqian
Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node
title Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node
title_full Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node
title_fullStr Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node
title_full_unstemmed Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node
title_short Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node
title_sort clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10009175/
https://www.ncbi.nlm.nih.gov/pubmed/36923426
http://dx.doi.org/10.3389/fonc.2023.1131725
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