Gastric carcinoma
Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume delineation of regional lymph node in patients with gastric carcinoma☆

https://doi.org/10.1016/j.radonc.2010.04.031Get rights and content

Abstract

Purpose

To study the pattern of lymph node metastases (LNM) of gastric carcinoma (GC) and clarify the clinical target volume delineation of regional lymph node (CTVn).

Methods and materials

The pattern of LNM of a total of 875 GC patients who had undergone gastrectomy and lymphadenectomy with more than 15 lymph nodes retrieved were retrospectively examined. The clinicopathologic factors related to LNM were analyzed using logistic regression analysis and linear regression.

Results

The rate of LNM in patients with upper GC was 75.3%, in middle ones 78.9%, in lower ones 64.9%, and 82.2% in patients with whole GCs. In terms of the ratio between metastatic and examined lymph nodes (N ratio) of GC patients, it was 35.8% in patients with upper tumors, 36.6% in middle ones, 27.6% in lower ones, and 51.0% in whole GCs. The maximum diameter and T stage of tumor emerged as statistically significant risk factors of the rate of LNM of GC (P < 0.001, 0.001, respectively; HR = 1.172, 2.132, respectively; 95% confidence interval: 1.083–1.268, 1.777–2.558, respectively). T stage (P < 0.001), the maximum diameter of tumor (P < 0.001), tumor differentiation (P = 0.018) and macroscopic types of tumor (P = 0.030) were significantly associated with N ratio. Our material showed an orderly spread to stations 1–16 clearly related to the position of the tumor (P < 0. 001), nevertheless, there was no statistical difference between different locations of tumor with regards of the rate of LNM (P = 0.614, HR = 0.945, 95% confidence interval: 0.759–1.177) as well as N ratio (P > 0.05).

Conclusions

The pattern of LNM in GC is mainly correlated with the maximum diameter of tumor, T stage, macroscopic types and histologic differentiation. Rate of LNM and N ratio can be recommended as applicable parameters for lymph nodes involvement of GC. These factors should be considered comprehensively to design the CTVn for radiotherapy (RT) of GC. Selective regional irradiation including the correlated lymphatic drainage regions should be performed as well.

Section snippets

Patients

From the total number of 1765 patients diagnosed with GC and who had undergone gastrectomy at the department of general surgical oncology in Shandong Cancer Hospital from January 2002 to December 2008, 875 patients were selected to be retrospectively studied. Eligibility criteria included: (a) patients with complete history, physical examination, and endoscopy of the upper gastrointestinal tract. Computed tomography (CT) of the chest and ultrasonography or CT of the abdomen, and/or positron

Patients and clinicopathologic features

As is shown in Table 1, there were 635 males and 240 females with a median age of 57 years (range 24–70 years), including 154 in the upper third, 209 in the middle third, 485 in the lower third, and 27 with whole GC. The maximum diameter of tumor was ⩽3.0 cm in 215 patients, 3.1–6.0 cm in 431 patients, and >6.0 cm in 229 patients. In terms of the T stage, 57 patients had T1 invasion, 134 patients T2 invasion, 191 ones T3 invasion and 493 cases T4 invasion. In terms of the macroscopic types, there

Discussion

GC is one of the most common causes of cancer death worldwide. It is characterized by a high frequency of regionalized disease with nodal metastasis. For the treatment of GC, complete tumor resection, whenever feasible, is the standard treatment. However, although the goal of each surgical attempt is to achieve an R0 resection, it is only possible for less than 50% of patients [16], [17]. The 5-year survival rate of patients with advanced loco-regional GC who have undergone curative resection

Conflict of interest statement

All authors disclose to have no financial and personal relationships with other people or organizations that could inappropriately influence their work.

Acknowledgment

The authors thank Jufu Dong and Kun Yang for the work of picture drawing.

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    ☆

    This study was supported in part by 30670617 and 30970861 from National Nature Science Foundation of China.

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