A Prognostic Study Of Extracapsular Spread Of Lymph Node In Gastric Carcinoma

Objective:Gastric cancer is one of the common malignant tumors in clinic.Most patientswere diagnosed with advanced gastric cancer, and overall survival is still poor. It is wellknown that lymph node metastasis is one of the most important prognostic factors ingastric carcinoma.The lymph node metastasis incidence of early gastric carcinoma is10%.It is significantly higher when the tumor invasion of the myometrium.It is stillunknown that the relationship between the clinical factors of extracapsular spread of lymphnode metastasis [ESM] and the prognosis of gastric cancer.Moreover, it is as yet unknownif extracapsular spread of lymph node metastasis [ESM] is an early or late event in cancerprogression. It has not been established if extracapsular spread of lymph node metastasis[ESM] is associated with local or haematogenous recurrences.The aim of this study is toinvestigate the relationship between the extent of extracapsular spread of lymph nodemetastasis [ESM]of gastric cancer and the prognosis of gastric cancer, to provide guidancefor the treatment of gastric cancer.Methods:The main technology of this study is that gastric cancer resection specimens toobtain adequate lymph node metastasis and the negative lymph nodes should beexcluded.After the operation,lymph nodes were fixed in formalin, bisected along themaximum plane,processed for paraffin embedding, and stained with hematoxylin and eosin.The number of resected lymph nodes, number of metastatic lymph nodes,and number ofextracapsular spread of lymph node metastasis [ESM] were determined.to analyze therelationship between the extent of extracapsular spread of lymph node metastasis [ESM]and the prognosis of gastric cancer, in order to provide clinical guidance to reduce themortality of gastric cancer surgery and to guide postoperative treatment.Eligible cases werecollected from80cases,53cases of males and27females,tumor stage was classifiedaccording to the seventh edition AJCC classificition,0cases in stage Ⅰ; Ⅱ21cases;55 cases of Phase III; IV of4cases. Tumor location: upper53; middle22; fundus5cases.69cases of poorly differentiated; differentiated in11cases.60cases of chemotherapy;without chemotherapy of20cases, vascular invasion (including nerves, blood vessels,lymphatic) positive of15cases and negative of65cases, VEGF negative54cases;positiveof26cases, p53negative48cases; positive of32cases,73cases of CEA with normal(less than5ng/ml), elevated (greater than equal to5ng/ml)7cases of serum; CA199normal (small35KU/L) of73cases, elevated (greater than is equal35KU/L) of7cases.positive extracapsular spread of lymph node metastasis [ESM] was47and negative of33cases. Relationship between extracapsular spread of lymph node metastasis [ESM] andtumor location, T stage, N stage, tumor differentiation, number of metastatic lymph nodeswere evaluated. SPSS13.0was used to analyze the results.The Cox proportional hazardsmodel was used to verify the effects of different covariates on survival. Differences atP<0.05were considered significant.Result: Univariate analysis confirmed TNM, tumor size, vascular invasion,chemotherapy,CEA,CA-199,tumor location,extracapsular spread of lymph nodemetastasis,as significant prognostic factors(P<0.05),while gender,age, VEGF, p53, tumortype, CA-125, there is no statistical significance(p>0.1). The Cox proportional hazardsmodel was used to verify the significant results of univariate analysis. The results showthat extracapsular spread of lymph node metastasis [ESM] was identified as independentprognostic factor P <0.05. Other factors include TNM, tumor size, vascular invasion,chemotherapy,CA-199P <0.05,there is statistical significance.CONCLUSION:1. Extracapsular spread of lymph node metastasis [ESM]is associatedwith higher tumor stages and is an independent negative prognostic factor in gastric cancer.2. Patients with Extracapsular spread of lymph node metastasis have more higherincideince risk for local recurrence and distant metastases than patients withoutExtracapsular lymph node involvement.3. Patients with extracapsular spread showed significantly poorer prognosis than those withintracapsular metastasis. 4.Extracapsular spread of Lymph node have a higher lymph node staging.