Gastric Cancer
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2005; 11(38): 5920-5925
Published online Oct 14, 2005. doi: 10.3748/wjg.v11.i38.5920
Prognostic implication of isolated tumor cells and micrometastases in regional lymph nodes of gastric cancer
Hye Seung Lee, Min A Kim, Han-Kwang Yang, Byung Lan Lee, Woo Ho Kim
Hye Seung Lee, Department of Pathology, Seoul National University Bundang Hospital, Gyeonggi 463-707, Korea
Min A Kim, Woo Ho Kim, Department of Pathology and Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-799, Korea
Han-Kwang Yang, Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
Byung Lan Lee, Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
Author contributions: All authors contributed equally to the work.
Supported by a grant (FG03-11-02) from the 21C Frontier Functional Human Genome Project from the Ministry of Science and Technology of Korea
Correspondence to: Dr. Woo Ho Kim, Department of Pathology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-799, Korea. woohokim@snu.ac.kr
Telephone: +82-2-7408269 Fax: +82-2-7655600
Received: February 24, 2005
Revised: May 8, 2005
Accepted: May 12, 2005
Published online: October 14, 2005
Abstract

AIM: To determine the prognostic significance of isolated tumor cells (ITCs) and lymph node micrometastases in gastric cancer.

METHODS: Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecutive gastric cancers were reviewed. Cytokeratin immunostaining was performed in 280 node-negative cases and 5 cases indefinite for lymph node metastases. Lymph node metastases were divided into ITCs, micrometastases, or macrometastases, according to the sizes of tumor deposits in largest dimension. ITCs were further classified into four groups according to metastasis pattern.

RESULTS: Lymph node metastases were identified by immunostaining in 58 of 280 node-negative cases (20.7%) and were not significantly associated with patient survival (P = 0.3460). After cytokeratin immunostaining, 196 cases were classified as pN1, which consisted of 20 cases with micrometastases detected by immunostaining (pN1mi(i+)), 34 cases with only micrometastases (pN1mi), and 142 cases with pN1 with one or more macrometastases (pN1). Cases with pN1mi and pN1mi(i+) had a significantly better prognosis than the cases with pN1 (P = 0.0037). ITCs were found in 38 of these 58 cases, and could be divided into four groups: 12 cases with only a single cell pattern, 7 cases with multiple individual cells, 5 cases with single small cluster, and 14 cases with multiple small clusters. Among these four groups, cases with ITCs of multiple individual cell pattern showed the worst survival (median survival: 28 mo, P<0.0001).

CONCLUSION: Both size and pattern of lymph node metastases can give prognostic information on the survival of gastric cancer patients.

Keywords: Immunohistochemistry; Cytokeratin; Patient survival; Lymph node metastasis