TY - JOUR
T1 - Pattern of lymph node metastases in gastric cancer
T2 - a side-study of the multicenter LOGICA-trial
AU - de Jongh, Cas
AU - Triemstra, Lianne
AU - van der Veen, Arjen
AU - Brosens, Lodewijk A. A.
AU - Luyer, Misha D. P.
AU - Stoot, Jan H. M. B.
AU - Ruurda, Jelle P.
AU - van Hillegersberg, Richard
AU - the LOGICA Study Group
AU - Brenkman, Hylke J. F.
AU - Seesing, Maarten F. J.
AU - Nieuwenhuijzen, Grard A. P.
AU - Ponten, Jeroen E. H.
AU - Tegels, Juul J. W.
AU - Hulsewe, Karel W. E.
AU - Wijnhoven, Bas P. L.
AU - Lagarde, Sjoerd M.
AU - de Steur, Wobbe O.
AU - Hartgrink, Henk H.
AU - Kouwenhoven, Ewout A.
AU - van Det, Marc J.
AU - Wassenaar, Eelco B.
AU - van Duijvendijk, P.
AU - Draaisma, Werner A.
AU - Broeders, Ivo A. M. J.
AU - van der Peet, Donald L.
AU - Gisbertz, Suzanne S.
N1 - Funding Information: No funding was received nor requested for this side-study. The LOGICA-trial (NCT02248519) was funded by ZonMw (The Netherlands Organization for Health Research and Development), Project Number 837002502. Funding Information: The authors sincerely thank all patients that participated in the LOGICA-trial. Furthermore, the authors would like to thank everyone from the ten participating hospitals who contributed in the data collection and local coordination of the LOGICA-trial. Additionally, the authors thank ZonMw (The Netherlands Organization for Health Research and Development) for financial support of the LOGICA-trial (Project Number 837002502). Also, the authors would like to thank Johnson & Johnson for providing an unrestricted educational grant for the proctoring of laparoscopic gastrectomy in centers before entering the LOGICA-trial. Moreover, the authors would like to thank PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, for acquiring the pathology reports. In this aspect, the authors also thank LabPON (Laboratory Pathology East-Netherlands). Funding Information: The authors sincerely thank all patients that participated in the LOGICA-trial. Furthermore, the authors would like to thank everyone from the ten participating hospitals who contributed in the data collection and local coordination of the LOGICA-trial. Additionally, the authors thank ZonMw (The Netherlands Organization for Health Research and Development) for financial support of the LOGICA-trial (Project Number 837002502). Also, the authors would like to thank Johnson & Johnson for providing an unrestricted educational grant for the proctoring of laparoscopic gastrectomy in centers before entering the LOGICA-trial. Moreover, the authors would like to thank PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, for acquiring the pathology reports. In this aspect, the authors also thank LabPON (Laboratory Pathology East-Netherlands). Collaborators (LOGICA Study Group): Hylke JF Brenkman1, Maarten F.J. Seesing1, Grard AP Nieuwenhuijzen2, Jeroen EH Ponten2, Juul JW Tegels3, Karel WE Hulsewe3, Bas PL Wijnhoven4, Sjoerd M Lagarde4, Wobbe O de Steur5, Henk H Hartgrink5, Ewout A Kouwenhoven6, Marc J van Det6, Eelco B Wassenaar7, P. van Duijvendijk7, Werner A Draaisma8, Ivo AMJ Broeders8, Donald L van der Peet9, Suzanne S Gisbertz10. Institutions and Affiliations:1University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, The Netherlands.1*UMC Utrecht, Department of Pathology, Utrecht, The Netherlands.2Catharina Hospital Eindhoven, Department of Surgery, Eindhoven, The Netherlands.3Zuyderland Medical Center, Department of Surgery, Sittard, The Netherlands.4Erasmus UMC, Department of Surgery, Rotterdam, The Netherlands.5Leiden UMC, Department of Surgery, Leiden, The Netherlands.6ZGT Almelo, Department of Surgery, Almelo, The Netherlands.7Gelre Hospitals Apeldoorn, Department of Surgery, Apeldoorn, The Netherlands.8Meander Medical Center, Department of Surgery, Amersfoort, The Netherlands.9Amsterdam UMC, Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands.10Amsterdam UMC, Department of Surgery, VU Amsterdam, Amsterdam, The Netherlands. Publisher Copyright: © 2022, The Author(s).
PY - 2022/11
Y1 - 2022/11
N2 - Background: The relation between gastric cancer characteristics and lymph node (LN) metastatic patterns is not fully clear, especially following neoadjuvant chemotherapy (NAC). This study analyzed nodal metastatic patterns. Methods: Individual LN stations were analyzed for all patients from the LOGICA-trial, a Dutch multicenter randomized trial comparing laparoscopic versus open D2-gastrectomy for gastric cancer. The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC. Results: Between 2015–2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 120 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; p < 0.05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR > 1, p > 0.05). However, distal tumors also metastasized to proximal LN stations, and vice versa. Despite NAC, each LN station (no. 1–9, 11 and 12a) showed metastases, regardless of tumor location, cT-stage, histological subtype and NAC treatment, including station 12a for cT1N0-tumors. LN metastases were present more frequently in diffuse versus intestinal tumors (66% versus 52%; p = 0,048), but not for cT3–4- versus cT1–2-stage (59% versus 51%; p = 0.259). However, the pattern of LN metastases was similar for these subgroups. Conclusions: The extent of lymphadenectomy cannot be reduced after NAC for gastric cancer. Although the pattern of LN metastases is related to tumor location, all LN stations contained metastases regardless of tumor location, cT-stage (including cT1N0-tumors), histological subtype, or NAC treatment. Therefore, D2-lymphadenectomy should be routinely performed during gastrectomy in Western patients.
AB - Background: The relation between gastric cancer characteristics and lymph node (LN) metastatic patterns is not fully clear, especially following neoadjuvant chemotherapy (NAC). This study analyzed nodal metastatic patterns. Methods: Individual LN stations were analyzed for all patients from the LOGICA-trial, a Dutch multicenter randomized trial comparing laparoscopic versus open D2-gastrectomy for gastric cancer. The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC. Results: Between 2015–2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 120 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; p < 0.05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR > 1, p > 0.05). However, distal tumors also metastasized to proximal LN stations, and vice versa. Despite NAC, each LN station (no. 1–9, 11 and 12a) showed metastases, regardless of tumor location, cT-stage, histological subtype and NAC treatment, including station 12a for cT1N0-tumors. LN metastases were present more frequently in diffuse versus intestinal tumors (66% versus 52%; p = 0,048), but not for cT3–4- versus cT1–2-stage (59% versus 51%; p = 0.259). However, the pattern of LN metastases was similar for these subgroups. Conclusions: The extent of lymphadenectomy cannot be reduced after NAC for gastric cancer. Although the pattern of LN metastases is related to tumor location, all LN stations contained metastases regardless of tumor location, cT-stage (including cT1N0-tumors), histological subtype, or NAC treatment. Therefore, D2-lymphadenectomy should be routinely performed during gastrectomy in Western patients.
KW - Gastric cancer
KW - Lymph node metastasis
KW - Lymphadenectomy
KW - Personalized medicine
UR - http://www.scopus.com/inward/record.url?scp=85138309630&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10120-022-01329-2
DO - https://doi.org/10.1007/s10120-022-01329-2
M3 - Article
C2 - 36103060
SN - 1436-3291
VL - 25
SP - 1060
EP - 1072
JO - Gastric cancer
JF - Gastric cancer
IS - 6
ER -