THE EFFECT OF LYMPH NODE DISSECTION ON THE DEVELOPMENT OF METACHRONOUS PERITONEAL DISSEMINATION AFTER GASTRIC CANCER RADICAL TREATMENT
Abstract
Background. Metachronous peritoneal dissemination (MPD) is a prevailing pattern of gastric cancer (GC) progression, significantly aggravating the outcomes of its radical treatment. As intraperitoneal dissemination of tumor cells can occur during lymphodissection (LD), it is essential to assess its influence on the development of MPD. Objective. To evaluate the influence of LD volume on MPD development in patients radically operated on for cancer. Material and methods. There have been analyzed the outcomes of 1080 patients radically operated on for cancer (pT1-4N0-3M0) without esophageal transition (647 men, 433 women) depending on the volume of LD performed - D1 (n=151) or D2 (n=929). Survival rates (Kaplan-Meier multiplier estimation method), cumulative incidence (CI) of competing events - MPD, metastases of other localization, mortality not related to gastric cancer were estimated (competing risks analysis). Results. There has been demonstrated the possibility of intraoperative dissemination of tumor cells during LD in the presence of metastatic changes of regional lymphocollectors and in the absence of adjuvant treatment, it being manifested by the increase of cumulative incidence of MPD only (for patients after D1 LD - from 8,3±2,8% at pN0 to 29,1±6,2% at pN1-3 (pGray<0,05); for patients after D2 LD - from 9.4±1.3% at pN0 to 27.3±2.1% at pN1-3 (pGray<0,05)), and in combination with other distant lymphohematogenic metastases (for patients after D1 LD, from 0 at pN0 to 1.8±1.8% at pN1-3; for patients after D2 LD, from 3.1±0.8% at pN0 to 11.1±1.5% at pN1-3 (pGray<0,05)). Conclusions. The evaluation of regional lymphatic collectors state seems to be reasonable when assessing the probability of MPD development. The type of LD performed does not affect the CI of GC progression including MPD development.
References
Ter-Ovanesov MD, Fatuev OE, Gaboyan AS, Levitsky AV, Lesnidze EE, Baksiyan GA. The current status of problem of combined treatment for locally advanced gastric cancer. Achievements and failures: the main trends of clinical oncology. Problems in oncology. 2015;61(3):329-338. edn: TUWEEZ. (Russian).
Kodama Y, Sugimachi K, Soejima K, Matsusaka T, Inokuchi K. Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg. 1981;5(2):241-8. https://doi.org/10.1007/BF01658301.
Maruyama K, Gunvén P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg. 1989;210(5):596-602. https://doi.org/10.1097/00000658-198911000-00005.
Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JH, Meijer S, Plukker JT, van Elk PJ, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22(11):2069-77. https://doi.org/10.1200/JCO.2004.08.026.
Ministry of Health of the Republic of Belarus. Ob utverzhdenii nekotoryh klinicheskih protokolov "Algoritmy diagnostiki i lechenija zlokachestvennyh novoobrazovanij". Prikaz № 258 (March 11, 2012). [Internet]. Minsk; 2012. Available from: https://minzdrav.gov.by/upload/dadvfiles/000674_38002_258.pdf (Russian).
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101-12. https://doi.org/10.1007/s10120-011-0041-5.
Fine JP, Gray RJ. A Proportional Hazards Model for the Subdistribution of a Competing Risk. Journal of the American Statistical Association. 1999;94(446):496-509. https://doi.org/10.1080/01621459.1999.10474144.
Kuk D, Varadhan R. Model selection in competing risks regression. Stat Med. 2013;32(18):3077-88. https://doi.org/10.1002/sim.5762.
Subdistribution Analysis of Competing Risks [Internet]. Available from: https://cran.r-project.org/package=cmprsk.
Kuznetsova A, Brockhoff PB, Christensen RHB. lmerTest Package: Tests in Linear Mixed Effects Models. Journal of Statistical Software. 2017;82(13):1-26. https://doi.org/10.18637/jss.v082.i13.
Reutovich MYu, Krasko OV, Ivanov AV. The effect of the extent of surgery and lymph node dissection on the development of Metachronous peritoneal dissemination in gastric cancer. Oncology and Radiology of Kazakhstan. 2023;3(69):53-58. https://doi.org/10.52532/2663-4864-2023-3-69-53-58. https://www.elibrary.ru/edlqbr. (Russian).
Takebayashi K, Murata S, Yamamoto H, Ishida M, Yamaguchi T, Kojima M, Shimizu T, Shiomi H, Sonoda H, Naka S, Mekata E, Okabe H, Tani T. Surgery-induced peritoneal cancer cells in patients who have undergone curative gastrectomy for gastric cancer. Ann Surg Oncol. 2014;21(6):1991-7. https://doi.org/10.1245/s10434-014-3525-9.
Ilhan E, Alemdar A, Ureyen O, Bas K. The Importance of Extensive Intraoperative Peritoneal Lavage as a Promising Method in Patients with Gastric Cancer Showing Positive Peritoneal Cytology without Overt Peritoneal Metastasis and Other Therapeutic Approaches. J Invest Surg. 2017;30(5):318-324. https://doi.org/10.1080/08941939.2016.1247930.
Reutovich M. Evaluation of the reck gene methylation statusin prediction of metachronous peritoneal dissemination in patients with resectable gastric cancer. Eurasian Journal of Oncology. 2021;9(1):40-48. https://doi.org/10.34883/PI.2021.9.1.016. https://www.elibrary.ru/pyyhhp. (Russian).
Reutovich M, Krasko O, Ivanov A, Zakharava V. The effect of clinical and morphological features of tumor process on the development of metachronous peritoneal dissemination in the post-radical surgery period. Eurasian Journal of Oncology. 2023;11(3):171-87. https://doi.org/10.34883/PI.2023.11.3.018. https://www.elibrary.ru/rcjbiu. (Russian).
Caspers IA, Sikorska K, Slagter AE, van Amelsfoort RM, Meershoek-Klein Kranenbarg E, van de Velde CJH, Lind P, Nordsmark M, Jansen EPM, Verheij M, van Sandick JW, Cats A, van Grieken NCT. Risk Factors for Metachronous Isolated Peritoneal Metastasis after Preoperative Chemotherapy and Potentially Curative Gastric Cancer Resection: Results from the CRITICS Trial. Cancers (Basel). 2021;13(18):4626. https://doi.org/10.3390/cancers13184626.
Deng J, Liu J, Wang W, Sun Z, Wang Z, Zhou Z, Xu H, Liang H. Validation of clinical significance of examined lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system. Chin J Cancer Res. 2018;30(5):477-491. https://doi.org/10.21147/j.issn.1000-9604.2018.05.01.
