title: Strong association of lymph node metastasis with intraperitoneal free cancer cell (IFCC) in advanced gastric cancer.
abstract: OBJECTIVE
  Advanced gastric cancer is a disease with dismal prognosis, which is mainly characterized by the emerging intraperitoneal free gastric cancer cells (IFCC). Our interest is to elucidate a causative phenotype linking to IFCC.
  
  
  METHODS
  Two hundred and sixty-nine resected gastric cancer patients examined for IFCC were enrolled at the Kitasato University Hospital to evaluate the clinical significance of the interaction between IFCC and other tumor phenotypes.
  
  
  RESULTS
  IFCC was not found in the 22 early gastric cancers, and we were thus restricted to evaluate the remaining gastric cancers beyond the muscuralis propria (MP). Among the 247 advanced gastric cancer patients, IFCC was a potent univariate prognostic factor (p<0.0001) as well as lymph node metastasis (P<0.0001), depth of invasion (P=0.0015), and age (P=0.009). IFCC affects poor prognosis more strongly in the modest node disease (n0/n1) than in the severe node disease (n2/n3/M), even after considering D2 dissection. In the modest node disease, multivariate prognostic analysis revealed IFCC as an independent prognostic factor, and lymph node metastasis (n1 against n0 disease) is the only independent predictive tumor factor of IFCC in the logistic regression analysis. As a result, we finally noticed that lymph node metastasis exists in almost advanced gastric cancer with IFCC, while IFCC was hardly detected unless lymph node metastasis exists.
  
  
  CONCLUSIONS
  IFCC could be rather strongly associated with lymph node metastasis than depth of invasion in advanced gastric cancer, and transition from the node disease to the peritoneal disease plays a critical role in gastric cancer progression affecting dismal prognosis. Its regulation may be an optimal therapeutic target of advanced gastric cancer.
authors.affiliation: Department of Surgery, Kitasato University Higashi Hospital, Kanagawa, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sakuramoto
authors.forename: Shiro
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Natsuya
authors.initials: N
authors.lastname: Katada
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010534:Peritoneal Neoplasms / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*