title: Prognostic significance and the role in TNM stage of extranodal metastasis within regional lymph nodes station in gastric carcinoma.
abstract: The role of extranodal metastasis (ENM) in TNM stage in gastric carcinoma (GC) is controversial. This study was aimed to make a detailed investigation of the prognostic significance and the role in TNM stage of ENM in GC. The patients with primary GC, who underwent gastrectomy with curative intention in West China Hospital from January 2005 to December 2011, were retrospectively enrolled. The prognosis and clinicopathological traits were compared between ENM positive (ENMP) and negative (ENMN) groups in all patients, TNM I-II, III and IV stages, respectively. The significance of the number and the role in TNM stage of ENM were also assessed. In our study, 1457 patients were enrolled, with 1324 (90.9%) in ENMN group and 133 (9.1%) in ENMP group. ENMP group had significantly more advanced GC and worse prognosis (all p<0.05) than ENMN group in all patients, TNM I-II stages and TNM III stage. ENM>2 subgroup had remarkably larger tumor size (p=0.002) and more advanced N stage (p=0.016) than ENM=1-2 subgroup. The number of ENM was an independent prognostic factor in ENMP group (p=0.029). The prognosis of ENM>2 in TNM I-III stages was significantly worse than ENMN patients in TNM III stage. The C-index of TNM stage plus the number of ENM was significantly higher than that of current TNM stage alone (p=0.005). In conclusion, the patients in ENMP subgroup had more advanced GC and worse prognosis than those in ENMN subgroup. It might be more reasonable to categorize ENM>2 into TNM IV stage.
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Xiao-Long
authors: XL
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Lin-Yong
authors: LY
authors: Zhao
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Lian
authors: L
authors: Xue
authors: West China School of Medicine, Sichuan University, Chengdu 610041, China.
authors: Yu-Hui
authors: YH
authors: Xu
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Wei-Han
authors: WH
authors: Zhang
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Kai
authors: K
authors: Liu
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Xin-Zu
authors: XZ
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Kun
authors: K
authors: Yang
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Bo
authors: B
authors: Zhang
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Zhi-Xin
authors: ZX
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Jia-Ping
authors: JP
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Institution of Digestive Surgery, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Zong-Guang
authors: ZG
authors: Zhou
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Jian-Kun
authors: JK
authors: Hu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology*
keywords: C-index; TNM stage; extranodal metastasis; gastric carcinoma; prognosis