Case Control Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2017; 23(45): 8000-8007
Published online Dec 7, 2017. doi: 10.3748/wjg.v23.i45.8000
Recurrence in node-negative advanced gastric cancer: Novel findings from an in-depth pathological analysis of prognostic factors from a multicentric series
Gian Luca Baiocchi, Sarah Molfino, Carla Baronchelli, Simone Giacopuzzi, Daniele Marrelli, Paolo Morgagni, Maria Bencivenga, Luca Saragoni, Carla Vindigni, Nazario Portolani, Maristella Botticini, Giovanni De Manzoni
Gian Luca Baiocchi, Sarah Molfino, Nazario Portolani, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25121, Italy
Carla Baronchelli, Department of Pathology, Spedali Civili di Brescia, Brescia 25121, Italy
Simone Giacopuzzi, Maria Bencivenga, Giovanni De Manzoni, 1st Department of General Surgery, Borgo Trento Hospital, University of Verona, Verona 37129, Italy
Daniele Marrelli, Department of Human Pathology and Oncology, Surgical Oncology, University of Siena, Siena 53100, Italy
Paolo Morgagni, Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
Luca Saragoni, Department of Pathology, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
Carla Vindigni, Department of Pathology, Azienda Ospedaliera Universitaria Senese, Siena 53100, Italy
Maristella Botticini, IGIER, Università Bocconi, Milan 20100, Italy
Author contributions: Baiocchi GL designed and coordinated this study; Molfino S acquired and analyzed the data and wrote the first draft of the paper; Baronchelli C, Giacopuzzi S, Marrelli D, Morgagni P, Bencivenga M, Saragoni L, Vindigni C, Portolani N, and De Manzoni G made substantial contributions to the research questions. Botticini M helped with literature review and critically revised the manuscript. All authors contributed to the final approval of the article.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the University of Brescia, Italy.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gian Luca Baiocchi, MD, Associate Professor, Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, III Chirurgia Generale, Spedali Civili di Brescia, P.le Spedali Civili 1, Brescia 25121, Italy. gianluca.baiocchi@unibs.it
Telephone: +39-030-3995600 Fax: +39-030-3397476
Received: February 19, 2017
Peer-review started: February 20, 2017
First decision: March 7, 2017
Revised: September 20, 2017
Accepted: October 17, 2017
Article in press: October 17, 2017
Published online: December 7, 2017
Abstract
AIM

To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up.

METHODS

We enrolled 41 patients treated with curative gastrectomy for pT2-4aN0 gastric carcinoma between 1992 and 2010, who developed recurrence (Group 1). We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer, and compared them with 437 pT2-4aN0 patients without recurrence (Group 2). We analyzed lymphatic embolization, microvascular infiltration, perineural infiltration, and immunohistochemical determination of p53, Ki67, and HER2 in Group 1 and in a subgroup of Group 2 (Group 2bis) of 41 cases matched with Group 1 according to demographic and pathological characteristics.

RESULTS

T4a stage and diffuse histotype were associated with recurrence in the group of pN0 patients. In-depth pathological analysis of two homogenous groups of pN0 patients, with and without recurrence during long-term follow-up (groups 1 and 2bis), revealed two striking patterns: lymphatic embolization and perineural infiltration (two parameters that pathologists can easily report), and p53 and Ki67, represent significant factors for recurrence.

CONCLUSION

The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.

Keywords: N0 gastric cancer, Recurrence, Prognostic factors, Pathological analysis, Lymphatic embolization, Perineural infiltration, p53, Ki67

Core tip: We analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up in 4 Italian centers belonging to the Italian Research Group on Gastric Cancer between 1992 and 2010. Lymph node metastasis is the most important prognostic factor in patients undergoing radical surgery for gastric carcinoma. In-depth pathological analysis of two homogenous groups of pN0 patients, with and without recurrence during long-term follow-up, revealed two striking patterns: lymphatic embolization and perineural infiltration (two parameters that pathologists can easily report), and p53 and Ki67, represent significant factors for recurrence. The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.