The prognostic significance of isolated tumor cells in the lymph nodes of gastric cancer patients
Fukagawa, T.; Sasako, M.; Ito, S.; Nakanishi, H.; Iinuma, H.; Natsugoe, S.; Katai, H.; Shimoda, T.
Gastric Cancer Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 13(3): 191-196
The clinical significance of isolated tumor cells (ITC) detected immunohistochemically in the lymph nodes of gastric cancer patients is controversial. The aim of this study was to examine the prognostic impact of ITC in patients with gastric cancer. The data of a total of 402 patients with pathological T2N0 and T2N1 gastric cancer who underwent gastrectomy with D2 lymph node dissection between 1984 and 1990 at four participant hospitals were analyzed. All resected lymph nodes were reexamined by serial sectioning with hematoxylin & eosin (H&E) staining, and evaluated by immunohistochemistry using antibody against cytokeratin (AE1/3). The prevalence and prognostic significance of ITC were investigated. ITC were detected in 187 of the 402 (47%) patients. A multivariate analysis identified the nodal status, histological type, and tumor size as significant factors predictive of the presence/absence of ITC. The 5-year and 10-year overall survival rates of patients with vs those without ITC were 84.4% (95% confidence interval [CI], 79.1-89.0) and 70.4% (95% CI, 64.1-76.7) vs 83.9% (95% CI, 78.6-89.2) and 72.0% (95% CI, 65.4-78.5), respectively. The hazard ratio for death in patients with ITC as compared with those without ITC was 0.90 (95% CI, 0.64-1.26; P = 0.53). The presence of ITC in the lymph nodes does not affect the prognosis of patients with gastric cancer who have undergone gastrectomy with D2 lymph node dissection.