Background/Aims: The morphological distribution of tumor cells in metastatic lymph nodes has been investigated in positive sentinel lymph nodes in several solid cancers. The aim of this study was to clarify the effect of the distribution of metastatic foci in lymph nodes on the prognosis in gastric cancer. Methods: The distribution of metastatic foci in the 100 node-positive patients who had undergone curative gastrectomy were classified into two groups: (1) massive type, in which the tumor occupied the entire lymph node, and (2) non-massive type, in which the tumor did not occupy the entire lymph node. Results: There were 38 patients in the massive type group and 62 patients in the non-massive type group. The 10-year survival rate was significantly poorer in the massive type group (p = 0.001). Multivariate analysis showed that distributional type and nodal status were independent prognostic factors. UICC N stage was subcategorized by distributional type, and survival was shown to be significantly worse in the massive type in the N1 group (p = 0.035). Conclusion: It seems necessary to take the morphological distribution of metastatic foci into consideration when dealing with node-positive patients who had received curative resection for gastric cancer.

1.
Sobin LH, Wittekind C: UICC/AJCC TNM Classification of Malignant Tumors, ed 6. New York, Wiley-Liss, 2002.
2.
Siewert JR, Bottcher K, Stein HJ, Roder JD: Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998;228:449–461.
3.
Inoue K, Nakane Y, Iiyama H, Sato M, Kanbara T, Nakai K, Okumura S, Yamamichi K, Hioki K: The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 2002;9:27–34.
4.
Dhar DK, Tachibana M, Kinukawa N, Riruke M, Kohno H, Little AG, Nagasue N: The prognostic significance of lymph node size in patients with squamous esophageal cancer. Ann Surg Oncol 2002;9:1010–1016.
5.
Dhar DK, Kubota H, Kinukawa N, Maruyama R, Kyriazanos ID, Ohno S, Nagasue N: Prognostic significance of metastatic lymph node size in patients with gastric cancer. Br J Surg 2003;90:1522–1530.
6.
Weaver DL, Krag DN, Ashikaga T, Harlow SP, O’Connell M: Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma: a multicenter study. Cancer 2000;88:1099–1107.
7.
Turner RR, Chu KU, Qi K, Botnick LE, Hansen NM, Glass EC, Giuliano AE: Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node. Cancer 2000;89:574–581.
8.
Cochran AJ, Wen DR, Huang RR, Wang HJ, Elashoff R, Morton DL: Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol 2004;17:747–755.
9.
Dewar DJ, Newell B, Green MA, Topping AP, Powell BWEM, Cook MG: The microanatomic location of metastatic melanoma in sentinel lymph nodes predicts nonsentinel lymph node involvement. J Clin Oncol 2004;22:3345–3349.
10.
Yanagita S, Natsugoe S, Uenosono Y, Arima H, Kozono T, Ehi K, Arigami T, Higashi H, Aikou T: Morphological distribution of metastatic foci in sentinel lymph nodes with gastric cancer. Ann Surg Oncol 2008;15:770–776.
11.
Natsugoe S, Aikou T, Shimada M, Yoshinaka H, Takao S, Shimazu H, Matsushita Y: Occult lymph node metastasis in gastric cancer with submucosal invasion. Surg Today 1994;24:870–875.
12.
Starz H, Balda BR, Krämer KU, Büchels H, Wang H: A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma. Cancer 2001;91:2110–2120.
13.
Millis RR, Springall R, Lee AHS, Ryder K, Rytina ERC, Fentiman ISF: Occult axillary lymph node metastases are of no prognostic significance in breast cancer. Br J Cancer 2002;86:396–401.
14.
Arai K, Iwasaki Y, Takahashi T: Clinicopathological analysis of early gastric cancer with solitary lymph node metastasis. Br J Surg 2002;89:1435–1437.
15.
Van der Velden J, van Lindert AC, Lammes FB, ten Kate FJ, Sie-Go DM, Oosting H, Heintz AP: Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival. Cancer 1995;75:2885–2890.
16.
Nakamura K, Morisaki T, Noshiro H, Torata N, Kinukawa N, Tanaka M: Morphometric analysis of regional lymph nodes with and without metastasis from early gastric carcinoma. Cancer 2000;88:2438–2442.
17.
Woolgar JA, Rogers SN, Lowe D, Brown JS, Vaughan ED: Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread. Oral Oncol 2003;39:130–137.
18.
Okamoto T, Tsuburaya A, Kameda Y, Yoshikawa T, Cho H, Tsuchida K, Hasegawa S, Noguchi Y: Prognostic value of extracapsular invasion and fibrotic focus in single lymph node metastasis of gastric cancer. Gastric Cancer 2008;11:160–167.
19.
Yasunaga M, Yamasaki F, Tokunaga O, Iwasaka T: Endometrial carcinomas with lymph node involvement: novel histopathologic factors for predicting prognosis. Int J Gynecol Pathol 2003;22:341–346.
20.
Morimoto Y, Kurosawa H, Tanaka T Yamashita Y, Kito S, Okabe S, Takahashi T, Ohba T: Correlation between the incidence of central nodal necrosis in cervical lymph node metastasis and the extent of differentiation in oral squamous cell carcinoma. Dentomaxillofac Radiol 2006;35:18–23.
21.
Liang MT, Chen CCC, Wang CP, Wang CC, Lin WD, Liu SA: The association of lymph node volume with cervical metastatic lesions in head and neck cancer patients. Eur Arch Otorhinolaryngol 2009;266:883–887.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.