Abstract
Background
Microsatellite instability (MSI) is one of the new groups of molecular divisions of
gastric cancer (GC). The aim of this study was to investigate the pattern of lymph
node metastasis according to MSI status.
Methods
MSI analysis of 361 GC patients with information about lymph node stations was performed
using 5 quasimonomorphic mononucleotide repeats. The metastasis rates for each lymphatic
station was analyzed, combined with clinicopathologic characteristics. Stations were
divided into compartments 1–3 on the basis of Japanese Classification. A median number
(interquartile range, IQR) of 33 (18–50) lymph nodes were removed and analyzed.
Results
N0 status was observed in 53.7% MSI patients, and in 29.7% microsatellite stable (MSS)
(p < 0.001).The median value of involved nodes was 1 in MSI vs. 5 in MSS (p < 0.001).
Furthermore, the number of involved node stations was significantly lower in the MSI
group (p < 0.001). MSS tumors showed a higher propensity to spread to second and third
compartment nodes. In absence of lymphovascular invasion only 3.2% cases demonstrated
positive nodes beyond the first compartment. Skip metastases were seen in 6.1% MSS
patients and 0% MSI (p = 0.011). No difference in the 10-year cancer related survival
among MSI and MSS patients was found, for both those with 1st compartment (p = 0.223)
and with 2nd compartment involvement (p = 0.814).
Conclusions
MSI GC shows a high rate of N0 stage, a lower number of lymph node metastases, and
a less extensive spread to lymph node stations than MSS tumors. These data indicate
that tailored lymphadenectomy may be investigated for these patients.
Keywords
Abbreviations:
MSI (Microsatellite instability), GC (gastric cancer), MSS (microsatellite stable), OS (overall survival), UICC/AJCC (International Union Against Cancer/American Joint Cancer Committee), TNM (tumor node metastasis classification), mLNs (metastatic lymph nodes), PCR (polymerase chain reaction), MSI-L (microsatellite instability with low instability), MSI-H (microsatellite instability with high instability), JGCA (Japanese Gastric Cancer Association), JCOG (Japan Clinical Oncology Group), hMLH1 (human homologue of MLH mismatch repair gene), EGFR (epithelial growth factor receptor), HER-2 (human epidermal growth factor receptor 2), IHC (immunohistochemistry), ITCs (isolated tumor cells)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 13, 2017
Accepted:
September 1,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
