Clinical Value of Extramural and Extranodal Cancer Permeation as a Prognostic Indicator in Patients with Gastric Cancer

Hideto Itoh, Kazuo Hase, Toshiyuki Suganuma, Sohichi Tomimatsu, Hiroyuki Wakiyama, Hitoshi Horii, Tsuyoshi Hayashi, Hiroshi Uchida, Kazushige Okada and Shoichi Yamada

Japan Self Defence Force Central Hospital

Introduction: Tumor nodules without any histological lymph node architecture are often observed in perigastric adipose tissue of gastric cancer specimens. This type of cancer spread is defined as extramural and extranodal cancer permeation (EX). We clarified the clinical value of EX as a prognostic indicator. Methods: Subjects were 275 patients undergoing A or B curative gastrectomy with lymphadenectomy for gastric cancer from 1988 to 1997. We examined surgical specimens microscopically. Results: Of the 275, 78 (28%) showed EX with an average diameter of 3.4mm ranging from 0.2 to 15mm. Higher incidences of EX were significantly associated with tumors with a diameter of 4cm or more, tumors invading the subserosa or deeper, undifferentiated tumor histology, positive lymph node metastasis, and moderate to severe lymphatic permeation. Survival in patients with EX was significantly lower than that in those with tumors negative for EX (p<0.001, 5-year survival 33%vs. 91%). Multivariate analysis using Cox's proportional hazard model revealed that EX was a significant prognostic indicator (p<0.001). Discussion: The presence of EX may indicate such an ominous biological attitude of gastric cancer that it can be a valuable prognostic indicator in gastric cancer patients.

Key words
extramural and extranodal cancer permeation, gastric cancer, lymph node metastasis, prognostic factor

Reprint requests
Hideto Itoh 1-19-6-207 kamiaoki, Kawaguchi, 333-0844 JAPAN

Accepted
May 29, 2002

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