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Skip lymph node metastasis in gastric cancer: is it skipping or skipped?

 Yoon Young Choi  ;  Ji Yeong An  ;  Ali Guner  ;  Dae Ryong Kang  ;  In Cho  ;  In Gyu Kwon  ;  Hyun Beak Shin  ;  Woo Jin Hyung  ;  Sung Hoon Noh 
 GASTRIC CANCER, Vol.19(1) : 206-215, 2016 
Journal Title
Issue Date
Adult ; Aged ; Female ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymph Nodes/pathology ; Lymphatic Metastasis/pathology* ; Male ; Middle Aged ; Prognosis ; Stomach Neoplasms/mortality* ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery
Gastric cancer ; Prognosis ; Skip metastasis
BACKGROUND: Skip metastasis is the presence of a metastatic lymph node (LN) in an extraperigastric (EP) area without perigastric (PG) involvement. The mechanism and prognosis of skip metastasis are still unknown. The purpose of this study was to scrutinize the clinical significance of skip metastasis in gastric cancer. METHODS: Data were reviewed from 6,025 patients who had undergone gastrectomy for primary gastric cancer. Patients were categorized as a PG-only group when the metastatic LNs were limited to only the PG area, as a PG + EP group if metastatic LNs extended to both the PG area and the EP area, and as a skip group if metastatic LNs were in the EP area but there were no metastatic LNs in the PG area. RESULTS: After we had performed matching, the prognosis of the skip group was worse than that of the PG-only group (adjusted hazard ratio 1.69, 95% confidence interval 1.13-2.54) and was similar to that of the PG + EP group (adjusted hazard ratio: 1.54, 95% confidence interval 0.92-2.59). The number of retrieved LNs was less in the skip group than in the other groups, especially from the PG area (p < 0.001). CONCLUSIONS: The prognosis of the skip group was worse than that of the PG-only group and was similar to that of the PG + EP group when the tumor stage was considered. It is difficult to conclude whether skip metastasis is real skipping of cancer cells or a result of inadequate LN sampling. Further evaluation of LNs in the PG area of the skip group could provide more clues for the mechanism of skip metastasis.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Choi, Yoon Young(최윤영) ORCID logo https://orcid.org/0000-0002-2179-7851
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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