Year: 2004
Type: letter
Abstract: Operate on My Stomach Cancer?Oh, No-Not You, or Not Yet! TO THE EDITOR: Gastric cancer is more common in men than in women. 1 Interestingly, this applies in all endemic and nonendemic areas, but the reason for this phenomenon remains unclear.Because we do not know the genetic basis for the increased susceptibility of men, one may speculate that female hormones provide some degree of protection; alternatively, do men not expose themselves to more carcinogens (smoking, food, alcohol, and so on) than do women?In a recent article by Kattan et al, 2 they indicate that there were more women (63.5%) than men in their database.I suspect that this is a typographical error; however, if it is not, I wonder about the explanation for this unusual distribution.In their nomogram, the men have a slightly worse prognosis than the women.This is likely due to more frequent proximal localization of the primary in men than in women.Nonetheless, the most important statement in their article is not that the increasing number of metastatic nodes imparts a worse outcome in terms of overall survival (this is well known), but that the lower number of examined nonmetastatic nodes resulted in a poor outcome.The number of examined nonmetastatic nodes was previously recognized as an independent prognostic factor. 3In the nomogram, patients who had zero to 10 examined nonmetastatic nodes incurred more points (thus worse survival time) than those in whom 30 examined nodes were nonmetastatic.Is there not a strong message here?Simply stated, the evidence supports the notion that more nodes one removes, the better off is the patient.In a recent article by Le Voyer et al, 4 it was demonstrated that the number of lymph nodes examined in 3,411 patients undergoing colon cancer surgery was an independent prognostic variable and survival of patients increased as more nodes were examined.Thus, this concept may apply to all gastrointestinal cancers.Most patients in the United States with newly diagnosed, local-regional gastric or gastroesophageal cancer have a cancer that is T3, N Ն 1, or both.An increase in the T stage correlates with an increase in the percentage of N Ն 1 stage. 5,6The more lymph nodes one examines, the more metastatic nodes that are likely to be found. 7,8There is also a strong correlation between the T stage and the frequency of N2 nodal group involvement, as defined by the Japanese classification. 5,7,8Can one make a compelling argu-
Source: Journal of Clinical Oncology
Author: Jaffer A. Ajani
Institution: The University of Texas MD Anderson Cancer Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2109571057