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Diabetes mellitus promoted Lymph node metastasis in gastric cancer: a 15-year single-institution experience

Chinese Medical Journal 2022年第8期135卷 950-961页

作者： Xinhua Chen Yuehong Chen Tao Li Weiqi Liang Huilin Huang Hongtao Su Chuyang Sui Yanfeng Hu Hao Chen Tian Lin Tao Chen Liying Zhao Hao Liu Guoxin Li Jiang Yu Department of General Surgery&Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor Nanfang HospitalThe First School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdong 510515China

Background: Previous studies have revealed that diabetes mellitus (DM) promotes disease progress of gastric cancer (GC). This study aimed to further investigating whether DM advanced Lymph nodes (LNs) metastasis in GC.Methods: The clinicopathologic data of GC patients with >15 examined LN (ELN) between October 2004 and December 2019 from a prospectively maintained database were included. The observational outcomes included the number (N3b status) and anatomical distribution (N3 stations) of metastatic LN (MLN).Results: A total of 2142 eligible patients were included in the study between October 2004 and December 2019. N3 stations metastasis (26.8% in DMvs. 19.3% in non-DM,P = 0.026) and N3b status (18.8% in DMvs. 12.8% in non-DM,P = 0.039) were more advanced in the DM group, and multivariate logistic regression analyses confirmed that DM was an independent factor of developing N3 stations metastasis (odds ratio [OR] = 1.771,P= 0.011) and N3b status (OR= 1.752,P= 0.028). Also, multivariate analyses determined DM was independently associated with more MLN (β = 1.424,P = 0.047). The preponderance of N3 stations metastasis (DMvs. non-DM, T1-2: 2.2%vs. 4.9%, T3: 29.0%vs. 20.3%, T4a: 38.9%vs. 25.8%, T4b: 50.0%vs. 36.6%;ELN16-29: 8.6%vs. 10.4%, ELN30-44: 27.9%vs. 20.5%, ELN ≥ 45: 37.7%vs. 25.3%), N3b status (DMvs. non-DM, T1-2: 0%vs. 1.7%, T3: 16.1%vs. 5.1%, T4a: 27.8%vs. 19.1%, T4b: 44.0%vs. 28.0%;ELN16-29: 8.6%vs. 7.9%, ELN30-44: 18.0%vs. 11.8%, ELN ≥ 45: 26.4%vs. 17.3%), and the number of MLN (DMvs. non-DM, T1-2: 0.4vs. 1.1, T3: 8.6vs. 5.2, T4a: 9.7vs. 8.6, T4b: 17.0vs. 12.8;ELN16-29: 3.6vs. 4.6, ELN30-44: 5.8vs. 5.5, ELN ≥ 45: 12.0vs. 7.7) of DM group increased with the advancement of primary tumor depth stage and raising of ELN.Conclusions: DM was an independent risk factor for promoting LN metastasis. The preponderance of LN involvement in the DM group was aggravated with the advancement of tumor depth.

关键词： Diabetes mellitus Gastric cancer Lymph node Metastasis

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Comparisons of minimally invasive esophagectomy and open esophagectomy in Lymph node metastasis/dissection for thoracic esophageal cancer

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Chinese Medical Journal 2022年第20期135卷 2446-2452页

作者： Zhenhua Li Chunyue Gai Yuefeng Zhang Shiwang Wen Huilai Lv Yanzhao Xu Chao Huang Bo Zhao Ziqiang Tian Department of Thoracic Surgery the Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China Department of Medical Iconography the Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China

Background:The study aimed to clarify the characteristics of Lymph node metastasis(LNM)and to compare the oncologic outcomes of minimally invasive esophagectomy(MIE)with open esophagectomy(OE)in terms of Lymph node dissection(LND)in thoracic esophageal cancer patients.Methods:The data from esophageal cancer patients who underwent MIE or OE from January 2016 to January 2019 were retrospectively reviewed.The characteristics of LNM in thoracic esophageal cancer were discussed,and the differences in numbers of LND,LND rate,and LNM rate/degree of upper mediastinum between MIE and OE were compared.Results:For overall characteristics of LNM in 249 included patients,the highest rate of LNM was found in upper mediastinum,while LNM rate in middle and lower mediastinum,and abdomen increased with the tumor site moving down.The patients were divided into MIE(n=204)and OE groups(n=45).In terms of number of LND,there were significant differences in upper mediastinum between MIE and OE groups(8[5,11]vs.5[3,8],PLymph node showed there was no significant difference except the subgroup of upper mediastinal 2L and 4L group(3[1,5]vs.0[0,2],PLymph node showed that there was no significant difference except 2L group(11.1%[5/45]vs.38.1%[8/21],P=0.025).The LNM degree of OE group was significantly higher than that of MIE group(27.2%[47/173]vs.7.6%[32/419],P<0.001),and the comparative analysis of regional LNM degree showed that there was no significant difference except 2L(34.7%[17/49]vs.7.7%[13/169],P<0.001)and 4L(23.8%[5/21]vs.3.9%[2/51],P=0.031)subgroups.Conclusion:MIE may have an advantage in LND of upper mediastinum 2L and 4L groups,while it was similar to OE

关键词： Esophageal neoplasms Lymph node Minimally invasive esophagectomy Open esophagectomy

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Nomogram for predicting axillary Lymph node pathological response in node-positive breast cancer patients after neoadjuvant chemotherapy

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Chinese Medical Journal 2022年第3期135卷 333-340页

作者： Wenyan Wang Xin Wang Jiaqi Liu Qiang Zhu Xiang Wang Pilin Wang Department of Breast Surgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China Department of Breast Surgical Oncology National Cancer Center/Cancer Hospital of Chinese Academy of Medical SciencesBeijing 100021China

Background:Pathological complete response(pCR)of axillary Lymph nodes(ALNs)is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy(NAC),and ALN status is an important prognostic factor for breast cancer patients.This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.Methods:This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences.We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR.A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients.The adjusted area under the receiver operating characteristic curve(AUC)was calculated to quantify the ability to rank patients by risk.Internal validation was performed using the 50/50 hold-out validation method.The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.Results:In this retrospective study,115(24.6%)patients achieved ALN pCR after NAC.Multivariate analysis showed that clinical tumor stage(Odds ratio[OR]:0.321,95%confidence interval[CI]:0.121-0.856;P=0.023);primary tumor response(OR:0.189;95%CI:0.123-0.292;P<0.001),and estrogen receptor status(OR:0.530,95%CI:0.304-0.925;P=0.025)were independent predictors of ALN pCR.The nomogram was constructed based on the result of multivariate analysis.In the internal validation of performance of nomogram,the AUCs for the training and test sets were 0.719 and 0.753,respectively.The nomogram was validated in external cohorts with AUCs of 0.720,which demonstrated good discriminatory power in these data sets.Conclusion:We developed a nomogram to predict the likel

关键词： Breast cancer Neoadjuvant chemotherapy Lymph node Pathological response Nomogram

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Current status of Lymph node dissection in gastric cancer

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Chinese Journal of Cancer Research 2021年第2期33卷 193-202页

作者： Bin Ke Han Liang Department of Gastric Cancer Tianjin Medical University Cancer Institute and HospitalTianjin Key Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerNational Clinical Research Center for CancerTianjin 300060China

Gastrectomy with Lymph node(LN)dissection has been regarded as the standard surgery for gastric cancer(GC),however,the rational extent of lymphadenectomy remains controversial.Though gastrectomy with extended lymphadenectomy beyond D2 is classified as a non-standard gastrectomy,its clinical significance has been evaluated in many studies.Although hard evidence is lacking,D2 plus superior mesenteric vein(No.14 v)LN dissection is recommended when harbor metastasis to No.6 nodes is suspected in the lower stomach,and dissection of splenic hilar(No.10)LN can be performed for advanced GC invading the greater curvature of the upper stomach,and D2 plus posterior surface of the pancreatic head(No.13)LN dissection may be an option in a potentially curative gastrectomy for cancer invading the duodenum.Prophylactic D2+para-aortic nodal dissection(PAND)was not routinely recommended for advanced GC patients,but therapeutic D2 plus PAND may offer a chance of cure in selected patients,preoperative chemotherapy was considered as the standard treatment for GC with para-aortic node metastasis.There has been no consensus on the extent of lymphadenectomy for the adenocarcinoma of the esophagogastric junction(AEG)so far.The length of esophageal invasion can be used as a reference point for mediastinal LN metastases,and the distance from the esophagogastric junction to the distal end of the tumor is essential for determining the optimal extent of resection.The quality of lymphadenectomy may influence prognosis in GC patients.Both hospital volume and surgeon volume were important factors for the quality of radical gastrectomy.Centralization of GC surgery may be needed to improve prognosis.

关键词： Gastric cancer lymphadenectomy Lymph node prognosis

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Predictive value of E-cadherin and Ep CAM for detection of metastatic Lymph node in early gastric cancer

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Chinese Journal of Cancer Research 2020年第5期32卷 614-620页

作者： Bang Wool Eom Keun Won Ryu Hong Man Yoon Myeong-Cherl Kook Center for Gastric Cancer National Cancer CenterGoyang-si 10408Republic of Korea

Objective:There has been a demand for a tumor-specific marker for metastatic Lymph nodes in sentinel navigation surgery for gastric cancer.The aim of this study is to analyze protein expression in both primary tumors and metastatic Lymph nodes in early gastric cancer patients.Methods:We collected primary tumors and metastatic Lymph nodes from 71 patients who underwent curative gastrectomy and pathologically diagnosed with T1 N1 or T1 N2(8 th Union for International Cancer Control 8 th edition/American Joint Committee on Cancer staging system)gastric cancer.Immunohistochemistry was used to determine the expression of six cell membrane proteins,including carcinoembryonic antigen(CEA),E-cadherin,epithelial cell adhesion molecule(Ep CAM),P-cadherin,CD44 v6,and c-erb B2 in the patient samples.Results:The expression of CEA,E-cadherin,Ep CAM,P-cadherin,CD44 v6 and c-erb B2 in the evaluable primary tumor samples was 75.4%,97.1%,100%,89.9%,11.1%and 7.2%,respectively.Among cases wherein both the primary tumor and metastatic Lymph nodes were evaluable,double positivity(expression in both primary tumor and metastatic Lymph nodes)was observed for CEA,E-cadherin,Ep CAM,P-cadherin,CD44 v6 and c-erb B2 in 53.2%,97.9%,98.1%,76.6%,0 and 6.8%of the cases,respectively.The proportion of metastatic Lymph nodes positive for CEA,E-cadherin,Ep CAM,P-cadherin,CD44 v6 and c-erb B2 was 71.4%,100%,98.1%,83.7%,0,and75%,respectively in primary tumors positive for the same markers.Conclusions:E-cadherin and Ep CAM had an overlap of 100%and 98.1%between the primary tumor and metastatic Lymph nodes,respectively.Thus,E-cadherin and Ep CAM are potential molecular markers to detect metastatic Lymph nodes in patients with early gastric cancer.

关键词： Gastric cancer tumor-associated protein E-cadherin EpCAM Lymph node

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Orchestrating antigen delivery and presentation efficiency in Lymph node by nanoparticle shape for immune response

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药学学报:英文版 2023年第9期13卷 3892-3905页

作者： Hongjuan Zhao Yatong Li Beibei Zhao Cuixia Zheng Mengya Niu Qingling Song Xinxin Liu Qianhua Feng Zhenzhong Zhang Lei Wang School of Pharmaceutical Sciences Zhengzhou UniversityZhengzhou 450001China Luoyang Central Hospital Affiliated to Zhengzhou University Luoyang 471009China Key Laboratory of Advanced Pharmaceutical Technology Ministry of Education of ChinaZhengzhou UniversityZhengzhou 450001China Biotherapy Center the First Affiliated Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhou 450052China Tumor Immunity and Biomaterials Advanced Medical Center Zhengzhou UniversityLuoyang 471009China

Activating humoral and cellular immunity in Lymph nodes(LNs)of nanoparticle-based vaccines is critical to controlling tumors.However,how the physical properties of nanovaccine carriers orchestrate antigen capture,lymphatic delivery,antigen presentation and immune response in LNs is largely unclear.Here,we manufactured gold nanoparticles(AuNPs)with the same size but different shapes(cages,rods,and stars),and loaded tumor antigen as nanovaccines to explore their disparate characters on above four areas.Results revealed that star-shaped AuNPs captured and retained more repetitive antigen epitopes.On lymphatic delivery,both rods and star-shaped nanovaccines mainly drain into the LN follicles region while cage-shaped showed stronger paracortex retention.A surprising finding is that the star-shaped nanovaccines elicited potent humoral immunity,which is mediated by CD4^(+)T helper cell and follicle B cell cooperation significantly preventing tumor growth in the prophylactic study.Interestingly,cage-shaped nanovaccines preferentially presented peptide-MHC I complexes to evoke robust CD8^(+)T cell immunity and showed the strongest therapeutic efficacy when combined with the PD-1 checkpoint inhibitor in established tumor study.These results highlight the importance of nanoparticle shape on antigen delivery and presentation for immune response in LNs,and our findings support the notion that different design strategies are required for prophylactic and therapeutic vaccines.

关键词： Nanovaccines Nanoparticle shape Lymph node Antigen capture lymphatic delivery Antigen presentation Humoral immunity Cellular immunity

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Validation of clinical significance of examined Lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the American Joint Committee on Cancer(AJCC) TNM staging system

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Chinese Journal of Cancer Research 2018年第5期30卷 477-491页

作者： Jingyu Deng Jinyuan Liu Wei Wang Zhe Sun Zhenning Wang Zhiwei Zhou Huimian Xu Han Liang Department of Gastric Cancer Tianjin Medical University Cancer Institute & Hospital National Clinical Research Center of Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin's Clinical Research Cancer for Cancer Department of Gastric and Pancreatic Surgery Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Department of Surgical Oncology the First Affiliated Hospital of China Medical University

Objective： To validate the necessity of increasing the examined Lymph node （ELN） count for enhancing the accuracy of prognostic evaluation of gastric cancer （GC） patients after curative gastrectomy in multiple medical centers of China.Methods： The clinicopathological data of 7,620 patients who underwent the curative resection for GC between 2001 and 2011 were included to demonstrate whether the ELN count is indispensable for enhancing the accuracy of prognostic evaluation of GC patients after surgery. After a meticulous stratification by using the cut-point survival analysis, all included 7,620 patients were allocated into three groups as： less than 16 （〈16）, between 16 and 30 （16-30）, and more than 30 （〉30） ELNs. Survival differences among various subgroups of GC patients were analyzed to assess the impact of the ELN count on the stage migration in accordance with the overall survival （OS） of GC patients.Results： Survival analyses revealed that the ELN count was positively correlated with the OS （P：0.001） and was an independent prognostic predictor （P〈0.01） of 7,620 GC patients. Stratum analysis showed that the accuracy of prognostic evaluation could be enhanced when the ELN count was no less than 16 （≥16） for node-negative patients and 〉30 for node-positive patients. Stage migrations were mainly detected in the various subgroups of patients with specific pN stages as follows： pN0 with 16-30 ELNs （pN016-30） and pN0 with 〉30 ELNs （pN0〉30）, pN0 with 〈16 ELNs （pN0〈16） and pNl〉30, pNl〈l6 and pN216_30, pNl：6_30 and pN2〉30, pN3a〈l6 and pN3b16-30, and pN3a〈16 and pN3 b〉30. These findings indicate that increasing the ELN count is a prerequisite to guarantee precisely prognostic evaluation of GC patients.Conclusions： The ELN count should be proposed to be 〉30 for acquiring the accurate prognostic evaluadort for GC patients, especially for node-positive patients.

关键词： Stomach neoplasm Lymph node metastasis prognosis

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18F-prostate specific membrane antigen positron emission tomography/computerized tomography for Lymph node staging in medium/high risk prostate cancer: A systematic review and meta-analysis

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中华医学杂志(英文版) 2024年第8期137卷 949-958页

作者： Lv Zhengtong Song Liuqi Wang Miao Hou Huimin Li Haodong Wang Xuan Wang Jianye Wang Jianlong Liu Ming Beijing 100029 Department of Urology Beijing Hospital 3. National Center of Gerontology 4. Institute of Geriatric Medicine 5. Chinese Academy of Medical Sciences 6. Beijing 100730 7. China Peking University Fifth School of Clinical Medicine Peking University China-Japan Friendship School of Clinical Medicine

Background: Lymph node staging of prostate cancer (PCa) is important for planning and monitoring of treatment.18F-prostate specific membrane antigen positron emission tomography/computerized tomography (18F-PSMA PET/CT) has several advantages over68Ga-PSMA PET/CT, but its diagnostic value requires further investigation. This meta-analysis focused on establishing the diagnostic utility of18F-PSMA PET/CT for Lymph node staging in medium/high-risk PCa.Methods: We searched the EMBASE, PubMed, Cochrane library, and Web of Science databases from inception to October 1, 2022. Prostate cancer,18F, Lymph node, PSMA, and PET/CT were used as search terms and the language was limited to English. We additionally performed a manual search using the reference lists of key articles. Patients and study characteristics were extracted and the QUADAS-2 tool was employed to evaluate the quality of included studies. Sensitivity, specificity, the positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and 95% confidence interval (CI) were used to evaluate the diagnostic value of18F-PSMA PET/CT. Stata 17 software was employed for calculation and statistical analyses.Results: A total of eight diagnostic tests including 734 individual samples and 6346 Lymph nodes were included in this meta-analysis. At the patient level, the results of each consolidated summary were as follows: sensitivity of 0.57 (95% CI 0.39-0.73), specificity of 0.95 (95% CI 0.92-0.97), PLR of 11.2 (95% CI 6.6-19.0), NLR of 0.46 (95% CI 0.31-0.68), DOR of 25 (95% CI 11-54), and AUC of 0.94 (95% CI 0.92-0.96). At the lesion level, the results of each consolidated summary were as follows: sensitivity of 0.40 (95% CI 0.21-0.62), specificity of 0.99 (95% CI 0.95-1.00), PLR of 40.0 (95% CI 9.1-176.3), NLR of 0.61 (95% CI 0.42-0.87), DOR of 66 (95% CI 14-311), and AUC of 0.86 (95% CI 0.83-0.89).Conclusions: 18F-PSMA PET/CT showed moderate sensitivity but high specificity in Lymph node staging of medium/high-risk PCa. The

关键词： 18F-PSMA PET/CT Diagnostic test Lymph node Meta-analysis Prostate cancer

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胃癌及其淋巴结转移的诊断学分子标志物的鉴定

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Gastroenterology Report 2019年第1期7卷 57-66,I0002页

作者： Sharvesh Raj Seeruttun Wing Yan Cheung Wei Wang Cheng Fang Zhi-Min Liu Jin-Qing Li Ting Wu Jun Wang Chun Liang Zhi-Wei Zhou Department of Gastric Surgery Sun Yat-sen University Cancer CenterGuangzhouGuangdong 510060P.R.China State Key Laboratory of Oncology in South China GuangzhouGuangdong 510060P.R.China Collaborative Innovation Center for Cancer Medicine GuangzhouGuangdong 510060P.R.China Division of Life Science Center for Cancer Research and State Key Lab for Molecular NeuroscienceHong Kong University of Science and TechnologyHong KongP.R.China Fok Ying Tung Research Institute Hong Kong University of Science and TechnologyHong KongP.R.China Biomedical Research Institute Shenzhen-Peking University-Hong Kong University of Science and Technology Medical CenterShenzhenGuangdong 518036P.R.China

背景与目的:分子标志物是肿瘤快速诊断的重要工具。本研究旨在鉴定可用于临床诊断胃癌及其淋巴结转移的分子标记物。方法:前瞻性收集2014年12月1日至2015年12月31日期间的胃癌手术标本和相应的癌旁正常胃黏膜,以及胃周转移性和非转移性... 详细信息

背景与目的:分子标志物是肿瘤快速诊断的重要工具。本研究旨在鉴定可用于临床诊断胃癌及其淋巴结转移的分子标记物。方法:前瞻性收集2014年12月1日至2015年12月31日期间的胃癌手术标本和相应的癌旁正常胃黏膜,以及胃周转移性和非转移性淋巴结标本,采用实时定量PCR方法对9个目标基因进行定量检测。采用相对表达量来计算目标基因的mRNA表达水平。采用单因素方差分析(ANOVA)和Tukey多重比较检验来进行统计学比较,采用GraphPad Prism软件绘制统计分析图。结果:在9个受检基因中,INHBA和SPP1在胃癌组织中稳定高表达,其mRNA表达水平分别是相应癌旁胃黏膜的15.4和15.6倍(P<0.001);前者诊断胃癌的敏感性和特异性分别为91.3%和95.7%(ROC曲线下面积0.974),后者的敏感性和特异性分别为82.6%和87.0%(ROC曲线下面积0.924)。进一步分析转移性与非转移性淋巴结组织中上述两个基因的表达差异,结果显示,SPP1 mRNA表达水平两者差异无统计学意义(P=0.470),而转移性淋巴结中INHBA mRNA表达水平上调了4.1倍(P<0.001),其诊断淋巴结转移的敏感性和特异性分别为80.0%和81.5%(ROC曲线下面积0.857),而且能有效区别更严重的肿瘤进展,如T3与T4(P=0.003)、M0与M1(P=0.043),以及不同的组织学类型,如肠型与弥漫型(P=0.019)。结论:INHBA是用于诊断胃癌及其淋巴结转移的一种理想的分子标志物。

关键词： Diagnosis gastric cancer Lymph node metastasis molecular biomarker

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Assessment of programmed death-ligand 1 expression in primary tumors and paired Lymph node metastases of gastric adenocarcinoma

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 883-893页

作者： Brendha Cação Coimbra Marina Alessandra Pereira Leonardo Cardili Venancio Avancini Ferreira Alves Evandro Sobroza de Mello Ulysses Ribeiro Jr Marcus Fernando Kodama Pertille Ramos Department of Gastroenterology Instituto do CancerHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloFaculdade de MedicinaUniversidade de São PauloSão Paulo 01246000Brazil Department of Pathology Instituto do CancerHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 01246000Brazil

BACKGROUND Anti-programmed death-1/programmed death-ligand 1(PD-1/PD-L1)immuno-therapy has demonstrated promising results on gastric cancer(GC).However,PD-L1 can express differently between metastatic sites and primary tumors(PT).AIM To compare PD-L1 status in PT and matched Lymph node metastases(LNM)of GC patients and to determine the correlation between the PD-L1 status and clinicopathological characteristics.METHODS We retrospectively reviewed 284 GC patients who underwent D2-gastrectomy.PD-L1 was evaluated by immunohistochemistry(clone SP142)using the com-bined positive score.All PD-L1+PT staged as pN+were also tested for PD-L1 expression in their LNM.PD-L1(-)GC with pN+served as the comparison group.RESULTS Among 284 GC patients included,45 had PD-L1+PT and 24 of them had pN+.For comparison,44 PD-L1(-)cases with pN+were included(sample loss of 4 cases).Of the PD-L1+PT,54.2%(13/24 cases)were also PD-L1+in the LNM.Regarding PD-L1(-)PT,9.1%(4/44)had PD-L1+in the LNM.The agreement between PT and LNM had a kappa value of 0.483.Larger tumor size and moderate/severe peritumoral inflammatory response were associated with PD-L1 positivity in both sites.There was no statistical difference in overall survival for PT and LNM according to the PD-L1 status(P=0.166 and P=0.837,respectively).CONCLUSION Intra-patient heterogeneity in PD-L1 expression was observed between the PT and matched LNM.This disagreement in PD-L1 status may emphasize the importance of considering different tumor sites for analyses to select patients for immunotherapy.

关键词： Gastric cancer Lymph node Programmed death ligand 1 Stomach neoplasms Immunohistochemistry Metastasis

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