State of regional lymph nodes and prognosis in stomach cancer

Aim. Multiparameter analysis of the state of regional lymph nodes of stomach cancer to reveal prognostic criteria of patients’ 5-year survival.

Methods. The regional lymph nodes removed during surgery for stomach cancer in 170 oncologic patients were studied by means of histologic, immunohistochemical, electron microscopy and morphometric methods. The 5-year survival was calculated by the direct method.

Results. It was revealed that 5-year survival directly depends on the amount of involved lymph nodes. Detection of even single tumor cells in one regional lymph node worsens the prognosis for a patient’s life. The more metastases there are in lymph tissue, the worse the prognosis is. Immunomorphologic reactions and ultrastructural changes are of substantial significance. High 5-year survival was characteristic for hyperplasia of paracortical area with increased number of CD3(+) T-cells, the ultrastructure of which corresponds to activated (immune) lymphocytes, and for sinus histiocytosis as well with increased number of CD68(+) free macrophages in regional lymph nodes with pronounced phagocytic activity. Prognosis is worse in lymphoid follicular hyperplasia with high content of CD20(+) B-cells and plasmocytes. The lowest 5-year survival was accompanied by degenerative sinus histiocytosis, atrophy or sclerolipomatosis transformation of lymphoid tissue with hypoplasia of paracortical area and lymphoid follicles. Under an electron microscope active fibroblasts are seen synthesizing collagen and large number of degenerating cell forms, particularly, lymphocytes.

Conclusion. The 5-year survival of oncologic patients with stomach cancer is determined by the amount of metastatic regional lymph nodes, presence or absence of metastases, their volume in lymphoid tissue, histologic pattern and ultrastructural cell changes; comparative analysis of these criteria allows developing prognostic algorithm.