Preoperative and intraoperative lymph node staging in gastric cancer with metabolic and functional imaging

• Applicant: Dr. Felix Berlth
• Subject Area: General and Visceral Surgery
• Term: from 2017 to 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 377333553

Gastric cancer is still one of the deadliest cancers worldwide. As long as the patient is diagnosed in a non-metastatic disease, the surgical approach is the basis treatment strategy. The lymph node status is the most significant prognostic factor for a patient undergoing surgery for gastric cancer. Standardized techniques have been developed to perform a radical surgical treatment of the lymph nodes in gastric cancer surgery but the pre- and intraoperative opportunities of visualization of lymph nodes and possible lymph node metastasis are very limited. A technique, being powerful in such matter, could significantly improve patient selection and surgical and multimodal therapy for gastric cancer.In this project, performed in one of the leading centers for gastric cancer surgery, the Gastric Cancer Center, Department of Surgery, Seoul National University Hospital, Seoul, South Korea, the genetic and cellular background of detectable glucose enrichment in a Positron Emission Tomography (18-FDG-PET) in gastric cancer cells is investigated. Therefore, tumor samples of 250 gastric cancer patients, who received 18-FDG-PET preoperatively, are specifically analyzed regarding the expression of all known glucose transporters (GLUT-1 to GLUT-14) in tumor and lymph node metastasis. Further more, a patient derived xenograft (PDX) mouse model, which consists of 65 human cancers being transferred to immunodeficient mice and is analyzed genomewide for DNA/RNA alterations, is used to find correlations between protein expression, genetic profile and glucose enrichment in small-animal PET.Moreover, the “Near Infrared Fluorescence Spectroscopy”, an innovative method to intraoperatively assess the lymphatic drain and lymph nodes is evaluated for gastric cancer. In the beginning of the operation, the tumor site is injected with a fluorescence (Indocyaningreen), which is drained by the lymphatic system and can be detected by a camera system. The pattern of lymphatic specific fluorescence is correlated with the pattern of tumor infiltration and tumor localization in the histopathological report.The results of all investigations are used to create a protocol for patient selection and technical assessment in lymph node staging for gastric cancer. Further more, the results give evidence about the role of glucose transporter in tumor biology and genetic alterations being connected to the expression of those.

• DFG Programme: Research Fellowships
• International Connection: South Korea
• Host: Professor Han-Kwang Yang