Abstract
ObjectiveThe purpose of this study was to propose a novel subclassification of pT4 gastric cancers according to the width of serosal changes and to investigate the validity and clinical utility of this subclassification as a predictor of prognosis.MethodsA total of 780 pT4 stage gastric cancer patients classified according to the 7th American Joint Committee on Cancer (AJCC) staging system were reviewed. Clinicopathologic features were compared between patients with narrow serosal changes (nSE), wide serosal changes (wSE) and invasions of adjacent structures (SI). Prognostic factors were evaluated by univariate and multivariate analyses. The 7th AJCC and novel pT4 subclassification were compared for prognostic performance using the linear trend chi-square test, likelihood ratio chi-square test, and Akaike information criterion (AIC) in the Cox regression analysis.ResultsThe appropriate serosa infiltrate cutoff value was 8 cm. Most of the evaluated clinicopathologic features significantly differed between nSE and SI cancers. Only 3 factors were significantly different between wSE and SI cancers. The 5-year survival rates for patients with the novel pT4a and pT4b cancers were 47.2% and 14.52%, respectively, while they were 41.66% and 16.34% for the 7th AJCC pT4a and pT4b cancers, respectively. The novel pT4 subclassification had better discriminatory ability, monotonicity of gradients, and homogeneity and had smaller AIC values compared with the 7th AJCC pT4.ConclusionsIt is reasonable to subclassify pT4 to pT4a (nSE) and pT4b (wSE/SI) because the novel pT4 subclassification had more potential to identify the different prognoses for patients with gastric cancer.
Highlights
The prognosis of patients with gastric cancer continues to improve, it remains the fourth most common malignant tumor and the second leading cause of cancer-related death worldwide [1,2,3]
We hypothesized that tumors with large areas of serosal changes are similar to SI in biological behavior and prognosis and should be subclassified into the same subgroup of the pT4 stage to resolve the contradictions between previous studies
The patients were divided into a narrow serosal changes group and a wide serosal changes group
Summary
The prognosis of patients with gastric cancer continues to improve, it remains the fourth most common malignant tumor and the second leading cause of cancer-related death worldwide [1,2,3]. It is widely accepted that the most important prognostic indicators in gastric cancer are the depth of wall invasion (pT) and the status of lymph node metastasis (pN) [4,5,6]. The TNM classification of gastric cancer is one of the most commonly used staging systems. This system is accepted and maintained by the American Joint Committee on Cancer (AJCC). We hypothesized that tumors with large areas of serosal changes are similar to SI in biological behavior and prognosis and should be subclassified into the same subgroup of the pT4 stage to resolve the contradictions between previous studies
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