Abstract
BackgroundMargin positivity after gastric cancer resection is associated with poorer outcomes. However, the prognostic factors and the choice of postoperative adjuvant treatment of patients with positive margin (PM) after gastrectomy are still being debated.MethodsA single-center, retrospective analysis was conducted for patients with PM after gastrectomy from the China National Cancer Center Gastric Cancer Database (NCCGCDB) from 1998 to 2018. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors of overall survival (OS) and recurrence-free survival (RFS).ResultsA total of 449 patients were included in the study, including 192 (42.8%) in the proximal PM group (PPM), 205 (45.7%) in the distal PM group (DPM), and 52 (11.6%) in the bilateral PM group (BPM). The 3- and 5-year OS rates for the PM patients investigated were 47.5% and 39.3%, respectively, and the 3- and 5-year RFS rates were 60.0% and 53.6%, respectively. Multivariate Cox regression analysis proved total gastrectomy (hazard ratio (HR): 1.783, 95%CI: 1.133–2.805, p = 0.012), pT4 (HR: 5.264, 95%CI: 1.493–18.565, p = 0.01), pN2 (HR: 2.263, 95%CI: 1.164–4.397, p = 0.016), pN3 (HR: 2.327, 95%CI: 1.233–4.393, p = 0.009), and combined resection (HR: 1.952, 95%CI: 1.256–3.034, p = 0.003) to be independent risk factors of OS, and pT3 (HR: 9.257, 95%CI: 1.152–74.386, p = 0.036) and pT4 (HR: 11.361, 95%CI: 1.469–87.847, p = 0.020) to be independent risk factors for RFS. Adjuvant chemotherapy prolonged OS in the PPM group (p = 0.032) and prolonged RFS in the PPM group (p < 0.001) and the DPM group (p = 0.035) compared with surgery alone.ConclusionsAdvanced pathologic stage was associated with poor prognosis, and postoperative adjuvant chemotherapy might be recommended in PM patients after gastrectomy. Still, further prospective trials are warranted to verify and support our conclusions.
Highlights
Gastric cancer (GC) is the fifth most commonly diagnosed cancer and the third leading cause of cancer death worldwide, with more than 1 million new cases and nearly 800,000 deaths annually [1]
A total of 449 patients were included in the study, including 192 (42.8%) in the proximal PM group (PPM) group, 205 (45.7%) in the distal PM group (DPM) group, and 52 (11.6%) in the bilateral PM group (BPM) group
We found that the advanced pathologic stage was associated with poor prognosis, while postoperative adjuvant chemotherapy might prolong the recurrence-free survival (RFS) in Positive resection margin (PM) patients after gastrectomy, especially for patients with PPM and DPM
Summary
Gastric cancer (GC) is the fifth most commonly diagnosed cancer and the third leading cause of cancer death worldwide, with more than 1 million new cases and nearly 800,000 deaths annually [1]. Surgical resection is a potentially curative approach treatment for resectable GC, but recurrence and metastasis are still occurring at high rates [2]. Resection with a negative margin (R0) was verified to be one of the most important prognostic factors for this aggressive tumor [3]. Positive resection margin (PM) includes microscopic (R1) and macroscopic (R2) tumor cells visible on the resection margin [4]. Regardless of improvements in surgical technique and intraoperative frozen section examination, the incidence of PM still reached 1.8%– 5.1% for GC [5]. Due to the low incidence of PM, there is still a lack of adequate research on the clinical features and prognostic factors. Margin positivity after gastric cancer resection is associated with poorer outcomes. The prognostic factors and the choice of postoperative adjuvant treatment of patients with positive margin (PM) after gastrectomy are still being debated
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