Abstract
BackgroundTo investigate the relationship between tumor deposits (TDs) with the clinicopathological characteristics tumor-infiltrating lymphocytes (TILs) and prognosis of gastric cancer. Further analysis was done on the relationship between the number and maximum diameter of TDs with the clinicopathological characteristics and prognosis of gastric cancer.MethodsThe pathological findings of 369 patients with gastric cancer were retrospectively analyzed to observe the expression of TDs and the levels of stromal TILs. The relationship between TDs, clinicopathological characteristics, and levels of stromal TILs was compared using the chi-square test. Kaplan-Meier was used for survival analysis, and the log-rank test was used to determine the relationship between TDs and disease-free survival, cancer-specific survival, and overall survival. The prognostic value of TDs was assessed using multivariate Cox proportional hazards regression analysis. For further analysis, the optimal cutoff values for the number and maximum diameter of TDs were selected based on the receiver operating characteristic (ROC) curve.ResultsTDs were significantly associated with sex, lymphovascular invasion, perineural invasion, pathological T,N stage, and clinical stage (all P < 0.05). TILs levels are lower in TDs(+) group and higher in TDs(−) group. Compared with TDs(−) groups, TDs(+) group had poor disease-free survival, cancer-specific survival, and overall survival. TDs are negatively correlated with TILs, and TILs levels are lower in TDs(+) group and higher in TDs(−) group (P < 0.05). The samples are divided into the number of TDs (< 4 and ≥ 4) and the maximum diameter of TDs (< 7 mm and ≥ 7 mm). The number of TDs was significantly associated with pathological N stage (P < 0.05). The maximum diameter of TDs was significantly correlated with Lauren classification (P < 0.05) .TDs ≥ 4 had lower DFS, CSS, and OS (P < 0.05). The maximum diameter of TDs was not statistically significant with prognosis (P > 0.05).ConclusionTDs are independent prognosis predictors of gastric cancer. In the tumor microenvironment, TDs and TILs interact with each other to regulate the development of gastric cancer, thus affecting gastric cancer prognosis of patients. The number of TDs ≥ 4 has a worse prognosis compared to the number of TDs < 4.
Highlights
Gastric cancer is an important cancer worldwide, with the fourth highest mortality rate [1]
tumor deposits (TDs) were firstly described as colorectal cancer mesenteric satellites in 1935 [4], and according to the American Joint Cancer Committee (AJCC) 8th TNM staging system for colorectal cancer, TDs were clearly defined as discrete tumor nodules within the lymphatic drainage area of primary cancer and without identifiable lymph node tissue or identifiable vascular or neural structures [5]
TDs were significantly associated with sex, lymphovascular invasion (LVI), perineural invasion (PNI), pathological T,N stage, and clinical stage, whereas there was no statistical difference between age, histologic grade, Lauren classification, and mismatch repair gene (MMR) (Table 1)
Summary
Gastric cancer is an important cancer worldwide, with the fourth highest mortality rate [1]. TDs were included in staging treatment because they have been shown to be an independent prognostic factor [6, 7]. TDs have not been included in the pathological staging of gastric cancer due to limited research evidence. A few studies in the literature have found TDs to be strongly associated with a poor prognosis in gastric cancer [2, 8, 9]. This study aimed to investigate the relationship between TDs, TILs, and prognosis, to provide new ideas for the diagnosis and treatment of gastric cancer. To investigate the relationship between tumor deposits (TDs) with the clinicopathological characteristics tumor-infiltrating lymphocytes (TILs) and prognosis of gastric cancer. Further analysis was done on the relationship between the number and maximum diameter of TDs with the clinicopathological characteristics and prognosis of gastric cancer
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