Abstract
BackgroundThe relationship between gastric bare area adipose tissues invasion (GBAI) confirmed pathologically and the prognosis of gastric cancer (GC) patients is undefined. Till present, there has not been literature investigating this phenomenon. Here, we aimed at analyzing the implication of GBAI in GC.MethodsThe data of 1822 patients who underwent radical surgery between January 2000 and December 2013 at the Sun Yat-sen University Cancer Center were retrieved. Pathologically, tumor deposits (TDs) located > 5 mm from the leading edge of the primary tumor and the lymph nodes (LNs) station number 1, 2, 7, and 9 were considered GBAI. Kaplan-Meier method, log-rank test, and Cox’s proportional hazards model were employed to analyze.ResultsTwo hundred and five (11.3%) patients were pathologically diagnosed with GBAI, which was more commonly found in proximal or linitis lastica than distal GC (P < 0.001). There was significant difference in 5-year survival between patients with and without GBAI for stages IIB, IIIA, IIIB, and IIIC, respectively (P < 0.009 for IIB, IIIA, and IIIB; P = 0.021 for IIIC). Among the 205 GBAI patients, 61 had detailed radiological follow-up data in which 26 (34.7%) were found to have retroperitoneal infiltration, 27 (36.0%) had peritoneal metastasis, 10 (13.3%) had hematogenous metastasis, 16 (21.3%) had lymphatic metastasis, and 16 (21.3%) had others.ConclusionsGBAI was identified as a predictor of unfavorable prognosis for GC and was more commonly found in the proximal or linitis plastica of the stomach than in distal stomach. Retroperitoneal infiltration was one of the most commonly identified metastatic route for GC associated with GBAI after radical surgery.
Highlights
The latest global cancer statistics showed that gastric cancer (GC) is the sixth most common cancer affecting the global population but still rank third as the leading cause of cancer mortality [1]
We aimed to identify the incidence of gastric bare area adipose tissues invasion (GBAI) in a large cohort of GC and to evaluate its association with the clinicopathological characteristics and prognosis of GC
Eight parameters were significantly associated with the Overall survival (OS) on univariate analyses, namely, age, tumor size, tumor site, vascular invasion, adipose tissues invasion, GBAI, depth of invasion, and nodal status (Table 1)
Summary
The latest global cancer statistics showed that gastric cancer (GC) is the sixth most common cancer affecting the global population but still rank third as the leading cause of cancer mortality [1]. Solely considering the TNM staging system for optimal prognostication may not be reliable as it has been showed that GC patients despite being classified within the same TNM subgroup may still have different survival outcomes, possibly related to tumor heterogeneity [5]. Abundant researches have tried to identify other prognostic factors such as vascular invasion, nerve invasion, adipose connective tissue invasion, ratio of lymph node metastasis, and more, but their global acceptance and application has been limited [6,7,8,9] as their clinical applicability are controversial and yet to be widely validated. We aimed at analyzing the implication of GBAI in GC
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