Abstract
To compare the survival and prognosis after surgical treatment of patients with gastric adenocarcinoma which extends to the muscular layer (T2), and patients whose tumor invades the subserosa (T3). This was a retrospective study of 122 patients with gastric cancer invading the muscularis propria and subserosa, undergoing surgical treatment from January 1997 to December 2008 and followed-up until December 2010. We analyzed demographic, surgical and pathological variables. Of the 122 patients, 22 (18%) were excluded from the final analysis because they showed: positive margin or less than 15 lymph nodes in the surgical specimen, early postoperative mortality and second primary tumors. Among the 100 patients included, 75 had tumors inveding the muscularis propria (T2) and 25 with extension to the subserosa (T3). Overall survival was 83.8%, and 90.6% for T2 and 52.1% or T3. Univariate analysis showed statistical significance in: lymph node metastasis (p = 0.02), tumor size (p = 0.000), tumor pathological stage (p = 0.000), lymph node pathologic stage (p = 0.000) and staging by classification of groups TNM-UICC/AJCC, 2010 (p = 0.000). In multivariate analysis, independent prognostic factors were tumor size and lymph node pathological staging (pN). The lymph node status and tumor size are independent prognostic factors in tumors with invasion of the muscularis propria and in tumors with invasion of subserosa. T2 lesions have smaller size, lower rate of lymph node metastasis and therefore better prognosis than T3.
Highlights
A análise do estadiamento TNM-UICC/AJCC17, 2010, também demonstrou diferença significativa na sobrevivência em cinco anos, de acordo com os grupos de estádios
To compare the survival and prognosis after surgical treatment of patients with gastric adenocarcinoma which extends to the muscular layer (T2), and patients whose tumor invades the subserosa (T3)
Sarela et al.[22] também encontraram diferença significativa na sobrevivência entre T2 e T3 (64% vs. 46%, p=0,005), entretanto, quando o estadiamento linfonodal era adequado, com mais de 15 linfonodos ressecados, os autores encontraram resultados diferentes: a sobrevivência nos pacientes N0 foi semelhante no T2 e T3 (90% vs. 86%, p=0,8) e nos do N1, a sobrevivência não foi significativamente diferente no T2 e T3 (56% vs. 44%, p=0,3)
Summary
O tumor que invade as camadas mucosa e submucosa (T1), independente do comprometimento linfonodal, é classificado como câncer gástrico precoce (CGP), com sobrevivência em cinco anos de 93,5% dos pacientes operados, sendo de 72,8% naqueles com linfonodos positivos, e de 95,6%, quando não há metástases linfonodais. Os fatores prognósticos associados à sobrevivência foram o tamanho do tumor (p=0,000), a invasão do tumor na parede gástrica – pT – (p=0,000), a presença de metástase linfonodal (p=0,02), o número de linfonodos comprometidos – pN – (p=0,000) e o estadiamento por grupo da classificação TNM-UICC/AJCC17 (p=0,000).
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