Abstract
BackgroundThe prognostic importance of tumor size in gastric cancer is unclear. This study investigated whether the inclusion of tumor size could improve prognostic accuracy in node-negative gastric cancer.MethodsClinical and pathological data of 492 patients with node-negative gastric cancer who underwent radical surgery in our department from January 1995 to December 2008 were analyzed. The prognostic accuracy of T stage was compared with that of T stage plus tumor size. The ability of tumor size to improve the 95% confidence interval (CI) of postoperative 5-year survival rate in gastric cancer patients was assessed. Different T stages plus tumor size were further analyzed to assess improvements in prognosis.ResultsMean tumor size was 3.79±1.98 cm with a normal distribution. Multivariate analysis showed that tumor size and T stage were independent prognostic factors. Postoperative 5-year survival rate tended to decrease as tumor size increased in 1 cm increments. The addition of tumor size to T stage improved accuracy in predicting 5-year survival by 4.2% (P<0.05), as well as improving the 95% CI of postoperative 5-year survival rate by 3.2–5.1%. The addition of tumor size improved the predictive accuracy of postoperative 5-year survival rate by 3.9% (95% CI 70.4%–91.1%, P = 0.033) in patients with stage T3N0M0 tumors and by 6.5% (95% CI 68.7%–88.4%, P = 0.014) in patients with stage T4aN0M0 tumors.ConclusionsTumor size is an independent prognostic factor for survival in patients with node-negative gastric cancer, as well as improving prognostic accuracy in stage T3/4aN0M0 tumors.
Highlights
Gastric cancer is a common gastrointestinal malignancy in China and the second most common cause of cancer-related deaths worldwide [1,2]
Lymph nodes were meticulously dissected from the en bloc specimens, and the classification of the dissected lymph nodes was determined by specialized surgeons who reviewed the excised specimens after surgery based on the Japanese Classification of Gastric Carcinoma (JCGC) [12]
Receiver operating characteristic (ROC) analysis indicated that a cutoff value of 4.75 cm yielded a sensitivity of 53.9% and a specificity of 73.2% in predicting survival after gastric surgery (AUC = 0.730, 95% confidence interval (CI) 0.573–0.689, P = 0.000) (Fig. 2b)
Summary
Gastric cancer is a common gastrointestinal malignancy in China and the second most common cause of cancer-related deaths worldwide [1,2]. Lymph node metastasis remains one of the most important predictors of survival following curative resection in gastric cancer [3,4,5]. Overall survival is better in patients with node-negative than node-positive gastric cancer, a significant number of the former still develop recurrence [6,7]. Identifying the prognostic factors associated with improved outcomes in patients with node-negative gastric cancer is important. To assess the prognosis impact of tumor size on patient survival, we retrospectively analyzed outcomes in 492 patients with node-negative gastric cancer. The prognostic importance of tumor size in gastric cancer is unclear. This study investigated whether the inclusion of tumor size could improve prognostic accuracy in node-negative gastric cancer
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