Pathological features and survival analysis of gastric cancer patients with positive surgical margins: A large multicenter cohort study

Abstract

ObjectiveTo investigate the factors related to positive surgical margins of gastric cancer and their correlation with the prognosis of these patients. MethodsThe clinicopathological data of gastric cancer patients undergoing gastrectomy were collected, and the relationship between surgical margins status and patient outcome was analyzed. ResultsA total of 10080 patients were included, among which 311 (3.1%) had positive surgical margins. pT3-4, pN+ and M1 were independent risk factors for positive margins, and a tumor in the middle of the stomach was a protective factor (p < 0.05). The 5-year overall survival (OS) rates of the patients with positive and negative margins after propensity score matching (PSM) were 24.2% and 36.8%, respectively (p < 0.001). For M0 patients, the 5-year OS of the margin-positive patients was lower than that of the margin-negative patients, and was higher than that of patients with M1. For the M1 patients, no statistically significant difference in 5-year OS was noted between patients with positive and negative margins. Age, positive margins, tumor location, pN+, and M1 were independent prognostic factors for OS in patients undergoing gastrectomy, and pN2-3 and M1 stages were independent prognostic factors for patients with positive surgical margins. Postoperative chemotherapy could improve the 5-year OS in pN2-3 and M1 margin-positive patients (p < 0.05). ConclusionThe prognosis of M0 gastric cancer patients with positive surgical margins is poor, and it is recommended that these patients should undergo routine intraoperative frozen-section pathological examination to reduce the risk of positive surgical margins.