Abstract
BackgroundPreoperative therapy has gained wide interest in advanced gastric cancer patients due to its potential advantages of improved disease control. Selection of high risk patients based on preoperative staging is crucial to choose the candidates for neoadjuvant therapy.MethodsOur institutional review board approved this retrospective study and waived the requirement for patient consent. We searched 394 advanced gastric cancer patients (pT2-4) who underwent curative resection in 2010 without neoadjuvant therapies. Two abdominal radiologists independently reviewed the preoperative CT including tumor depth on CT (CT-tumor depth), which was categorized as follows: intramural, minimal extramural(<1mm), spiculated extramural(≥1mm) and nodular extramural infiltration. The impact of clinicoradiologic factors on disease recurrence and disease free survival (DFS) was evaluated. Recursive partitioning analysis was performed to suggest prediction models for recurrence.ResultsOf total 394 patients, 86 patients (21.8%) experienced recurrence. Spiculated (≥1mm) and nodular extramural tumor infiltration and CT size of 5-10cm were independent predictors of disease recurrence and significantly associated with worse DFS. Lymph node involvement on CT was not significantly associated with patient outcome. Among patients with same pT4a stage, the recurrence rate rises and DFS gets worse as the extramural tumor infiltration progresses (P < 0.001). The prediction model for recurrence revealed that size and CT-tumor depth were the two major discriminating factors.ConclusionCT-tumor depth and size could be used as independent predictors for prognosis. Preoperative CT can be used for prognostic stratification to select high risk patients for whom neoadjuvant therapies might be considered.
Highlights
Gastric cancer is the third and fifth leading worldwide cause of death in males and females, respectively [1] and is one of the most common cancers in Korea [2]
Selection of high risk patients based on preoperative staging is crucial to choose the candidates for neoadjuvant therapy
computed tomography (CT)-tumor depth and size could be used as independent predictors for prognosis
Summary
Gastric cancer is the third and fifth leading worldwide cause of death in males and females, respectively [1] and is one of the most common cancers in Korea [2]. The only curative treatment for advanced gastric cancer is complete resection of tumors with negative margins (R0 resection) and D2 lymphadenectomy. A significant number of completely resected patients experience tumor recurrence [3, 4]. For locally advanced gastric cancer, perioperative chemotherapy has been established as the standard treatment to overcome high rates of recurrence [5, 6]. Significant evidence has indicated the advantages of neoadjuvant therapies in patients with gastric cancer. Several studies have reported that high R0 resection rate and survival were achieved with neoadjuvant chemotherapy followed by curative surgery [10,11,12]. Preoperative therapy has gained wide interest in advanced gastric cancer patients due to its potential advantages of improved disease control. Selection of high risk patients based on preoperative staging is crucial to choose the candidates for neoadjuvant therapy
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