Abstract
BackgroundChemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. Accordingly, it is important to distinguish between stage III/IV and stage I/II gastric cancer, but clinical staging is less accurate than pathological staging. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer.MethodsWe reviewed 2722 patients who underwent gastrectomy at our hospital from January 1996 to December 2015. As pretreatment factors potentially related to tumor stage, we assessed age, sex, tumor markers, tumor diameter, tumor location, tumor histology, and macroscopic type. Factors showing significance on multivariate analysis were used to develop the Clinical Stage Prediction score (CSP score), and a cutoff value for the score was determined by receiver operating characteristics analysis.ResultsAccording to multivariate analysis, clinical factors associated with stage III/IV disease were elevation of the carcinoembryonic antigen level, tumor diameter ≥ 60 mm, circumferential gastric involvement, esophageal infiltration, mucinous adenocarcinoma, and macroscopic types 2–4.The CSP score was obtained by weighting these factors according to the non-standardized β-coefficient. Receiver operating characteristics analysis indicated that the optimum cutoff value of the CSP score was 17 points. Among 1042 patients with a CSP score ≥ 17 points, 820 patients (78.7%) had stage III/IV gastric cancer. Conversely, among 1680 patients with a CSP score < 17 points, 1547 patients (92.1%) had stage I/II gastric cancer. When discrimination of stage III/IV gastric cancer from stage I/II gastric cancer by the CSP score was assessed, the sensitivity was 78.7%, specificity was 92.1%, positive predictive value was 86.0%, and negative predictive value was 87.5%.ConclusionsThe CSP score can be helpful for differentiating stage III/IV gastric cancer from stage I/II gastric cancer based on pretreatment clinical factors.
Highlights
Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer
The depth of tumor invasion is recorded as the T category, lymph node metastasis is recorded as the N category, and the presence/absence and sites of distant metastasis are recoded as the M category
Regarding the influence of tumor extent and location, stage III/IV disease was significantly associated with tumors located on the anterior wall or posterior wall of the stomach, circumferential tumors, tumors in the upper third or middle third of the stomach, and tumors invading the esophagus or duodenum
Summary
Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer. In patients with stage I/II gastric cancer, a good outcome can be achieved by endoscopic resection or standard surgical treatment. Most patients with stage III/IV gastric cancer undergo resection of the primary tumor, the overall survival rate is only 14.9–67.1% [1, 2]. Gastrectomy with postoperative adjuvant chemotherapy is currently the standard treatment for stage III gastric cancer, but preoperative neoadjuvant chemotherapy using more potent anticancer. III/IV gastric cancer could be differentiated from stage I/ II gastric cancer by using the CSP score
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