Abstract
BackgroundAdvanced gastric cancer sometimes causes macroscopic serosal change (MSC) due to direct invasion or inflammation. However, the prognostic significance of MSC remains unclear.MethodsA total of 1410 patients who had been diagnosed with deeper-than-pathological-T2 gastric cancer and undergone R0 gastrectomy with lymph node dissection at the National Cancer Center Hospital during January 2000 and December 2012 were restrospectively reviewed.ResultsMSC was not found in 108 of the 506 patients with pathological T4a (21.3%), whereas it was detected in 250 of the 904 patients with pathological T2-T3 (27.7%). The sensitivity, specificity and accuracy for diagnosing pathological serosa exposed (SE) by MSC were 78.7, 72.3 and 74.6%, respectively. The MSC-positive cases had a worse 5-year overall survival (OS) than the MSC-negative cases in pT3 (72.9% vs. 84.3%, p = 0.001), pT4a (56.2% vs. 73.4%, p = 0.001), pStageIIB (76.0% vs. 88.4%, p = 0.005), pStageIIIA (63.4% vs. 75.6%, p = 0.019), pStageIIIB (53.6% vs. 69.2%, p = 0.029) and pStage IIIC (27.6% vs. 50.0%, p = 0.062). A multivariate analysis showed that MSC was a significant independent predictor for the OS (hazard ratio [HR]: 1.587, 95%CI 1.209–2.083, p = 0.001) along with the tumor depth (HR: 7.742, 95%CI: 2.935–20.421, p < 0.001), nodal status (HR:5.783, 95% CI 3.985–8.391, p < 0.001) and age (HR:2.382, 95%CI: 1.918–2.957, p < 0.001). Peritoneal recurrence rates were higher in the MSC-positive cases than in the MSC-negative cases at each pT stage.ConclusionsIn this study, the MSC was one of the independent prognostic factors in patients with resectable locally advanced gastric cancer.
Highlights
Advanced gastric cancer sometimes causes macroscopic serosal change (MSC) due to direct invasion or inflammation
A multivariate analysis showed that MSC was a significant independent predictor for the overall survival (OS) along with the tumor depth (HR: 7.742, 95%CI: 2.935–20.421, p < 0.001), nodal status (HR:5.783, 95% CI 3.985–8.391, p < 0.001) and age (HR:2.382, 95%CI: 1.918–2.957, p < 0.001)
Such macroscopic serosal change (MSC) is usually consistent with pathological serosa exposed (SE), it is sometimes indicative of pathological subserosa (SS)
Summary
Advanced gastric cancer sometimes causes macroscopic serosal change (MSC) due to direct invasion or inflammation. Surgeons can diagnose tumor invasion exposed to the serosa based on changes in the color or irregularities at the serosal surface of the primary tumor Such macroscopic serosal change (MSC) is usually consistent with pathological serosa exposed (SE), it is sometimes indicative of pathological subserosa (SS). Several previous studies have shown that patients with macroscopic serosal invasion had a worse prognosis than those without such invasion [5, 6] They only showed that patients with pathologically negative but surgically positive serosal invasion had a similar survival to those with pathologically positive serosal invasion. They did not examine the recurrence pattern or deeply discuss the role of MSC. Their study has only about one-third the number of patients compared to our study, and includes D3 dissection, and includes about 32% of R2 resections
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