Prognostic impact of microscopic positive margin in gastric cancer patients.

BACKGROUND

Complete resection with negative surgical margins has been a long-held surgical philosophy based on the concept that even minimal remaining cancer cells will develop recurrences.

OBJECTIVES

This study investigated the clinical significance of microscopic positive margin on the outcome of patients with gastric cancers.

METHODS

The relationships between the margin status and other clinicopathologic factors were examined in gastric cancer patients undergoing gastrectomy, and then the prognostic impact of the margin status was evaluated by univariate and multivariate analysis.

RESULTS

The microscopic positive margin was identified in 23 patients (2.8%) by standard H&E staining. The positive margin showed a strong correlation significantly with tumor size (P < 0.05). Microscopic positive margin was found to be a significant prognostic factor on univariate analysis (5-year survival rate 51.9% vs. 82.2%, P < 0.0001), as well as multivariate analysis (risk ratio 3.24, 95% CI: 1.24-6.50, P < 0.01). Detailed analysis of margin status demonstrated that patients with positive margin in a deep site and/or in multiple layers showed poor survival.

CONCLUSIONS

Microscopic positive margin was found to be an independent prognostic factor in gastric cancer patients. The status of the surgical margin might provide useful information for selecting additional treatments and performing intensive follow-up.