Hosoda Kei, Yamashita Keishi, Katada Natsuya, Moriya Hiromitsu, Mieno Hiroaki, Sakuramoto Shinichi, Kikuchi Shiro, Watanabe Masahiko
Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan,
Surg Today. 2015 Jan;45(1):68-77. doi: 10.1007/s00595-014-1060-8. Epub 2014 Oct 29.
This study was designed to clarify whether preoperative tumor size is an independent prognostic factor (IPF) for patients with Borrmann type III gastric cancer.
The study group comprised 350 patients with Borrmann type III gastric cancer. We performed a log-rank plot analysis to establish the threshold value of preoperative tumor size for the prediction of overall survival (OS). Factors with P < 0.10 on univariate prognostic analyses for OS were put into a Cox's proportional hazards model to identify the IPFs.
Peritoneal lavage cytology (CY) was the strongest IPF for patients with Borrmann type III gastric cancer (P < 0.0001). We were able to measure the tumor size preoperatively in 135 patients with negative CY results (CY0). The cutoff tumor size for the prediction of OS was 5.3 cm. A Cox's proportional hazards model showed that pathological lymph-node metastasis (P = 0.007) and preoperative tumor size (P = 0.018) were significant IPFs in the CY0 patients. Patients with a preoperative tumor size of <5.3 cm had satisfactory outcomes, with a 5-year OS rate of >80 %.
Preoperative tumor size is an IPF for patients with Borrmann type III gastric cancer and CY0. Thus, preoperative tumor size may be a useful factor for deciding on whether neoadjuvant chemotherapy is indicated.
本研究旨在明确术前肿瘤大小是否为Borrmann III型胃癌患者的独立预后因素（IPF）。
研究组包括350例Borrmann III型胃癌患者。我们进行了对数秩图分析，以确定预测总生存期（OS）的术前肿瘤大小阈值。对OS进行单因素预后分析时P<0.10的因素纳入Cox比例风险模型，以确定IPF。
腹膜灌洗细胞学检查（CY）是Borrmann III型胃癌患者最强的IPF（P<0.0001）。我们能够对135例CY结果为阴性（CY0）的患者术前测量肿瘤大小。预测OS的肿瘤大小临界值为5.3 cm。Cox比例风险模型显示，病理淋巴结转移（P=0.007）和术前肿瘤大小（P=0.018）是CY0患者的重要IPF。术前肿瘤大小<5.3 cm的患者预后良好，5年OS率>80%。
术前肿瘤大小是Borrmann III型胃癌和CY患者的IPF。因此，术前肿瘤大小可能是决定是否需要新辅助化疗的有用因素。
