Yamashita Keishi, Ema Akira, Hosoda Kei, Mieno Hiroaki, Moriya Hiromitsu, Katada Natsuya, Watanabe Masahiko
Keishi Yamashita, Akira Ema, Kei Hosoda, Hiroaki Mieno, Hiromitsu Moriya, Natsuya Katada, Masahiko Watanabe, Department of Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
World J Gastrointest Oncol. 2017 Apr 15;9(4):166-175. doi: 10.4251/wjgo.v9.i4.166.
To evaluate whether a high risk macroscopic appearance (Type IV and giant Type III) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage II/III (pStage II/III) gastric cancer.
One hundred and seventy-two advanced gastric cancer (defined as pT2 or beyond) patients with pStage II/III who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined.
Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival (RFS) (35.7%) and overall survival (OS) (34%) than an average risk appearance ( = 0.0003 and < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13 Japanese Gastric Cancer Association (JGCA) pT ( = 0.01), but not with the 13 JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13 JGCA pStage ( < 0.0001) and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified high-risk macroscopic appearance ( = 0.036, HR = 2.29 for RFS and = 0.021, HR = 2.74 for OS) as an independent prognostic indicator.
A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13 JGCA stage in pStage II/III advanced gastric cancer.
评估高风险宏观表现（IV型和巨大III型）与根治性手术后预后不良是否相关，因为其在病理II/III期（pStage II/III）胃癌中的预后相关性仍不明确。
对172例接受根治性手术加辅助S1化疗的pStage II/III期进展期胃癌（定义为pT2及以上）患者进行评估，研究高风险宏观表现的预后相关性。
通过术前记录的图像回顾性识别具有高风险宏观表现的进展期胃癌。高风险宏观表现的无复发生存期（RFS）（35.7%）和总生存期（OS）（34%）明显差于平均风险表现（分别为P = 0.0003和P < 0.0001）。高风险宏观表现与日本胃癌协会（JGCA）的13个pT分期显著相关（P = 0.01），但与13个JGCA pN分期无关。在RFS和OS的单因素分析中，预后因素包括JGCA的13个pStage分期（P < 0.0001）以及其他临床病理因素，包括宏观表现。对单因素预后因素进行多变量Cox比例风险模型分析，结果显示高风险宏观表现是独立的预后指标（RFS的P = 0.036，HR = 2.29；OS的P = 0.021, HR = 2.74）。
高风险宏观表现与预后不良相关，它可能是pStage II/III期进展期胃癌中独立于JGCA 13分期的预后因素。
