Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China.
Eur J Surg Oncol. 2018 May;44(5):600-606. doi: 10.1016/j.ejso.2018.01.240. Epub 2018 Feb 3.
The status of serosal invasion is often discordance between pathological and intraoperative evaluation. Our study sought to develop a risk-scoring system (RSS) to predict the probability of pT4a for macroscopic serosal invasion (MSI) positive patients and reevaluate the serosal invasion status.
A total of 1301 pT3/pT4a gastric cancer patients with curative surgery were reviewed. We constructed the RSS to predict the probability of pT4a and assigned MSI-positive patients into different risk groups based on the risk scores. The prognostic significance of these risk groups was also evaluated.
Univariate and multivariate analyses identified that tumor location, Lauren type, Borrmann type, tumor size, lymphovascular invasion and pN stage were risk factors related to pT4a. Survival analyses showed that pT3 MSI-positive patients in high-risk group had similar survival with pT4a patients. We incorporated these two groups into one stage and proposed a novel revised-T stage. Two-step multivariate analyses indicated that the revised-T stage showed better prediction ability for prognosis and peritoneal recurrence assessment than original pT stage and MSI status.
In our present study, we developed a RSS to predict the probability of pT4a for MSI-positive patients. Based on our RSS, we proposed a treatment algorithm to reevaluate the tumor invasion for MSI-positive patients in clinical practice. Future studies should include other preoperative predictors to improve the clinical utility of our model.
浆膜侵犯的状态在病理和术中评估之间经常存在不一致。我们的研究旨在开发一种风险评分系统（RSS），以预测宏观浆膜侵犯（MSI）阳性患者发生 pT4a 的概率，并重新评估浆膜侵犯状态。
共回顾了 1301 例接受根治性手术的 pT3/pT4a 胃癌患者。我们构建了 RSS 来预测 pT4a 的概率，并根据风险评分将 MSI 阳性患者分配到不同的风险组。还评估了这些风险组的预后意义。
单因素和多因素分析确定肿瘤位置、Lauren 型、Borrmann 型、肿瘤大小、血管淋巴管侵犯和 pN 分期是与 pT4a 相关的危险因素。生存分析表明，高危组的 pT3 MSI 阳性患者与 pT4a 患者具有相似的生存。我们将这两组合并为一个阶段，并提出了一个新的修订 T 分期。两步多因素分析表明，修订后的 T 分期在预测预后和腹膜复发评估方面优于原始 pT 分期和 MSI 状态。
在本研究中，我们开发了一种 RSS 来预测 MSI 阳性患者发生 pT4a 的概率。基于我们的 RSS，我们提出了一种治疗算法，用于在临床实践中重新评估 MSI 阳性患者的肿瘤侵犯情况。未来的研究应包括其他术前预测因子，以提高我们模型的临床实用性。
