Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Eur J Surg Oncol. 2018 Dec;44(12):1990-1996. doi: 10.1016/j.ejso.2018.10.062. Epub 2018 Oct 20.
The aim of this study was to investigate the prognostic value of tumor deposits (TDs) in patients with gastric cancer after radical gastrectomy.
We retrospectively reviewed 1518 patients who had undergone radical gastrectomy in Zhongshan Hospital between 2003 and 2011. Correlations between TDs and other clinicopathological characteristics were analyzed. Univariate and multivariate analysis of prognostic factors were conducted. The predictive ability of different staging systems incorporating TDs were evaluated.
The presence of TDs was found in 193 (13%) specimens. Large tumor size, proximal part, poor differentiated histology, advanced T stage, advanced N stage, lymphovascular invasion and perineural invasion were more common for patients with TDs. The Kaplan-Meier survival analysis revealed that survival of patients with TDs was significantly poorer than those without (P < 0.001). Multivariate analysis showed that presence of TDs was an independent prognostic factor for overall survival (hazard ratio (HR) = 1.359, P = 0.001). We proposed a new staging system to incorporate TDs into TNM staging system that the presence of TDs would upstage N stage except for N3b patients. The results of chi-square, AUC, C-index and AIC all showed that our revised scheme was better than the primary system and other schemes.
The presence of TDs is an independent prognostic factor for gastric cancer patients. The TNM staging system would be more effective to predict the prognosis for gastric cancer patients after incorporating TDs using our revised scheme.
本研究旨在探讨胃癌根治性胃切除术后肿瘤沉积物（TDs）的预后价值。
我们回顾性分析了 2003 年至 2011 年间在中山医院接受根治性胃切除术的 1518 例患者。分析了 TDs 与其他临床病理特征之间的关系。进行了单因素和多因素预后因素分析。评估了纳入 TDs 的不同分期系统的预测能力。
在 193 份（13%）标本中发现存在 TDs。TDs 患者的肿瘤较大、位于近端、组织学分化较差、T 分期较晚、N 分期较晚、淋巴管侵犯和神经周围侵犯更为常见。Kaplan-Meier 生存分析显示，存在 TDs 的患者的生存明显差于无 TDs 的患者（P<0.001）。多因素分析表明，TDs 的存在是总生存的独立预后因素（危险比（HR）=1.359，P=0.001）。我们提出了一种新的分期系统，将 TDs 纳入 TNM 分期系统，除了 N3b 患者外，TDs 的存在会使 N 分期升级。卡方检验、AUC、C 指数和 AIC 的结果均表明，我们的修正方案优于原方案和其他方案。
TDs 的存在是胃癌患者的独立预后因素。通过使用我们的修正方案将 TDs 纳入 TNM 分期系统，该系统在预测胃癌患者预后方面将更为有效。
