Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
World J Surg Oncol. 2019 Mar 8;17(1):47. doi: 10.1186/s12957-019-1589-5.
Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. Accordingly, it is important to distinguish between stage III/IV and stage I/II gastric cancer, but clinical staging is less accurate than pathological staging. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer.
We reviewed 2722 patients who underwent gastrectomy at our hospital from January 1996 to December 2015. As pretreatment factors potentially related to tumor stage, we assessed age, sex, tumor markers, tumor diameter, tumor location, tumor histology, and macroscopic type. Factors showing significance on multivariate analysis were used to develop the Clinical Stage Prediction score (CSP score), and a cutoff value for the score was determined by receiver operating characteristics analysis.
According to multivariate analysis, clinical factors associated with stage III/IV disease were elevation of the carcinoembryonic antigen level, tumor diameter ≥ 60 mm, circumferential gastric involvement, esophageal infiltration, mucinous adenocarcinoma, and macroscopic types 2-4. The CSP score was obtained by weighting these factors according to the non-standardized β-coefficient. Receiver operating characteristics analysis indicated that the optimum cutoff value of the CSP score was 17 points. Among 1042 patients with a CSP score ≥ 17 points, 820 patients (78.7%) had stage III/IV gastric cancer. Conversely, among 1680 patients with a CSP score < 17 points, 1547 patients (92.1%) had stage I/II gastric cancer. When discrimination of stage III/IV gastric cancer from stage I/II gastric cancer by the CSP score was assessed, the sensitivity was 78.7%, specificity was 92.1%, positive predictive value was 86.0%, and negative predictive value was 87.5%.
The CSP score can be helpful for differentiating stage III/IV gastric cancer from stage I/II gastric cancer based on pretreatment clinical factors.
化疗联合或不联合手术是 III/IV 期胃癌的一线治疗方法，而手术是 I/II 期胃癌的一线治疗方法。因此，区分 III/IV 期和 I/II 期胃癌非常重要，但临床分期不如病理分期准确。本研究旨在开发一种临床评分系统，以区分 III/IV 期胃癌和 I/II 期胃癌。
我们回顾了 1996 年 1 月至 2015 年 12 月在我院行胃切除术的 2722 例患者。作为可能与肿瘤分期相关的预处理因素，我们评估了年龄、性别、肿瘤标志物、肿瘤直径、肿瘤部位、肿瘤组织学和大体类型。多因素分析显示有统计学意义的因素用于开发临床分期预测评分（CSP 评分），并通过接受者操作特征分析确定评分的截断值。
根据多因素分析，与 III/IV 期疾病相关的临床因素包括癌胚抗原水平升高、肿瘤直径≥60mm、环周胃受累、食管浸润、黏液腺癌和大体类型 2-4。CSP 评分是通过根据非标准化β系数对这些因素进行加权获得的。接受者操作特征分析表明，CSP 评分的最佳截断值为 17 分。在 CSP 评分≥17 分的 1042 例患者中，820 例（78.7%）患有 III/IV 期胃癌。相反，在 CSP 评分<17 分的 1680 例患者中，1547 例（92.1%）患有 I/II 期胃癌。当使用 CSP 评分评估 III/IV 期胃癌与 I/II 期胃癌的鉴别时，敏感性为 78.7%，特异性为 92.1%，阳性预测值为 86.0%，阴性预测值为 87.5%。
CSP 评分可根据术前临床因素有助于区分 III/IV 期胃癌和 I/II 期胃癌。
