Luo Jun, Jiang Yuming, Chen Xinhua, Chen Yuehong, Gurung Jhang Lopsang, Mou Tingyu, Zhao Liying, Lyu Guoqing, Li Tuanjie, Li Guoxin, Yu Jiang
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China.
Chin J Cancer Res. 2020 Apr;32(2):186-196. doi: 10.21147/j.issn.1000-9604.2020.02.06.
The proximal margin (PM) distance for distal gastrectomy (DG) of gastric cancer (GC) remains controversial. This study investigated the prognostic value of PM distance for survival outcomes, and aimed to combine clinicopathologic variables associated with survival outcomes after DG with different PM distance for GC into a prediction nomogram.
Patients who underwent radical DG from June 2004 to June 2014 at Department of General Surgery, Nanfang Hospital, Southern Medical University were included. The first endpoints of the prognostic value of PM distance (assessed in 0.5 cm increments) for disease-free survival (DFS) and overall survival (OS) were assessed. Multivariate analysis by Cox proportional hazards regression was performed using the training set, and the nomogram was constructed, patients were chronologically assigned to the training set for dates from June 1, 2004 to January 30, 2012 (n=493) and to the validation set from February 1, 2012 to June 30, 2014 (n=211).
Among 704 patients with pTNM stage I, pTNM stage II, T1-2, T3-4, N0, differentiated type, tumor size ≤5.0 cm, a PM of (2.1-5.0) cm. PM≤2.0 cm showed a statistically significant difference in DFS and OS, while a PM>5.0 cm was not associated with any further improvement in DFS and OS. a PM of 2.1-5.0 cm. In patients with pTNM stage III, N1, N2-3, undifferentiated type, tumor size >5.0 cm, the PM distance was not significantly correlated with DFS and OS between patients with a PM of (2.1-5.0) cm and a PM≤2 cm, or between patients with a PM >5.0 cm and a PM of (2.1-5.0) cm, so there were no significant differences across the three PM groups. In the training set, the C-indexes of DFS and OS, were 0.721 and 0.735, respectively, and in the validation set, the C-indexes of DFS and OS, were 0.752 and 0.751, respectively.
It is necessary to obtain not less than 2.0 cm of PM distance in early-stage disease, while PM distance was not associated with long-term survival in later and more aggressive stages of disease because more advanced GC is a systemic disease. Different types of patients should be considered for removal of an individualized PM distance intra-operatively. We developed a universally applicable prediction model for accurately determining the 1-year, 3-year and 5-year DFS and OS of GC patients according to their preoperative clinicopathologic characteristics and PM distance.
胃癌远端胃切除术（DG）的近端切缘（PM）距离仍存在争议。本研究探讨了PM距离对生存结局的预后价值，旨在将与不同PM距离的胃癌DG术后生存结局相关的临床病理变量整合到一个预测列线图中。
纳入2004年6月至2014年6月在南方医科大学南方医院普通外科接受根治性DG的患者。评估PM距离（以0.5 cm递增）对无病生存期（DFS）和总生存期（OS）预后价值的首要终点。使用训练集进行Cox比例风险回归多变量分析，并构建列线图，按时间顺序将患者分配到2004年6月1日至2012年1月30日的训练集（n = 493）和2012年2月1日至2014年6月30日的验证集（n = 211）。
在704例pTNM I期、pTNM II期、T1 - 2、T3 - 4、N0、分化型、肿瘤大小≤5.0 cm的患者中，PM为（2.1 - 5.0）cm。PM≤2.0 cm在DFS和OS方面显示出统计学显著差异，而PM>5.0 cm与DFS和OS的进一步改善无关。PM为2.1 - 5.0 cm。在pTNM III期、N1、N2 - 3、未分化型、肿瘤大小>5.0 cm的患者中，PM为（2.1 - 5.0）cm的患者与PM≤2 cm的患者之间，或PM>5.0 cm的患者与PM为（2.1 - 5.0）cm的患者之间，PM距离与DFS和OS无显著相关性，因此三个PM组之间无显著差异。在训练集中，DFS和OS的C指数分别为0.721和0.735，在验证集中，DFS和OS的C指数分别为0.752和0.751。
早期疾病需获得不少于2.0 cm的PM距离，而在疾病的晚期和侵袭性更强的阶段，PM距离与长期生存无关，因为更晚期的胃癌是一种全身性疾病。术中应考虑为不同类型的患者切除个体化的PM距离。我们开发了一个普遍适用的预测模型，可根据胃癌患者的术前临床病理特征和PM距离准确确定其1年、3年和5年的DFS和OS。
