Li Yang, Li Shuo, Liu Lu, Zhang Li-Yu, Wu Di, Xie Tian-Yu, Wang Xin-Xin
Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
World J Gastrointest Oncol. 2023 Sep 15;15(9):1605-1615. doi: 10.4251/wjgo.v15.i9.1605.
The current prognostic significance of perigastric tumor deposits (TDs) in gastric cancer (GC) remains unclear.
To assess the prognostic value of perigastric TDs and put forward a new TNM staging framework involving TDs for primary GC.
This study retrospectively analyzed the pathological data of 6672 patients with GC who underwent gastrectomy or surgery for GC with other diseases from January 1, 2012 to December 31, 2017 at the Chinese PLA General Hospital. According to the presence of perigastric TDs or not, the patients were divided into TD-positive and TD-negative groups by using the method of propensity score matching. The differences between TD-positive and TD-negative patients were analyzed using binary logistic regression modeling. The Kaplan-Meier method was used to plot survival curves. Multivariate Cox regression modeling and the log-rank test were used to analyze the data.
Perigastric TDs were found to be positive in 339 (5.09%) of the 6672 patients with GC, among whom 237 were men (69.91%) and 102 were women (30.09%) (2.32:1). The median age was 59 years (range, 27 to 78 years). Univariate and multivariate survival analyses indicated that TD-positive GC patients had a poorer prognosis than TD-negative patients ( < 0.05). The 1-, 3-, and 5-year overall survival rates of GC patients with TDs were 68.3%, 19.6%, and 11.2%, respectively, and these were significantly poorer than those without TDs of the same stages. There was significant variation in survival according to TD locations among the GC patients ( 0.05). A new TNM staging framework for GC was formulated according to TD location. When TDs appear in the gastric body, the original stages T1, T2, and T3 are classified as T4a with the new framework, and the original stages T4a and T4b both are classified as T4b. When TDs appear in the lesser curvature, the previous stages N0, N1, N2, and N3 now both are classified as N3. When TDs appear in the greater curvature or the distant tissue, the patient should be categorized as having M1. With the new GC staging scheme including TDs, the survival curves of patients in the lower grade TNM stage with TDs were closer to those of patients in the higher grade TNM stage without TDs.
TDs are a poor prognostic factor for patients with primary GC. The location of TDs is associated with the prognosis of patients with primary GC. Accordingly, we developed a new TNM staging framework involving TDs that is more appropriate for patients with primary GC.
目前胃癌（GC）中胃周肿瘤沉积物（TDs）的预后意义仍不明确。
评估胃周TDs的预后价值，并提出一种新的包含TDs的原发性GC的TNM分期框架。
本研究回顾性分析了2012年1月1日至2017年12月31日在中国人民解放军总医院接受胃癌切除术或因胃癌合并其他疾病而接受手术的6672例GC患者的病理数据。根据是否存在胃周TDs，采用倾向评分匹配法将患者分为TD阳性组和TD阴性组。使用二元逻辑回归模型分析TD阳性和TD阴性患者之间的差异。采用Kaplan-Meier法绘制生存曲线。使用多变量Cox回归模型和对数秩检验分析数据。
6672例GC患者中，339例（5.09%）胃周TDs呈阳性，其中男性237例（69.91%），女性102例（30.09%）（男女比例为2.32:1）。中位年龄为59岁（范围27至78岁）。单因素和多因素生存分析表明，TD阳性的GC患者预后比TD阴性患者差（P<0.05）。有TDs的GC患者1年、3年和5年总生存率分别为68.3%、19.6%和11.2%，明显低于相同分期无TDs的患者。GC患者中，根据TD位置的不同，生存率存在显著差异（P<0.05）。根据TD位置制定了一种新的GC的TNM分期框架。当TDs出现在胃体时，新框架下原T1、T2和T3期均归类为T4a，原T4a和T4b期均归类为T4b。当TDs出现在胃小弯时，之前的N0、N1、N2和N3期现在均归类为N3。当TDs出现在胃大弯或远处组织时，患者应归类为M1。在包含TDs的新GC分期方案下，较低TNM分期有TDs的患者的生存曲线更接近较高TNM分期无TDs的患者的生存曲线。
TDs是原发性GC患者的不良预后因素。TDs的位置与原发性GC患者的预后相关。因此，我们制定了一种新的包含TDs的TNM分期框架，该框架更适用于原发性GC患者。
