Ma Yubo, Zhang Shengjie, Wang Yi, Hu Can, Chen Jinxia, Pang Chuhong, Liang Chen, Yuan Li, Du Yian
The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
J Gastrointest Surg. 2023 Nov;27(11):2352-2364. doi: 10.1007/s11605-023-05853-z. Epub 2023 Oct 17.
Mucinous gastric carcinoma (MGC) is a distinct histologic subtype of gastric cancer (GC) that is often diagnosed at an advanced stage. The clinicopathological characteristics and prognosis of MGC, when compared to adenocarcinoma and signet-ring cell carcinoma (SRCC), are currently subjects of debate and require further investigation.
In this study, we conducted an investigation on 4,417 patients who were hospitalized with GC at Zhejiang Cancer Hospital between April 2008 and December 2019. The objective was to compare the prognosis and clinicopathological characteristics of MGC with other types of GC.
In comparison to adenocarcinoma, MGC patients exhibited more advanced tumor infiltration (p < 0.001), lower tumor differentiation (p < 0.001), and higher rates of preoperative tumor marker positivity (except for AFP and CA125) (all p < 0.05). However, after propensity score matching (PSM) to eliminate confounding factors, MGC patients surprisingly exhibited a better prognosis than adenocarcinoma patients (p = 0.008), and the results in multifactorial COX regression were similar (HR = 0.792, 95% CI 0.629-0.997, p = 0.047). Among patients with MGC, age, pN stage, as well as preoperative levels of CA125 and CA724 (all p < 0.05), emerged as independent prognostic markers. While overall survival did not significantly differ between MGC and SRCC (p = 0.196), significant survival disparities emerged in advanced-stage patients (p = 0.009), with MGC showing better survival rates. Furthermore, a nomogram was developed to predict 1-, 3-, and 5-year survival in gastric cancer patients based on various factors, achieving a C-index of 0.772 (95% CI: 0.745-0.799).
While the poorer prognosis associated with MGC may be linked to its advanced stage and lower degree of differentiation, its biological behavior could contribute to improved survival.
黏液性胃癌（MGC）是胃癌（GC）的一种独特组织学亚型，常于晚期被诊断出来。与腺癌和印戒细胞癌（SRCC）相比，MGC的临床病理特征及预后目前仍存在争议，需要进一步研究。
在本研究中，我们对2008年4月至2019年12月期间在浙江省肿瘤医院住院的4417例GC患者进行了调查。目的是比较MGC与其他类型GC的预后及临床病理特征。
与腺癌相比，MGC患者的肿瘤浸润程度更高（p < 0.001），肿瘤分化程度更低（p < 0.001），术前肿瘤标志物阳性率更高（除甲胎蛋白和癌抗原125外）（均p < 0.05）。然而，在进行倾向评分匹配（PSM）以消除混杂因素后，MGC患者的预后出人意料地优于腺癌患者（p = 0.008），多因素COX回归结果相似（风险比=0.792，95%置信区间0.629 - 0.997，p = 0.047）。在MGC患者中，年龄、pN分期以及术前癌抗原125和癌抗原724水平（均p < 0.05）是独立的预后标志物。虽然MGC和SRCC的总生存期无显著差异（p = 0.196），但在晚期患者中出现了显著的生存差异（p = 0.009），MGC的生存率更高。此外，基于多种因素开发了一种列线图来预测胃癌患者1年、3年和5年生存率，C指数为0.772（95%置信区间：0.745 - 0.799）。
虽然MGC预后较差可能与其晚期阶段和较低分化程度有关，但其生物学行为可能有助于提高生存率。
