BACKGROUND The conventional guidelines to obtain a safe proximal resection margin(PRM)of5-6 cm during advanced gastric cancer(AGC)surgery are still applied by many surgeons across the world.Several recent studies have...BACKGROUND The conventional guidelines to obtain a safe proximal resection margin(PRM)of5-6 cm during advanced gastric cancer(AGC)surgery are still applied by many surgeons across the world.Several recent studies have raised questions regarding the need for such extensive resection,but without reaching consensus.This study was designed to prove that the PRM distance does not affect the prognosis of patients who undergo gastrectomy for AGC.AIM To investigate the influence of the PRM distance on the prognosis of patients who underwent gastrectomy for AGC.METHODS Electronic medical records of 1518 patients who underwent curative gastrectomy for AGC between June 2004 and December 2007 at Asan Medical Center,a tertiary care center in Korea,were reviewed retrospectively for the study.The demographics and clinicopathologic outcomes were compared between patients who underwent surgery with different PRM distances using one-way ANOVA and Fisher’s exact test for continuous and categorical variables,respectively.The influence of PRM on recurrence-free survival and overall survival were analyzed using Kaplan-Meier survival analysis and Cox proportional hazard analysis.RESULTS The median PRM distance was 4.8 cm and 3.5 cm in the distal gastrectomy(DG)and total gastrectomy(TG)groups,respectively.Patient cohorts in the DG and TG groups were subdivided into different groups according to the PRM distance;≤1.0 cm,1.1-3.0 cm,3.1-5.0 cm and>5.0 cm.The DG and TG groups showed nostatistical difference in recurrence rate(23.5%vs 30.6%vs 24.0%vs 24.7%,P=0.765)or local recurrence rate(5.9%vs 6.5%vs 8.4%vs 6.2%,P=0.727)according to the distance of PRM.In both groups,Kalpan-Meier analysis showed no statistical difference in recurrence-free survival(P=0.467 in DG group;P=0.155 in TG group)or overall survival(P=0.503 in DG group;P=0.155 in TG group)according to the PRM distance.Multivariate analysis using Cox proportional hazard model revealed that in both groups,there was no significant difference in recurrence-free survival according to the PRM distance.CONCLUSION The distance of PRM is not a prognostic factor for patients who undergo curative gastrectomy for AGC.展开更多
AIM:To investigate the prognostic impact of metastatic lymph node ratio(rN) on gastric cancer after curative distal gastrectomy.METHODS:A total of 634 gastric cancer patients who underwent curative resection(R0) of ly...AIM:To investigate the prognostic impact of metastatic lymph node ratio(rN) on gastric cancer after curative distal gastrectomy.METHODS:A total of 634 gastric cancer patients who underwent curative resection(R0) of lymph nodes at distal gastrectomy in 1995-2004.Correlations between positive nodes and retrieved nodes,between rN and retrieved nodes,and between rN and negative lymph node(LN) count were analyzed respectively.Prognostic factors were identif ied by univariate and multivariate analyses.Staging accuracy of the pN category(5th UICC/TNM system) and the rN category was compared according to the survival rates of patients.A linear regression model was used to identify the relation between rN and 5-year survival rate of the patients.RESULTS:The number of dissected LNs was related with metastatic LNs but not related with rN.Cox regression analysis showed that depth of invasion,pN and rN category were the independent predictors of survival(P < 0.05).There was a signif icant difference in survival between LN stages classif ied by the rN category or by the pN category(P < 0.05).However,no signif icant difference was found in survival rate between LN stages classif ied by the pN category or by the rN category(P > 0.05).Linear regression model showed a signif icant linear correlation between rN and the 5-year survival rate of gastric cancer patients(β = 0.862,P < 0.001).Pearson's correlation test revealed that negative LN count was negatively correlated with rN(P < 0.001).CONCLUSION:rN category is a better prognostic tool than the 5th UICC pN category for gastric cancer patients after curative distal gastrectomy.Increased negative LN count can reduce rN and improve the survival rate of gastric cancer patients.展开更多
AIM: To characterize patterns of gastric cancer recurrence and patient survival and to identify predictors of early recurrence after surgery.METHODS: Clinicopathological data for 417 consecutive patients who underwent...AIM: To characterize patterns of gastric cancer recurrence and patient survival and to identify predictors of early recurrence after surgery.METHODS: Clinicopathological data for 417 consecutive patients who underwent curative resection for gastric cancer were retrospectively analyzed. Tumor and node status was reclassified according to the 7th edition of the American Joint Committee on Cancer tumor-node-metastasis classification for carcinoma of the stomach. Survival data came from both the patients' follow-up records and telephone followups.Recurrent gastric cancer was diagnosed based on clinical imaging, gastroscopy with biopsy, and/or cytological examination of ascites, or intraoperative findings in patients who underwent reoperation.Predictors of early recurrence were compared in patients with pT1 and pT2-4a stage tumors. Pearson's χ 2 test and Fisher's exact test were used to compare differences between categorical variables. Survival curves were constructed using the Kaplan-Meier method and compared via the log-rank test. Variables identified as potentially important for early recurrence using univariate analysis were determined by multivariate logistic regression analysis.RESULTS: Of 417 gastric cancer patients, 80(19.2%)were diagnosed with early gastric cancer and the remaining 337(80.8%) were diagnosed with locally advanced gastric cancer. After a median follow-up period of 56 mo, 194 patients(46.5%) experiencedrecurrence. The mean time from curative surgery to recurrence in these 194 patients was 24 ± 18 mo(range, 1-84 mo). Additionally, of these 194 patients,129(66.5%) experienced recurrence within 2 years after surgery. There was no significant difference in recurrence patterns between early and late recurrence(P < 0.05 each). For pT1 stage gastric cancer, tumor size(P = 0.011) and pN stage(P = 0.048) were associated with early recurrence of gastric tumors.Patient age, pT stage, pN stage, Lauren histotype,lymphovascular invasion, intraoperative chemotherapy,and postoperative chemotherapy were independent predictors of early recurrence in patients with pT2-4a stage gastric cancer(P < 0.05 each).CONCLUSION: Age, pT stage, pN stage, Lauren histotype, lymphovascular invasion, intraoperative chemotherapy, and postoperative chemotherapy are independent factors influencing early recurrence of pT2-4a stage gastric cancer.展开更多
文摘BACKGROUND The conventional guidelines to obtain a safe proximal resection margin(PRM)of5-6 cm during advanced gastric cancer(AGC)surgery are still applied by many surgeons across the world.Several recent studies have raised questions regarding the need for such extensive resection,but without reaching consensus.This study was designed to prove that the PRM distance does not affect the prognosis of patients who undergo gastrectomy for AGC.AIM To investigate the influence of the PRM distance on the prognosis of patients who underwent gastrectomy for AGC.METHODS Electronic medical records of 1518 patients who underwent curative gastrectomy for AGC between June 2004 and December 2007 at Asan Medical Center,a tertiary care center in Korea,were reviewed retrospectively for the study.The demographics and clinicopathologic outcomes were compared between patients who underwent surgery with different PRM distances using one-way ANOVA and Fisher’s exact test for continuous and categorical variables,respectively.The influence of PRM on recurrence-free survival and overall survival were analyzed using Kaplan-Meier survival analysis and Cox proportional hazard analysis.RESULTS The median PRM distance was 4.8 cm and 3.5 cm in the distal gastrectomy(DG)and total gastrectomy(TG)groups,respectively.Patient cohorts in the DG and TG groups were subdivided into different groups according to the PRM distance;≤1.0 cm,1.1-3.0 cm,3.1-5.0 cm and>5.0 cm.The DG and TG groups showed nostatistical difference in recurrence rate(23.5%vs 30.6%vs 24.0%vs 24.7%,P=0.765)or local recurrence rate(5.9%vs 6.5%vs 8.4%vs 6.2%,P=0.727)according to the distance of PRM.In both groups,Kalpan-Meier analysis showed no statistical difference in recurrence-free survival(P=0.467 in DG group;P=0.155 in TG group)or overall survival(P=0.503 in DG group;P=0.155 in TG group)according to the PRM distance.Multivariate analysis using Cox proportional hazard model revealed that in both groups,there was no significant difference in recurrence-free survival according to the PRM distance.CONCLUSION The distance of PRM is not a prognostic factor for patients who undergo curative gastrectomy for AGC.
文摘AIM:To investigate the prognostic impact of metastatic lymph node ratio(rN) on gastric cancer after curative distal gastrectomy.METHODS:A total of 634 gastric cancer patients who underwent curative resection(R0) of lymph nodes at distal gastrectomy in 1995-2004.Correlations between positive nodes and retrieved nodes,between rN and retrieved nodes,and between rN and negative lymph node(LN) count were analyzed respectively.Prognostic factors were identif ied by univariate and multivariate analyses.Staging accuracy of the pN category(5th UICC/TNM system) and the rN category was compared according to the survival rates of patients.A linear regression model was used to identify the relation between rN and 5-year survival rate of the patients.RESULTS:The number of dissected LNs was related with metastatic LNs but not related with rN.Cox regression analysis showed that depth of invasion,pN and rN category were the independent predictors of survival(P < 0.05).There was a signif icant difference in survival between LN stages classif ied by the rN category or by the pN category(P < 0.05).However,no signif icant difference was found in survival rate between LN stages classif ied by the pN category or by the rN category(P > 0.05).Linear regression model showed a signif icant linear correlation between rN and the 5-year survival rate of gastric cancer patients(β = 0.862,P < 0.001).Pearson's correlation test revealed that negative LN count was negatively correlated with rN(P < 0.001).CONCLUSION:rN category is a better prognostic tool than the 5th UICC pN category for gastric cancer patients after curative distal gastrectomy.Increased negative LN count can reduce rN and improve the survival rate of gastric cancer patients.
基金Supported by the Beijing Municipal Natural Science Foundation,No.7132209Capital Health Research and Development Special Fund,No.2014-3-4014+1 种基金Hubei Province Health and Family Planning Scientific Research Project,No.WJ2015MB137Wuhan City Medical Research Project,No.WX15B14
文摘AIM: To characterize patterns of gastric cancer recurrence and patient survival and to identify predictors of early recurrence after surgery.METHODS: Clinicopathological data for 417 consecutive patients who underwent curative resection for gastric cancer were retrospectively analyzed. Tumor and node status was reclassified according to the 7th edition of the American Joint Committee on Cancer tumor-node-metastasis classification for carcinoma of the stomach. Survival data came from both the patients' follow-up records and telephone followups.Recurrent gastric cancer was diagnosed based on clinical imaging, gastroscopy with biopsy, and/or cytological examination of ascites, or intraoperative findings in patients who underwent reoperation.Predictors of early recurrence were compared in patients with pT1 and pT2-4a stage tumors. Pearson's χ 2 test and Fisher's exact test were used to compare differences between categorical variables. Survival curves were constructed using the Kaplan-Meier method and compared via the log-rank test. Variables identified as potentially important for early recurrence using univariate analysis were determined by multivariate logistic regression analysis.RESULTS: Of 417 gastric cancer patients, 80(19.2%)were diagnosed with early gastric cancer and the remaining 337(80.8%) were diagnosed with locally advanced gastric cancer. After a median follow-up period of 56 mo, 194 patients(46.5%) experiencedrecurrence. The mean time from curative surgery to recurrence in these 194 patients was 24 ± 18 mo(range, 1-84 mo). Additionally, of these 194 patients,129(66.5%) experienced recurrence within 2 years after surgery. There was no significant difference in recurrence patterns between early and late recurrence(P < 0.05 each). For pT1 stage gastric cancer, tumor size(P = 0.011) and pN stage(P = 0.048) were associated with early recurrence of gastric tumors.Patient age, pT stage, pN stage, Lauren histotype,lymphovascular invasion, intraoperative chemotherapy,and postoperative chemotherapy were independent predictors of early recurrence in patients with pT2-4a stage gastric cancer(P < 0.05 each).CONCLUSION: Age, pT stage, pN stage, Lauren histotype, lymphovascular invasion, intraoperative chemotherapy, and postoperative chemotherapy are independent factors influencing early recurrence of pT2-4a stage gastric cancer.
