A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection.
Federico BozzettiG. BonfantiAlberto MorabitoRosaria BufalinoVelio MenottiS AndreolaRoberto DociLeandro Gennari
125
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
This study was done to define the prognostic role of some clinical and pathologic variables in patients with carcinoma of the stomach who underwent a curative subtotal gastrectomy for cancer located at the lower two-thirds of the stomach. An univariate and multivariate analysis, according to Cox's regression model, was retrospectively performed upon 361 patients operated upon at the Istituto Nazionale Tumori of Milan from 1965 to 1979 by a curative subtotal gastrectomy. Data were stored by an IBM 4331 computer. Several factors were taken into consideration: age, sex, site and size of tumor, gross appearance, histologic type, invasion of the gastric wall, nodal status and symptoms. Of six variables selected by the univariate analysis, only four (sex, age, lymph node status and degree of invasion in the gastric wall) were validated by the multivariate evaluation, whereas tumor size and symptoms lost their prognostic relevance. The most important variables were nodal status and the degree of invasion in the gastric wall. The influence of age had a different impact on survival time, depending upon nodal status. In fact, patients with positive nodes who were less than 60 years old had the worst prognosis; the same age group with negative nodes had the best prognosis. Multifactorial analysis, according to the automatic interaction detection procedure, showed that prognosis worsened progressively beginning with female patients with negative nodes at pT1 or pT2 (91.6 per cent five year survival rate), male patients with negative nodes at pT1 or pT2 (76.3 per cent five year survival rate), female patients with negative nodes at pT3 or pT4 (62.4 per cent), male patients with negative nodes at pT3 or pT4 (40.0 per cent), patients more than 60 years old with negative nodes (36.8 per cent) and patients less than 60 years old with positive nodes (20.8 per cent). In our opinion, these parameters should be taken into consideration when stratification of patients as candidates to undergo adjuvant treatment after surgical treatment is planned.Keywords:
Univariate analysis
Stomach cancer
Gastric carcinoma
Cite
This study was done to define the prognostic role of some clinical and pathologic variables in patients with carcinoma of the stomach who underwent a curative subtotal gastrectomy for cancer located at the lower two-thirds of the stomach. An univariate and multivariate analysis, according to Cox's regression model, was retrospectively performed upon 361 patients operated upon at the Istituto Nazionale Tumori of Milan from 1965 to 1979 by a curative subtotal gastrectomy. Data were stored by an IBM 4331 computer. Several factors were taken into consideration: age, sex, site and size of tumor, gross appearance, histologic type, invasion of the gastric wall, nodal status and symptoms. Of six variables selected by the univariate analysis, only four (sex, age, lymph node status and degree of invasion in the gastric wall) were validated by the multivariate evaluation, whereas tumor size and symptoms lost their prognostic relevance. The most important variables were nodal status and the degree of invasion in the gastric wall. The influence of age had a different impact on survival time, depending upon nodal status. In fact, patients with positive nodes who were less than 60 years old had the worst prognosis; the same age group with negative nodes had the best prognosis. Multifactorial analysis, according to the automatic interaction detection procedure, showed that prognosis worsened progressively beginning with female patients with negative nodes at pT1 or pT2 (91.6 per cent five year survival rate), male patients with negative nodes at pT1 or pT2 (76.3 per cent five year survival rate), female patients with negative nodes at pT3 or pT4 (62.4 per cent), male patients with negative nodes at pT3 or pT4 (40.0 per cent), patients more than 60 years old with negative nodes (36.8 per cent) and patients less than 60 years old with positive nodes (20.8 per cent). In our opinion, these parameters should be taken into consideration when stratification of patients as candidates to undergo adjuvant treatment after surgical treatment is planned.
Univariate analysis
Stomach cancer
Gastric carcinoma
Cite
Citations (125)
Abstract OBJECTIVE: To investigate prognostic significance of n1 and n2 station metastatic lymph node ratio(rN) after distal gastric cancer surgery . METHODS: A total of 408 patients who underwent radical distal gastrectomy (D2) under general anesthesia in 2012-2014. The critical value of rN1 and rN2 were calculated respectively. Prognostic factors were identified by univariate and multivariate analyses. RESULTS: An rN1 of 0.140 and rN2 of 0.100 was found to be the best cut-off value to determine the prognosis of patients with distal gastric cancer (p < 0.001).Univariate and multivariate analysis show that gender, age, nerves invaded, carcinoma nodules, LNS, LNS1, LNS2 were non-prognostic factors.tumor size, depth of invasion,blood vessels invaded,degree of differentiation,rN, PLNS1,rN1, PLNS2, rN2,pTNM were prognostic factors. Among prognostic factors, the partial regression coefficients were, from high to low, pTNM, rN2, rN2, rN. CONCLUSION: RN1 and RN2 is a better prognostic tool for gastric cancer patients after curative distal gastrectomy.which is a beneficial and reliable technique for evaluating lymph node metastasis.
Univariate analysis
Univariate
Gastric carcinoma
Cite
Citations (0)
Background. The influence of DNA content on the prognosis in stomach cancer is controversial. Method. After curative resection of stomach carcinomas (adenocarcinomas [n = 58J]); signet ring cell carcinomas [n = 24J]; undifferentiated carcinomas [n = 21J], the influence of the DNA content and histomorphologic parameters on the prognosis was examined. Results. In the multivariate regression analysis, the prognosis depended on the lymph node status (P = 0.0009), pT stage (P = 0.02), tumor localization (P = 0.03), and histologic type (P = 0.05). The prognosis was independent of the DNA content. Furthermore, the degree of differentiation, operative procedure, safety distance, size of the tumor, and sex and age of the patient also did not influence the prognosis. Conclusions. The DNA content of the tumor cells in stomach carcinoma does not influence prognosis. Cancer 1992; 70:1819–1824.
Stomach cancer
Signet ring cell
Gastric carcinoma
Cite
Citations (10)
Thirty-six cases of a heterochronous cancer in the remnant stomach following a partial gastrectomy for gastric cancer have been compared with 12 cases of gastric cancer following a gastrectomy for benign diseases. Lesions of a heterochronous cancer are characteristically similar to those of a synchronous multiple gastric cancer. Patients with a heterochronous cancer were found to have high rates of synchronous multiple cancers in the resected stomach as compared with none found in gastric cancer patients following surgical operation for a benign disease. Lesions of cancer after surgery for a benign disease when found were mostly in the anastomosis of the remnant stomach. These findings suggest that a heterochronous gastric cancer may develop into lesions of multiple cancers.
Stomach cancer
Cite
Citations (0)
Objective To evaluate negative lymph node count (NLNC) in prediction of prognosis of T3 gastric cancer after radical resection.Method 214 T3 patients of radical gastrectomy with complete clinical and follow-up data between Jan 2003 to Dec 2007 were enrolled.Survival was determined by the Kaplan-Metier method and univariate analysis was done by Log-rank test,Multivariate analysis was performed using the COX proportional hazard regression model.-2loglikelihood value and the hazard ratio (HR) value were used to compared the value of number of lymph node-negative (NLNC) staging and pN staging and lymph node metastasis rate (MLR) in gastric cancer prognosis evaluation.Results Univariate analysis showed that,pN stage (x2 =31.664),MLR stage (x2 =34.123),tumor size (x2 =5.025),type of differentiation (x2 =5.993),Borrmann classification (x2 =5.401),NLNC stage (x2 =37.256) were related to survival (P ＜ 0.05).COX multivariate analysis showed that-2loglikelihood of pN staging is 1 336.761,HR value is 1.464,-2loglikelihood value of MRL staging is 1 335.821,HR value is 1.441.-2loglikelihood value of NLNC staging is 1 326.902,HR value is 1.725.The N0 and N1 staging prognosis in different NLNC staging was significant (P =0.008,P =0.014).Conclusions Sufficient number of negative lymph node prolongs survival and reduces the risk of early recurrence in advanced gastric cancer.
Key words:
Stomach neoplasms; Lymph node excision; Neoplasm metastasis; Prognosis
Univariate analysis
Stomach cancer
Cite
Citations (0)
From 1965 to 1985, 1,150 patients underwent gastrectomy for carcinoma of the stomach invading beyond the submucosa. One thousand, one hundred and forty-one patients were studied for five years or longer. The patients were classified into two groups--those treated from 1965 to 1974 (n = 622) and those treated from 1975 to 1985 (n = 519). In the more recent group, there was a significant increase in the number of patients more than 70 years of age, in the number of female patients, of carcinomas present in the upper two-thirds of the stomach, in tumors exceeding 10 centimeters and diffusely infiltrative type and in early cancer-simulating type of advanced carcinoma in gross appearance and in undifferentiated type adenocarcinomas in histology. Although differences in the incidence of patients treated by radical procedures, such as extensive lymph node dissection and combined resection of adjacent organs, were not statistically significant, the incidence for those who underwent total gastrectomy was significantly increased. The over-all long term survival rate remained unchanged during 1965 to 1985 (five year survival rate of 31.3 versus 32.8 per cent). However, there was a significantly longer survival period for patients who underwent total gastrectomy (five year survival rate of 22.9 versus 28.3 per cent) (p less than 0.05). Much of the improvement can be attributed to an increase in the detection of relatively small advanced carcinomas and of advanced carcinomas of the stomach simulating early carcinoma in the upper one-third of the stomach. Therefore, we emphasize the need to diagnose advanced carcinoma of the stomach when the lesion is in an earlier stage of disease.
Submucosa
Stomach cancer
Cite
Citations (33)
Greater clarification has resulted since the discussion at the 38th Stomach Cancer Research Meeting on the frequency of a cancer developing in the remaining portion of a stomach after excision of a previous gastric cancer. Further, fewer reports have appeared of early stage cancers in the remaining stomach. Reported here is a case of a patient with an early stage stomach cancer, type I, that occurred 5.5 years after resection of an early stomach cancer, type IIc + III, at a point some distance removed from the anastomosis of the remaining stomach. Total extirpation of the remaining stomach resulted. Two years later, surgery to remove a pulmonary small cell carcinoma in this patient also was performed. The paper presents a study of this case.
Stomach cancer
Cite
Citations (0)
The aim of this study was to elucidate what factors affect the survival of patients with advanced gastric carcinoma. The relationship between the survival of 282 patients over a period of 15 years and 12 prognostic factors was investigated. In univariate analysis, lymph node involvement, depth of invasion, gross form, type of operation, maximum tumor diameter, and lymphatic invasion were found to correlate significantly with survival. Lymph node involvement, gross form, type of operation, and depth of invasion were selected by the Cox proportional hazard model with variable selection methods and found significant. Lymph node involvement was shown to correlate most significantly with survival by both univariate and multivariate analyses. Kaplan-Meier survival curves could indicate that the survival rates of the selected factors were worsening in proportion to the relative risk ratios. These results suggest that further contrivance of therapies should be considered for patients in high risk categories.
Univariate
Gastric carcinoma
Univariate analysis
Cite
Citations (18)
The prognosis of some patients with gastric tumors that have infiltrated adjacent organs may be improved by operations that include complete removal of these structures. However, such a radical operation raises concerns about operative risk.We performed a retrospective analysis of 55 patients whose gastric primary tumors invaded adjacent organs to evaluate the effect of combined removal on postoperative survival. Prognostic factors were also determined by the univariate and multivariate analysis.Cumulative 5-year survival of patients who underwent complete removal of invaded organs was significantly higher than that of patients who did not undergo complete removal of invaded organs or gastrectomy alone. No significant difference was noted between groups in mortality at 30 days after operation. Univariate and multivariate analysis seeking prognostic factors revealed that completeness of the combined removal of invaded organs was among the predictors of outcome.In conclusion, our study suggested that complete removal of invaded organs simultaneously with gastrectomy can prolong postoperative survival of patients with gastric cancer directly invading adjacent organs.
Univariate analysis
Univariate
Cite
Citations (8)
To discuss the reasonable surgery for gastric body cancer.From January 2001 to December 2006, the clinicopathological data of 145 patients with a tumor in the middle third of the stomach underwent radical gastric resection were analyzed retrospectively. We conducted comparative analysis for the differences in clinicopathological characteristics and prognosis between total gastrectomy (TG) and subtotal gastrectomy (STG).The 98 patients underwent TG, 47 received STG. There were significant differences in aspects of tumor size, depth of tumor, nodal status and TNM stage between the 2 groups. Patients with more advanced cancer were more likely to receive TG. The 5-year survival rate for TG was lower (25.5%) than STG (63.8%) (χ(2) = 11.707, P = 0.000). However, if tumor stages were stratified, there was no significant difference in the 5-year survival rate. TNM stage (P = 0.044) and histologic type (HR = 1.834, 95%CI: 1.073 - 3.135, P = 0.027) were independent prognostic factors.The overall survival rate of STG for gastric cancer in the middle third of the stomach is better than that of TG. If the radical resection margin can be obtained for gastric body carcinoma, STG is considered instead of TG.
Surgical margin
Resection margin
Stomach cancer
Gastric carcinoma
Cite
Citations (2)