Tumor Depth Prediction of Gastric Cancer With a T4 Score
Kiyoaki TaniguchiMasaho OtaTakuji YamadaAkiko SerizawaSho KotakeShunichi ItoKazuomi SuzukiMasalazu Yamamoto
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Abstract:
Peritoneal metastases are often found at surgery of pT4 gastric cancers, preventing R0 resection. In the event of successful R0 resection, distant metastases still occur in a sizeable proportion of patients. Estimation of the depth of invasion has a relatively low accuracy (57%-86%) compared with pathological findings. This study sought to develop a clinical score to distinguish between pathological stage T4 (pT4) and pT1-3 gastric cancer.Reviewing the data of 2,771 patients who had undergone gastrectomy at our hospital from January 1996-December 2016, we assessed demographic factors plus tumor markers, diameter, location, histology, and macroscopic type according to the fifth edition (2019) of the WHO classification. Significant factors on multivariate analysis were used to develop a pT4 gastric cancer depth prediction score (T4 score).Multivariate analysis revealed that the clinical factors associated with pT4 disease were CA19-9 elevation, tumor diameter ≥50 mm, poorly cohesive type adenocarcinoma, mucinous adenocarcinoma, and WHO macroscopic types 2-4. The T4 score was obtained by weighing these factors according to the β-coefficient. The optimum cutoff value of the T4 score was 4 points. A total of 79.4% of cases with a T4 score ≥4 points were stage pT4. A total of 93.9% of cases with a T4 score <4 points were stage pT1-3, with 91.1% sensitivity, 85.3% specificity, 79.4% positive predictive value, and 93.9% negative predictive value.T4 scoring can differentiate pT4 gastric cancer from pT1-3 gastric cancer.Keywords:
Stomach cancer
Clinicopathological factors influencing the survival and the effect of chemotherapy with special reference to S-1 were retrospectively analyzed in 41 patients who underwent gastrectomy for stage IV gastric cancer. Significantly better outcomes were observed in patients with H0, P0 or M0 than those with H1, P1 or M1, respectively. Curability B surgery showed a significantly better result than curability C. A significantly better result was demonstrated in patients treated with S-1 alone than those treated with chemotherapy other than S-1 or in patients without chemotherapy. Multivariate analysis revealed that H0, M0 and chemotherapy with S-1 were significant and independent prognostic factors. Moreover, the patients treated with S-1 for more than 12 months showed a significantly better outcome than those treated with S-1 for less than 12 months. It is concluded that curative resection (curability B) and the longer period of postoperative chemotherapy with S-1 is the treatment of choice to improve the outcome of patients with stage IV gastric cancer.
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Postoperative morbidity and mortality were studied in 72 patients who consecutively underwent total gastrectomy for primary gastric malignancy. Patients aged greater than or equal to 70 years (n = 32) were compared with younger patients (n = 40). Two patients in both groups died postoperatively, making the surgical mortality 6.3% and 5%, respectively. Major surgical complications arose postoperatively in 12 cases. Conservative measures (balloon dilation of anastomotic stricture, protracted drainage, and puncture and drainage of intraabdominal abscess) sufficed in five cases, while reoperation was required in seven. One of these seven patients died. The remaining three deaths were due to myocardial infarction, cerebral vascular insult and exudative pericarditis, respectively. The median postoperative hospital stay was 14 days in the younger and 15 days in the older patient group. Approximately half of the patients in both groups were alive 2 years postoperatively. Total gastrectomy is a meaningful and reasonably safe operation for primary gastric malignancy also in elderly patients.
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Univariate analysis
Univariate
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INTRODUCTION: Lung ressection is the treatment of choice in Non-Small Cell Lung Cancer (NSCLC). Besides TNM staging, other features have been reported as significant prognostic factors. AIM: To analyze factors affecting relapse and survival in NSCLC after complete ressection. METHODS: A retrospective study was conducted, including patients with NSCLC completely ressected in the last 12 years. Clinical and histological factors were assessed and its influence on survival free of relapse and overall survival was determined. RESULTS: 160 patients were included, 77.5% male and 22.5% female, with a median age of 65years. Relapse occurred in 69 patients (median survival free of relapse - 56 months). At univariate analysis, an association was found between reduced survival free of relapse and age≤62 years, clinical tumor size≥4cm, clinical TNM stage>IB, clinical T>1, clinical N>0, pathological TNM stage>IB, pathological T>2, pathological N>0 and vascular invasion. At multivariate analysis, tumor size≥4cm (p=0.004), pathological TNM stage>IB (p=0.023) and vascular invasion (p=0.024) were associated to a reduced survival free of relapse. 64 patients died (median overall survival – 112 months). At univariate analysis, an association was found between reduced overall survival and age≤62 years, clinical tumor size≥4cm, clinical TNM stage>IB, clinical N>0, pathological TNM stage>IB, pathological T>2, pathological N>0, vascular invasion and poor differentiation of tumor. At multivariate analysis, only pathological TNM stage>IB (p=0.029) remained associated a poorer overall survival. CONCLUSION: Besides TNM staging, other features are important on relapse and survival and should be considered for adjuvant therapy.
Univariate analysis
TNM staging system
Pathological staging
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OBJETIVO: Comparar os estadiamentos clínico e patológico em pacientes com câncer de pulmão não-pequenas células submetidos a tratamento cirúrgico e identificar as causas das discordâncias. MÉTODOS: Foram analisados, de forma retrospectiva, os dados de pacientes tratados no Serviço de Cirurgia Torácica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, e foram calculados a sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia para os estádios clínicos IA, IB e IIB. O índice kappa foi utilizado para determinar a concordância entre os estadiamentos clínico e patológico. RESULTADOS: Dentre os 92 pacientes estudados, 33,7% foram classificados como estádio clínico IA, 50% como IB e 16,3% como IIB. A concordância entre os estadiamentos clínico e patológico foi de 67,5% para IA, 54,3% para IB e 66,6% para IIB. O estadiamento clínico teve maior acurácia no estádio IA, e um kappa de 0,74 neste caso confirma uma substancial associação com o estadiamento patológico. A dificuldade em avaliar doença metastática linfonodal é responsável pela baixa concordância em pacientes com estádio clínico IB. CONCLUSÕES: A concordância entre os estadiamentos clínico e patológico é baixa, e, freqüentemente, os pacientes são subestadiados (no presente estudo, somente um caso foi superestadiado). São necessárias estratégias para melhorar o estadiamento clínico e, conseqüentemente, o tratamento e o prognóstico dos pacientes com câncer de pulmão não-pequenas células.
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urpose〕To explore the rational treatment of early stage gastric cancer in matrical hospitals.〔Methods〕Twenty cases with early stage gastric cancer underwent subtotal gastrectomy or D 1,D 2 radical surgery.Among them,10 cases underwent 6 cycles of postoperative FAM regimen.The result of follow up was compared with that of middle and late stage gastric cancer.〔Results〕The prognosis of early stage gastric cancer is clearly better than that of control group.〔Conclusion〕Unknown reason hemorrhage of upper alimentary tract should be considered precautionsly in case of early stage gastric cancer.In order to improve the cure rate of early stage gastric cancer,lymphadenectomy and postoperative chemotherapy are very helpful.
Alimentary tract
Lymphadenectomy
Regimen
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Objective To study the expression level of HER-2 gene in the same pathological stage gastric cancer,and discuss the feasibility of HER-2 gene being the prognostic indicator.Methods The expression of HER-2 in gastric cancer was detected by immunohistocehmical technique and analyzed in relation with the pathological stage and prognosis of the patients.Results The total positive rate of HER-2 in gastric cancer was 33.64％ (37/110).In stage Ⅱ,the weakly and strongly positive rates of gastric cancer were 21.31％ ( 13/61 ) and 9.84％ (6/61).In stage Ⅲ,the weakly and strongly positive rates of gastric cancer were 20.41％ (10/49) and 16.33％ (8/49).In the same pathological stage,the survival rate of patients with negative HER-2 expression was higher than weakly positive ones.And the survival rate of patients with strongly positive HER-2 expression was the lowest.The difference had statistical significance (P ＜ 0.01).Conclusion The prognosis of patients in the same stage was correlated with the expression level of HER-2,which can be used to evaluate the biological behavior and prognosis of gastric cancer.
Key words:
Stomach neoplasms; Pathology; Neoplasm staging; Prognosis; HER-2
Stomach cancer
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Helicobacter pylori is an identified carcinogen for gastric cancer, but the underlying mechanisms remain to be defined. The aim of this study is to analyze the incidence of Hp infection in our series of patients with gastric carcinoma.Between 1988 and 1998, 60 patients with diagnosis of gastric adenocarcinoma underwent partial or total gastrectomy. Forty-one were males and 19 females with an average age of 62 years (range 36-79). Twenty-seven cancers (45%) were localized in the lower third of the stomach, 17 (28%) in the middle third and eight (13%) in the upper third or cardias. In six patients (10%) the tumor was multicentric, while a recurrence on gastric stump after subtotal gastrectomy was present in two cases (3%). According to Lauren's criteria 39 cancers (65%) were of intestinal type, 16 (27%) of diffuse type and five (8%) of mixed type. The histologic preparations have been re-examined in order to verify the presence or not of Hp on gastric mucosa around neoplasm.Hp was found in 35 (58%) of the analyzed specimens and therefore a significant percentage of patients was Hp-positive at the time of diagnosis and surgery. Between 35 Hp-positive samples, 24 were adenocarcinomas of intestinal type, nine of diffuse type and two of mixed type, with a prevalence of Hp in intestinal type cancer.This study confirmed the high incidence of Hp infection in patients with gastric carcinoma, particularly in those with intestinal type cancer.
Helicobacter
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Objective To study the clinical pathological characteristics of young patients with gastric cancer.Methods The clinical expression pathological characteristics, treatment and prognosis in 34 cases of young gastric cancer were analysed respectively and compared with 40 cases of mid-old gastric cancer.Results The clinical expression of young patient with gastric cancer was similar to that of mid-old patients (P0.1). Therefore,the diagnosis was usually delayed ( P0.05).Among all the pathological types,the undifferentiation cancer and low differentiation adenocancer were common (79.4%),the rate of ectomy was low (41.2%),and the prognosis was bad, (the five-year living rate was 8.8%).There were differences (P0.01) between the two groups.Conclusion The state of illness normally develops very quickly among young gastric cancer patients. Meanwhile the metastasic of the cancer occurs very early. So the key to improve the prognosis is to diagnose the cancer as early as possible,and cure the patients as early as possible.
Stomach cancer
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Basal (medicine)
Progesterone receptor
Tissue microarray
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