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Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

  • Wang, Zheng (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College) ;
  • Ma, Li (Department of Respiration, First Affiliated Hospital of PLA General Hospital) ;
  • Zhang, Xing-Mao (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College) ;
  • Zhou, Zhi-Xiang (Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College)
  • Published : 2014.09.15

Abstract

Background: Early gastric cancer (EGC) is well accepted as having a favorable prognosis, but some patients experience an ominous outcome after curative resection. This study was aimed at evaluating predictive factors associated with prognosis of D2 gastrectomies in patients with early gastric cancer. Materials and Methods: A total of 518 patients with early gastric cancer who underwent D2 gastrectomies were reviewed in this study. The clinicopathological features and surgical outcomes were analyzed. The survival rate was estimated using the Kaplan-Meier method and compared by log rank test. Prognostic factors were analyzed using a multivariate Cox proportional hazards model. Results: The 5-year survival rate was 90.3%. Tumor infiltration, lymph node metastasis and lymphovascular invasion were significant prognostic factors for survival. Gender, age, tumor size, tumor location, macroscopic type and histological type were not significant prognostic factors. Multivariate analysis indicated that lymph node metastasis was an independent poor prognosis factor. Conclusions: Early gastric cancers with lymph node metastasis have a relatively poor prognosis after standard surgery. Even after curative resection, patients with EGC with positive lymph nodes should be closely followed and be considered as candidates for comprehensive therapies.

Keywords

Early gastric cancer;prognostic factor;lymph node metastasis;surgery

References

  1. Abe N, Mori T, Takeuchi H, et al (2005). Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early gastric cancer. Am J Surg, 190, 496-503. https://doi.org/10.1016/j.amjsurg.2005.05.042
  2. Adachi Y, Shiraishi N, Kitano S (2002). Modern treatment of early gastric cancer: review of the Japanese experience. Dig Surg, 19, 333-9. https://doi.org/10.1159/000065829
  3. Baghestani AR, Hajizadeh E, Fatemi SR (2009). Bayesian analysis for survival of patients with gastric cancer in Iran. Asian Pac J Cancer Prev, 10, 823-6.
  4. Borie F, Millat B, Fingerhut A, et al (2000). Lymphatic involvement in early gastric cancer. Arch Surg, 135, 1218-23. https://doi.org/10.1001/archsurg.135.10.1218
  5. Folli S, Dente M, Dell Amore D, et al (1995). Early gastric cancer: prognostic factor in 223 patients. Br J Surg, 82, 952-6. https://doi.org/10.1002/bjs.1800820732
  6. Gotoda T, Yamamoto H, Soetikno RM (2006). Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol, 41, 929-42. https://doi.org/10.1007/s00535-006-1954-3
  7. Haves N, Karat D, Scott DJ, et al (2002). Radical lymphadenectomy in the management of early gastric cancer. Br J Surg, 83, 1421-3.
  8. Hyung WJ, Noh SH, Lee JH, et al (2002). Early gastric carcinoma with signet ring cell histology. Cancer, 94, 78-83. https://doi.org/10.1002/cncr.10120
  9. Japanese Gastric Cancer Association (1998). Japanese classification of gastric carcinoma- 2nd English edition. Gastric Cancer, 1, 10-24. https://doi.org/10.1007/PL00011681
  10. Kitamura K, Yamaguchi T, Taniguchi M, et al (1997). Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol, 64, 42- 7. https://doi.org/10.1002/(SICI)1096-9098(199701)64:1<42::AID-JSO9>3.0.CO;2-P
  11. Kwee RM, Kwee TC (2008). Predicting lymph node status in early gastric cancer. Gastric Cancer, 11, 134-48. https://doi.org/10.1007/s10120-008-0476-5
  12. Lee YY, Oh DK, Choi KS, et al (2011). The current status of gastric cancer screening in Korea: report on the National Cancer Screening Programme, 2009. Asian Pac J Cancer Prev, 12, 3495-500.
  13. Miwa K (1984). Evaluation of the TNM classification of stomach cancer and proposal for its rationale stagegrouping. Jpn J Clin Oncol, 14, 385- 410.
  14. Murakami T (1971). Pathomorphological diagnosis: definition and gross classification of early gastric cancer. Gann Monogr Cancer Res, 11, 53-5.
  15. Nio Y, Tsubono M, Kawabata K, et al (1993). Comparison of surgical curves of gastric cancer patients after surgery according to the UICC stage classification and the general rules for gastric cancer study by the Japanese Research Society for Gastric Cancer. Ann Surg, 218, 47- 53. https://doi.org/10.1097/00000658-199307000-00008
  16. Noh SH, Hyung WJ, Cheong JH (2005). Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol, 90, 188-93. https://doi.org/10.1002/jso.20228
  17. Ohta H, Noguchi Y, Takagi K, et al (1987). Early gastric carcinoma with special reference to macroscopic classification. Cancer, 60, 1099-106. https://doi.org/10.1002/1097-0142(19870901)60:5<1099::AID-CNCR2820600530>3.0.CO;2-F
  18. Ono H, Kondo H, Gotoda T, et al (2001). Endoscopic mucosal resection for treatment of early gastric cancer. Gut, 48, 222-9.
  19. Seto Y, Nagawa H, Muto T (1997). Impact of lymph node metastasis on survival with early gastric cancer. World J Surg, 21, 186-90. https://doi.org/10.1007/s002689900213
  20. Siewert R, Kestlmeier R, Bush R, et al (1996). Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases. Br J Surg, 83, 1144-7. https://doi.org/10.1002/bjs.1800830836
  21. Tatematsu H, Miyahara R, Shimoyama Y, et al (2013). Correlation between magnifying narrow-band imaging endoscopy results and organoid differentiation indicated by cancer cell differentiation and its distribution in depressedtype early gastric carcinoma. Asian Pac J Cancer Prev, 14, 2765-9. https://doi.org/10.7314/APJCP.2013.14.5.2765

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