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Clinical Significance of Tumor Deposits in Gastric Cancer: a Retrospective and Propensity Score-Matched Study at Two Institutions

  • Lihu Gu
  • Ping Chen
  • Hui Su
  • Xinlong Li
  • Hepan Zhu
  • Xianfa Wang
  • Parikshit Asutosh Khadaroo
  • Danyi Mao
  • Manman ChenEmail author
Original Article
  • 41 Downloads

Abstract

Background

Gastric cancer (GC) treatment is largely determined by tumor stage. Despite improvements in the mode of treatment of various types of advanced disease, staging is still evolving. The role of tumor deposits (TDs) in staging remains debated. The purpose of this research is to investigate the relationship between TDs and prognosis in GC.

Methods

A total of 3098 patients were considered eligible for prognostic analysis (2706 patients in the TDs-negative group and 392 patients in the TDs-positive group). A one-to-one propensity score-matching analysis was performed using a logistic regression mode and the following covariates: age, gender, tumor location, size, differentiation, perineural invasion, lymphovascular invasion, pTNM stage, type of gastrectomy, and the number of lymph nodes retrieved between TDs-negative and TDs-positive group, then 323 patients in each group were analyzed. Univariate and multivariate analyses of prognostic factors were conducted accordingly. The predictive ability of different staging system incorporating TDs was evaluated.

Results

TDs were present in 14.5% cases and almost all of the patients (99%) suffered from advanced GC. Multivariate analysis showed that pN stage, chemotherapy, and TDs were the independent prognostic factors. The TDs-positive group showed a lower rate of 5-year disease-free survival compared with the TDs-negative group in all patients, stage II, and stage III patients (p = 0.001, 0.029, and 0.003, respectively). The 5-year disease-free survival for patients with TDs and without TDs was 27.6% and 34.4%, respectively.

Conclusions

Our research shows that TDs are closely associated with prognosis in GC. TDs should be incorporated into the TNM staging system, which could then accurately improve the staging reliability and prognostic assessment.

Keywords

Gastric cancer Tumor deposits Prognosis Tumor staging system 

Notes

Author Contributions

Manman Chen contributed to drafting, conception, and design; Lihu Gu, Ping Chen, and Hui Su contributed to manuscript writing; Lihu Gu, Xinlong Li, Hepan Zhu, and Xianfa Wang contributed to data collection; Parikshit Asutosh Khadaroo and Danyi Mao performed procedures and data analysis; All authors helped to perform the research.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4421_Fig4_ESM.png (2.5 mb)
Supplementary Fig. 1

Morphologic patterns of perigastric TD (hematoxylin and eosin staining, x40). (PNG 2570 kb)

11605_2019_4421_MOESM1_ESM.tif (22.9 mb)
High Resolution Image (TIF 23459 kb)
11605_2019_4421_Fig5_ESM.png (172 kb)
Supplementary Fig. 2

Kaplan-Meier plot of 5-year disease-free survival (DFS) according to TNM staging system. A scheme A by Sun et al. P < 0.001, chi-square = 52.050; B scheme B by Chen et al. P < 0.001, chi-square = 67.096; C scheme C by us. P < 0.001, chi-square = 63.098; D AJCC TNM 8th. P < 0.001, chi-square = 52.137. (PNG 172 kb)

11605_2019_4421_MOESM2_ESM.tif (3.3 mb)
High Resolution Image (TIF 3413 kb)
11605_2019_4421_MOESM3_ESM.docx (21 kb)
Supplementary Table 1 (DOCX 21 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of General Surgery, HwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
  2. 2.Department of General SurgeryZhejiang University School of Medicine Sir Run Run Shaw HospitalHangzhouChina
  3. 3.Monash University School of Public Health and Preventive MedicineMelbourneAustralia
  4. 4.Zhejiang Chinese Medical UniversityZhejiangChina
  5. 5.Affiliated Hospital of Medical School Ningbo University and Ningbo City Third HospitalNingboChina

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