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Risk Factors of Survival and Surgical Treatment for Advanced Gastric Cancer with Large Tumor Size

Abstract

Background

The purpose of this study was to clarify the clinical significance of tumor size in advanced gastric cancer and to evaluate the risk factors of survival in advanced gastric cancer with large tumor size.

Methods

The cut-off point for tumor size, 90th percentile value of tumor size in advanced gastric cancer, was determined to be 10 cm. We retrospectively studied the clinicopathological features and prognosis of 406 patients with advanced gastric tumors measuring 10 cm or more.

Results

Large tumors had a propensity for the following: Borrmann type IV, adjacent organ invasion, lymph node and distant metastasis, and stage IV classification. Tumor size was an independent risk factor for lymph node metastasis and survival in advanced gastric cancer. In patients with large advanced gastric cancer, Borrmann type IV, adjacent organ invasion, and N2–3 nodal involvement were independent factors associated with a poorer prognosis. The 5-year survival rate in large gastric cancer patients without any risk factors (65.5%) was similar with those in small gastric cancer patients (59.3%, P = 0.123).

Conclusion

Tumor size was a simple predictor for lymph node metastasis and survival in advanced gastric cancer. Radical surgery should be recommended for large advanced gastric cancer patients without risk factors, while large gastric cancer with risk factors may not be a surgically treatable disease.

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References

  1. 1.

    Nakamura K, Ueyama T, Yao T, et al. Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer 1992;70:1030–1037. doi:10.1002/1097-0142(19920901)70:5<1030::AID-CNCR2820700504>3.0.CO;2-C.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Michelassi F, Takanishi DM Jr, Pantalone D, et al. Analysis of clinicopathologic prognostic features in patients with gastric adenocarcinoma. Surgery 1994;116:804–809.

    PubMed  CAS  Google Scholar 

  3. 3.

    Yokota T, Ishiyama S, Saito T, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: A multiple logistic regression analysis. Scand J Gastroenterol 2004;39:380–384. doi:10.1080/00365520310008629.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Yu CC, Levison DA, Dunn JA, et al. Pathological prognostic factors in the second British stomach cancer group trial of adjuvant therapy in resectable gastric cancer. Br J Cancer 1995;71:1106–1110.

    PubMed  CAS  Google Scholar 

  5. 5.

    Adachi Y, Oshiro T, Mori M, et al. Tumor size as a simple prognostic indicator for gastric carcinoma. Ann Surg Oncol 1997;4:137–140. doi:10.1007/BF02303796.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Giuliani A, Caporale A, Di Bari M, et al. Maximum gastric cancer diameter as a prognostic indicator: Univariate and multivariate analysis. J Exp Clin Cancer Res 2003;22:531–538.

    PubMed  CAS  Google Scholar 

  7. 7.

    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer 1998;1:10–24.

    PubMed  Article  Google Scholar 

  8. 8.

    Sobin LH, Wittekind C. International union against carcinoma(UICC). TNM classification of malignant tumours. 5th ed. New York: Wiley-Liss, 1997.

    Google Scholar 

  9. 9.

    Hyung WJ, Cheong JH, Kim J, et al. Application of minimally invasive treatment for early gastric cancer. J Surg Oncol 2004;85:181–185. doi:10.1002/jso.20018.

    PubMed  Article  Google Scholar 

  10. 10.

    Shiraishi N, Sato K, Yasuda K, et al. Multivariate prognostic study on large gastric cancer. J Surg Oncol 2007;96:14–18. doi:10.1002/jso.20631.

    PubMed  Article  Google Scholar 

  11. 11.

    Adachi Y, Yasuda K, Inomata M, et al. Pathology and prognosis of gastric carcinoma: Well versus poorly differentiated type. Cancer 2000;89:1418–1424. doi:10.1002/1097-0142(20001001)89:7<1418::AID-CNCR2>3.0.CO;2-A.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Ichikura T, Tomimatsu S, Okusa Y, et al. Comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage based on their location in patients with gastric cancer. J Clin Oncol 1993;11:1894–1900.

    PubMed  CAS  Google Scholar 

  13. 13.

    Kunisaki C, Akiyama H, Nomura M, et al. Comparison of surgical results of d2 versus d3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: A multi-institutional study. Ann Surg Oncol 2006;13:659–667. doi:10.1245/ASO.2006.07.015.

    PubMed  Article  Google Scholar 

  14. 14.

    Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: Data from a large US-population database. J Clin Oncol 2005;23:7114–7124. doi:10.1200/JCO.2005.14.621.

    PubMed  Article  Google Scholar 

  15. 15.

    Shen KH, Wu CW, Lo SS, et al. Factors correlated with number of metastatic lymph nodes in gastric cancer. Am J Gastroenterol 1999;94:104–108. doi:10.1111/j.1572-0241.1999.00779.x.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Maehara Y, Kakeji Y, Oda S, et al. Time trends of surgical treatment and the prognosis for japanese patients with gastric cancer. Br J Cancer 2000;83:986–991. doi:10.1054/bjoc.2000.1427.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Maehara Y, Oiwa H, Oda S, et al. Surgical treatment and prognosis for patients with gastric cancer lesions larger than ten centimeters in size. Oncology 1995;52:35–40.

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Saito H, Osaki T, Murakami D, et al. Macroscopic tumor size as a simple prognostic indicator in patients with gastric cancer. Am J Surg 2006;192:296–300. doi:10.1016/j.amjsurg.2006.03.004.

    PubMed  Article  Google Scholar 

  19. 19.

    Yasuda K, Shiraishi N, Adachi Y, et al. Risk factors for complications following resection of large gastric cancer. Br J Surg 2001;88:873–877. doi:10.1046/j.0007-1323.2001.01782.x.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Lim L, Michael M, Mann GB, et al. Adjuvant therapy in gastric cancer. J Clin Oncol 2005;23:6220–6232. doi:10.1200/JCO.2005.11.593.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgement

This study was supported in part by a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (0412-CR01-0704-0001).

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Correspondence to Sung Hoon Noh.

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Li, C., Oh, S.J., Kim, S. et al. Risk Factors of Survival and Surgical Treatment for Advanced Gastric Cancer with Large Tumor Size. J Gastrointest Surg 13, 881 (2009). https://doi.org/10.1007/s11605-009-0800-3

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Keywords

  • Advanced gastric cancer
  • Tumor size
  • Surgical treatment