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The Relevance of Serosal Exposure Without Nodal Metastasis in Resectional Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

According to 8th AJCC/UICC TNM criteria, stage IIB includes pT1N3M0, pT2N2M0, pT3N1M0, and pT4aN0M0, which includes not only early gastric cancer but also locally advanced cancer. There are currently no data about whether there is any additional impact of serosal exposed cancer without nodal metastasis (pT4aN0) on patients’ survival outcomes compared with other subgroups in IIB.

Methods

Patients who underwent radical gastrectomy for gastric cancer patients were enrolled, including 427 patients in stage IIB; 20 (4.68%), 104 (24.35%), 172 (40.28%), and 131 (30.67%) patients were classified as pT1N3a, pT2N2, pT3N1, and pT4aN0, respectively. Clinicopathological characteristics, recurrence pattern, and survival and recurrence rates were analyzed according to the TNM subgroups.

Results

Cancer-specific and relapse-free survival were significantly worse in serosal exposed cancer than in nonserosal exposed cancer in stage IIB (P = 0.019 and P = 0.015). Recurrence rate was highest in the pT4aN0 subgroup (29.0%) in stage IIB, and peritoneal metastasis was the most common pattern. Survival outcomes of the pT4aN0 subgroup were not significantly different from those of the stage IIIA or pT4aN1 subgroups.

Conclusions

Patients with serosal exposed cancer without nodal metastasis shows worse cancer specific and disease-free survival with higher incidence of peritoneal metastasis than other subgroups in stage IIB. Further surveillance studies, including staging laparoscopy and active adjuvant therapy, are required in this subgroup of patients.

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Funding

This research was supported by Grants from the National Research Foundation of Korea (Grant Nos. 2012R1A1A1043576, 2015R1A1A1A05028000 and 2018R1D1A1B07045486); the Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Yoon Ju Jung MD, Ho Seok Seo MD, Ji Hyun Kim MD, Cho Hyun Park MD & Han Hong Lee MD

  2. Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Han Hong Lee MD

Authors
  1. Yoon Ju Jung MD
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  2. Ho Seok Seo MD
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  3. Ji Hyun Kim MD
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  4. Cho Hyun Park MD
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  5. Han Hong Lee MD
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Contributions

YJJ, HSS, JHK, CHP, HHL, CHP and HHL conceived and designed the study. YJJ and HSS wrote the manuscript and performed data analysis. JHK was responsible for data collection. HHL reviewed the manuscript and provided feedback. All authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to Han Hong Lee MD.

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All data and materials are available upon request.

Disclosure

The authors declare that they have no conflict of interest.

Ethics Approval

This study was approved by the Institutional Review Board of the College of Medicine, Catholic University of Korea (KC17RISI0036) in accordance with the Declaration of Helsinki and Good Clinical Practice. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or and appropriated substitute for it was obtained from all patients included in the study.

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Jung, Y.J., Seo, H.S., Kim, J.H. et al. The Relevance of Serosal Exposure Without Nodal Metastasis in Resectional Gastric Cancer. Ann Surg Oncol 26, 1772–1778 (2019). https://doi.org/10.1245/s10434-019-07221-1

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  • DOI: https://doi.org/10.1245/s10434-019-07221-1

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