Prognostic impact of a microscopic positive margin in patients undergoing gastrectomy for gastric cancer: a propensity score‑matched analysis of a multi‑institutional dataset
Prognostic impact of a microscopic positive margin in patients undergoing gastrectomy for gastric cancer: a propensity score‑matched analysis of a multi‑institutional dataset
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DOI：
10.1007/s00595-021-02365-8
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发表时间：
2021-08
期刊：
影响因子：
2.5
通讯作者：
Koki Nakanishi;M. Kanda;S. Ito;Y. Mochizuki;H. Teramoto;K. Ishigure;T. Murai;T. Asada;A. Ishiyama;H. Matsushita;D. Shimizu;C. Tanaka;M. Fujiwara;K. Murotani;Y. Kodera
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作者：
Koki Nakanishi;M. Kanda;S. Ito;Y. Mochizuki;H. Teramoto;K. Ishigure;T. Murai;T. Asada;A. Ishiyama;H. Matsushita;D. Shimizu;C. Tanaka;M. Fujiwara;K. Murotani;Y. Kodera
目的：分析显微阳性切缘对胃癌胃切除术后生存结局的影响。方法：对2010年至2014年间以治愈为目的行胃切除术的患者进行多机构数据分析。我们使用倾向评分匹配来严格平衡患者的肿瘤特征、背景和术后治疗，以比较具有显微镜阳性边缘和阴性边缘的患者的生存结果。结果3029例患者中，32例（1.1%）的切缘呈阳性。匹配后，我们纳入了128例患者进行回顾性分析：32例阳性边缘，96例阴性边缘。阳性切缘组的无复发生存期明显短于阴性切缘组（风险比[HR]， 1.62, 95%可信区间，1.00-2.63,p= 0.0485）。在pi - iii期患者中观察到一致的结果（HR, 1.65,p= 0.0835），而piv期患者的生存曲线重叠（HR, 1.29,p= 0.5934）。阳性切缘组的总复发率高于阴性切缘组（75% vs 58%,p= 0.0917）。这一趋势与局部复发（9%对3%）和远处复发（69%对55%）一致。结论镜下切缘阳性的胃癌根治性胃切除术患者的生存率低于镜下切缘阴性的胃癌患者。
PurposeWe analyzed the effect of a microscopic positive margin on survival outcomes after gastrectomy for gastric cancerMethodsWe analyzed a multi-institutional dataset to study patients who underwent gastrectomy with curative intent between 2010 and 2014. We used propensity score matching to strictly balance the patients’ oncological features, backgrounds, and postoperative treatment to compare the survival outcomes of those with microscopic positive margins and those with negative margins.ResultsAmong 3029 patients, 32 (1.1%) had positive margins. After matching, we enrolled 128 patients in this retrospective analysis: 32 with a positive margin and 96 with a negative margin. The recurrence-free survival of the positive-margin group was significantly shorter than that of the negative-margin group (hazard ratio [HR], 1.62, 95% confidence interval, 1.00–2.63,p= 0.0485). Consistent results were observed for patients with pStages I–III disease (HR, 1.65,p= 0.0835), whereas the survival curves overlapped in those with pStage IV disease (HR, 1.29,p= 0.5934). The prevalence of overall recurrence in the positive-margin group was higher than that in the negative-margin group (75% vs 58%,p= 0.0917). This trend was consistent with locoregional recurrence (9% vs 3%) and distant recurrence (69% vs 55%).ConclusionsThe survival of patients after curative gastrectomy for gastric cancer was worse in those with microscopic positive margins than in those with negative margins.