Evaluation of the impact of tumor deposits on prognosis in gastric cancer and a proposal for their incorporation into the AJCC staging system
Evaluation of the impact of tumor deposits on prognosis in gastric cancer and a proposal for their incorporation into the AJCC staging system
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肿瘤沉积对胃癌预后影响的评估以及将其纳入AJCC分期系统的建议
DOI：
10.1016/j.ejso.2018.10.062
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发表时间：
2018-12-01
期刊：
影响因子：
3.8
通讯作者：
Sun, Yihong
中科院分区：
文献类型：
--
作者：
Chen, Hao;Tang, Zhaoqing;Sun, Yihong
背景：本研究的目的是探讨肿瘤沉积物（TDs）在胃癌根治术后的预后价值。方法：回顾性分析2003 ~ 2011年中山医院行根治性胃切除术的患者1518例。分析TDs与其他临床病理特征的相关性。对预后因素进行单因素和多因素分析。评估不同分期系统合并TDs的预测能力。结果：检出TDs 193例（13%）。TDs患者多以肿瘤大、近端、组织学分化差、晚期T期、晚期N期、淋巴血管侵及神经周围侵为主。Kaplan-Meier生存分析显示，TDs患者的生存率明显低于无TDs患者（P < 0.001）。多因素分析显示，td的存在是影响总生存的独立预后因素（风险比(HR) = 1359, P = 0.001）。我们提出了一个新的分期系统，将TDs纳入TNM分期系统，除了N3b患者外，TDs的存在会抢N期的风头。卡方、AUC、C指数和AIC的结果均表明，我们修改后的方案优于原方案和其他方案。结论：TDs的存在是胃癌患者预后的一个独立因素。采用修订后的方案合并TDs后，TNM分期系统可以更有效地预测胃癌患者的预后。(C) 2018爱思唯尔有限公司，BASO-癌症外科协会和欧洲外科肿瘤学会。版权所有。
Background: The aim of this study was to investigate the prognostic value of tumor deposits (TDs) in patients with gastric cancer after radical gastrectomy.Methods: We retrospectively reviewed 1518 patients who had undergone radical gastrectomy in Zhongshan Hospital between 2003 and 2011. Correlations between TDs and other clinicopathological characteristics were analyzed. Univariate and multivariate analysis of prognostic factors were conducted. The predictive ability of different staging systems incorporating TDs were evaluated.Results: The presence of TDs was found in 193 (13%) specimens. Large tumor size, proximal part, poor differentiated histology, advanced T stage, advanced N stage, lymphovascular invasion and perineural invasion were more common for patients with TDs. The Kaplan-Meier survival analysis revealed that survival of patients with TDs was significantly poorer than those without (P < 0.001). Multivariate analysis showed that presence of TDs was an independent prognostic factor for overall survival (hazard ratio (HR) = 1359, P = 0.001). We proposed a new staging system to incorporate TDs into TNM staging system that the presence of TDs would upstage N stage except for N3b patients. The results of chi-square, AUC, C index and AIC all showed that our revised scheme was better than the primary system and other schemes.Conclusions: The presence of TDs is an independent prognostic factor for gastric cancer patients. The TNM staging system would be more effective to predict the prognosis for gastric cancer patients after incorporating TDs using our revised scheme. (C) 2018 Elsevier Ltd, BASO- The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.