Clinicopathological Characteristics of Patients with Proximal Third Gastric Carcinoma

Objective : Epidemiological studies show a continuing rise in the prevalence of proximal third gastric carcinoma (PGC), and the prognosis of patients with this carcinoma is poorer than that of patients with more distally located gastric carcinomas. We compared the clinicopathological features and prognosis of PGC patients with those of patients with middle/distal gastric carcinoma (MGC/DGC).

Material and methods : Of the 2696 patients diagnosed with gastric carcinoma who underwent surgery in our hospital in a 15-year period, 271 patients (10.1%) were diagnosed with PGC and retrospectively reviewed. Results : T1-category tumours were less common in patients with PGC than in patients with MGC/DGC (p < 0.001). Lymph node invasion was more common in patients with PGC than in patients with MGC/DGC (p < 0.05). Tumour stage (stage I) and T category (T1) significantly influenced the 5-year survival rates of patients whose tumours were resected with curative intent. The 5-year survival rate of patients whose PGC were resected with curative intent was higher than that of patients whose PGC were resected with palliative intent (57.4 vs. 12.6%, p < 0.001). The 5-year survival rate was 49.3% for patients with PGC and 57.3% for patients with MGC/DGC (p = 0.0273). Multivariate analysis showed that tumour size, lymph node status, and resection with curative intent were significant prognostic factors for survival in patients with PGC.

Conclusion : The poor prognosis of PGC is mainly due to its more advanced stage at diagnosis compared with that of more distally located gastric carcinoma. Early detection is important for improving the prognosis of patients with proximal third gastric carcinoma.     

Surgical outcomes in patients with T4 gastric carcinoma

BACKGROUND: There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer. STUDY DESIGN: We used univariate and multivariate analyses to review the surgical outcomes and prognostic factors of 117 patients who underwent surgery for T4 gastric carcinoma. RESULTS: Curative resection was performed in 38 (32.4%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 16.0% and the median survival time (MST) was 11 months for all 117 registered patients. The 5-year survival rates and MSTs in patients after curative and noncurative resection were 32.2% versus 9.5% and 20 months versus 8 months, respectively. These values differed considerably between the two groups (p < 0.0001). Curability was an independent prognostic factor among all registered patients, including those who underwent noncurative resection. A relatively small tumor diameter (< 100 mm) and few lymph node metastases (six or fewer metastatic lymph nodes) were independent prognostic factors when curative resection could be performed. Postoperative morbidity and mortality were acceptable after curative combined resection. CONCLUSIONS: We recommend the use of aggressive combined resection of adjacent organs, with extended lymph node dissection, for patients with T4 gastric carcinoma in whom curative resection can be used; that is, those with few metastatic lymph nodes (six or less) and a relatively small tumor diameter (100 mm). But noncurative resection should be avoided in patients with T4 gastric cancer.     

Lymph node involvement: the only prognostic factor after curative resection of cancer of the stomach. Results of a multivariate analysis

The aim of this study was to evaluate the independent influence of clinical and pathological variables on survival of patients with gastric carcinoma using the Cox regression proportional hazard model. Of 156 patients operated on for gastric adenocarcinoma, 46 (29.5%) underwent palliative operation, 24 (15.5%) had a palliative resection, and 86 (55%) had a curative resection. The overall 5-year survival rate was 25 +/- 4%. After curative resection, the 5-year survival rate was 44 +/- 6%. Univariate analysis applied to these patients showed that poor survival was related (p less than 0.01) to: age (over 80 years), absence of epigastric pain, vomiting and dysphagia, total gastrectomy, tumor size (more than 4 cm), lymph node involvement (LNI), invasion through the muscularis propria, absence of intestinal metaplasia near the tumor, and linitis plastica. In multivariate analysis, lymph node involvement was found to be the only independent prognostic factor. The 5-year survival rate was 75.5 +/- 8% without LNI, 28 +/- 10% with proximal LNI and 7 +/- 6% with distal LNI. Our results suggest that classification into 3 LNI groups is the best staging system for curative resection in gastric carcinoma.     

贲门癌根治术后患者预后的多因素分析

目的探讨贲门癌根治术后患者预后的影响因素。方法通过回顾性分析我院1994年7月至2003年12月间行根治性手术治疗并有完整随访资料的108例贲门癌患者的临床病理资料，探讨影响贲门癌预后的相关因素。结果108例患者中，SiewertⅡ型占68例，Ⅲ型占40例；淋巴结转移率为68．5％（74／108）。本组患者随访至2004年12月，平均生存时间为37个月（95％CI为29．3～44．7月），中位生存时间为26．6个月；1、3和5年生存率分别为77．2％、33．6％和21．8％。单因素分析结果显示，是否行脾切除术、肿瘤大小、肿瘤浸润深度及淋巴结转移情况是影响患者预后的因素。多因素分析结果显示，仅肿瘤浸润深度（P=0．009）及淋巴结转移情况（P=0．001）是影响患者预后的独立因素，OR值分别为2．373（95％CI为1．474～16．212）和2．269（95％CI为1．450～4．997）。结论贲门癌根治术后患者的预后与肿瘤浸润深度及淋巴结转移数目呈负相关。脾脏未受侵犯时应予以保留，全胃切除未能改善贲门癌根治术后患者的预后。     

Significant prognostic factors in patients with early gastric cancer

BACKGROUND: Early gastric cancer is defined as a gastric carcinoma confined to the mucosa or submucosa regardless of lymph node status, and it has an excellent prognosis with a 5-year survival rate of more than 90%. From 1985 to 1995, we encountered 266 cases of early gastric cancer in our hospital. METHODS: A retrospective analysis of the 266 cases of early gastric cancer was performed to evaluate the prognostic significance of clinicopathological features (age, gender, tumor size, tumor location, depth of invasion, lymph node metastasis, histological type, lymphatic invasion, vascular invasion, histological growth pattern, cancer-stromal relationship and type of operation). RESULTS: The overall survival rate of all the patients with early gastric cancer was 95.7%. In univariate analysis, the statistical significant prognostic factors were regional lymph node metastasis (P = 0.0004), lymphatic invasion (P = 0.0053) and cancer-stromal relationship (P = 0.0016). Absence of lymph node metastasis and lymphatic invasion, and a medullary-type histopathology were associated with improved survival. In multivariate analysis, the statistically significant prognostic factors were lymph node metastasis and cancer-stromal relationship. CONCLUSIONS: Presence of lymph node involvement and a scirrhous type of gastric cancer are associated with poor prognosis. Lymph node dissection with gastric resection is necessary for patients with early gastric cancer who have a high risk of lymph node metastasis. Postoperative chemotherapy is recommended for a scirrhous type of early gastric cancer.     

同期食管癌和胃癌的临床特征和预后分析

目的 探讨同期发生食管癌和胃癌的临床特征和影响预后的因素.方法 收集1979年6月至2005年4月就诊的44例同期食管鳞状细胞癌和胃腺癌患者的临床资料,用Kaplan-Meier曲线法和Log-rank检验进行生存率分析和患病风险因素的单因素分析,用COX比例风险模型进行多因素分析.结果 患者年龄41～77岁;有肿瘤家族史者占22.7%;其中胃癌易被漏诊.5年总生存率27%,中位生存期22个月;切除术后5年生存率33%,中位生存期31个月.单因素和多因素分析均显示胃癌淋巴结转移和手术根治程度是影响预后的独立因素.结论 手术切除是同期发生食管癌和胃癌主要的治疗方式.注重淋巴结清扫,尽量做到根治性切除,可能有利于改善患者的预后.     

Clinicopathologic Features of Gastric Carcinoma with Signet Ring Cell Histology

Background

Reports of clinicopathological features and prognosis in patients with signet ring cell carcinoma of the stomach (SRC) are conflicting. The aim was to describe the clinicopathological features and prognosis of patients with SRC in comparison with non-signet ring cell carcinoma of the stomach (NSRC).

Methods

In this retrospective study, we reviewed the records of 1,439 consecutive patients diagnosed with gastric carcinoma who were resected surgically from 1993 to 2003. Among them, 218 patients (15.1%) with SRC were compared with 1,221 patients with NSRC.

Results

There were significant differences in tumor size, tumor location, macroscopic type, depth on invasion, lymph node metastasis, lymphatic invasion, tumor stage, chemotherapy, and curability between the patients with SRC histology and NSRC. The overall 5-year survival of patients with SRC was 44.9% as compared with 36.0% for patients with NSRC (P?=?0.013). Multivariate analysis showed that lymph node metastasis and curative resection were significant factors affecting survival. A significant survival benefit for curative resection was observed, with a 5-year survival rate of 58.5% compared with non-curatively resected cases (8.4%).

Conclusions

When stage matched, SRC patients had a similar survival to NSRC patients. Curative resection is recommended to improve the prognosis of patients with SRC.     

Aggressive surgical treatment for T4 gastric cancer

Surgical treatment for locally advanced gastric cancer remains controversial, and many still question the benefits of extended resection. The aim of this study was to evaluate the effectiveness of combined resection of the involved organs with regard to survival in patients with gastric cancer. Between 1993 and 2000, among the 1638 patients with gastric cancer who underwent gastrectomy, 82 were found to have evidence of adjacent organ spread at laparotomy. A retrospective analysis of these patients was performed. Curative resections were carried out in 50 patients, whereas noncurative resections were performed in 32 patients. The 5-year survival rate in the group undergoing curative resection was 36.9%. The survival rate in the R0 group was significantly higher than the survival rate for patients undergoing noncurative resections. There was no significant difference in survival rates between patients with pT3 cancer and those with pT4 cancer. Seventy-one patients were pathologically proved to have lymph node metastasis, and the survival rate for patients with a lymph node ratio greater than 0.2 was lower than that in other groups. In multivariate analysis, peritoneal dissemination, lymph node ratio, and histologic findings were the predictors of survival. Patients with T4 gastric carcinoma, even with lymph node metastasis, might have benefited from aggressive surgery with curative intent.     

T4 gastric carcinoma: the benefit of non-curative resection

BACKGROUND: The prognosis of patients with gastric carcinoma with invasion of the adjacent organs (T4 gastric carcinoma) is very poor. We evaluated the survival benefit of resection in this group of patients. METHOD: We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection (n = 95) with patients with non-curative resection (n = 193) during the period 1986-2000. RESULTS: With a 33% curative resectability in patients with T4 gastric carcinoma, patients with tumour resection (curative and non-curative) had a significantly improved survival rate. The overall survival rate was higher for patients who underwent resection (11.6%) than for patients who were not resected (2.5%), regardless of curability (P < 0.001). Using Cox's proportional hazard regression model, lymph node invasion and curability were independent statistically significant prognostic parameters. The prognosis of patients with invasion to the peritoneum and adrenal glands was significantly poorer than that of patients in whom there was no such invasion. But, the number of organs invaded had no effect on patient survival. CONCLUSIONS: Patients with T4 gastric carcinoma might be benefited from curative resection. The results also emphasize the improved survivorship of T4 gastric carcinoma patients with resection compared with those who did not undergo resection. Although curative resection cannot be undertaken in patients with T4 gastric carcinoma, we recommend performing resection in patients with locally advanced gastric carcinoma, regardless of curability.     

Lymph node metastasis as a significant prognostic factor in early gastric cancer: Analysis of 1,136 early gastric cancers

Background: Gastric cancer is the most frquent cancer and the leading cause of death from cancer in Korea. Early gastric cancer has been defined as a gastric carcinoma confined to mucosa or submucosa, regardless of lymph node status, and has an excellent prognosis with a >90% 5-year survival rate. From 1974 to 1992, we encountered 7,606 cases of gastric cancer and performed 6,928 gastric resections. Among them, 1,136 cases were early gastric cancer (14.9% of all gastric cancer cases and 16.4% of resected gastric cancer cases). Methods: A retrospective analysis of 1,136 cases of early gastric cancer was performed to evaluate the prognostic significance of clinicopathologic features (sex, age, tumor location, gross type, histologic type, depth of invasion, status of lymph node metastasis, resection type). Lymph node metastasis was classified into three groups: N(n=0) for no lymph node metastasis; N(n=1–3) for one to three lymph node metastases; and N(n>3) for more than three lymph node metastases. All patients received radical total or subtotal gastrectomy with lymph node dissection. Results: In univariate and multivariate analysis of these nine factors, the only statistically significant prognostic factor was regional lymph node metastasis (p<0.001). The others had no statistically significant association with prognosis. Lymph node metastasis was present in 178 cases (15.7%). The factors associated with the lymph node metastasis were depth of invasion and gross type [protruding type (e.g., types I, IIa)]. One hundred twenty-five of these patients had one to three lymph node metastases, and 53 cases had more than three lymph node metastases. The difference in 5-year survival rates among these groups was statistically significant: 94.5% for N(n=0), 88.3% for N(n=1–3), and 77.3% for N(n>3). Conclusion: We propose that for early gastric cancer, lymph node dissection is necessary in addition to gastric resection, at least in patients with a high risk of lymph node metastasis.     

Clinicopathological characteristics of gastric carcinoma in young patients

Background and aims Gastric carcinoma is a common disease that usually affects older patients, rarely younger patients. Although the relationship between prognosis and the age of patients with gastric carcinoma is controversial, most investigators have suggested that young patients have a poorer prognosis. This study examined the clinicopathological features of young patients with gastric carcinoma.Patients and methods We retrospectively reviewed the hospital records of 1,833 patients with gastric carcinoma to compare the clinicopathological findings in young (aged <36 years) and older (aged 36 years) patients during the period 1988 to 1998 in a tertiary referral center in Gwangju City. Overall survival was the main outcome measure.Results Of the 1,833 patients, 137 (7.5%) were in the young age group. There were no significant differences in depth of invasion, lymph node invasion, hepatic metastasis, peritoneal dissemination, tumor stage or rate of curative resection. A significantly higher percentage of young patients had poorly differentiated histology (P=0.0001). The young patients with curatively resected gastric carcinoma had a better survival rate than young patients with non-resected gastric carcinoma (P<0.001). The 5-year survival rates of young and older patients did not differ statistically (39.6% vs 42.4%; P=0.254).Conclusion Young patients with gastric carcinoma do not have a worse prognosis than older patients. The important prognostic factor was whether the patients underwent curative resection.     

Prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer: impact of patterns of pelvic recurrence on curative resection

Background  The purpose of this study is to investigate prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer and determine whether recurrence patterns influence curative resection of recurrent tumor. Materials and methods  We examined 62 patients with isolated local recurrence following total mesorectal excision (TME) of the primary rectal cancer. Recurrence patterns were classified as central, anterior, posterior, lateral, and perineal with respect to the intra-pelvic tumor location. Prognostic factors affecting oncologic outcomes were analyzed, and the rate of curative resection was analyzed according to recurrence patterns. Results  The mean follow-up period was 49.0 ± 29.0 months, and the mean time to recurrence after TME was 27.9 ± 23.3 months. Twenty-three patients underwent curative resection, and the remaining 39 patients received palliative treatment. Patients with a central recurrence had the highest rate of curative resection (p = 0.006). The overall 5-year survival rate was 13.9% and significantly higher in those treated with curative resection (35.1%; p = 0.0002). Multivariate analysis demonstrated that disease-free survival less than 1 year and curative resection of local recurrence were independent prognostic factors influencing 5-year survival. Conclusion  Patients with central recurrences have a high probability of curative resection. Disease-free survival less than 1 year and curative resection of local recurrence were independent prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer.     

Prognosis of upper-third gastric carcinoma patients with invasion of the lower esophagus

Background and aims  Epidemiological studies show a continuing rise in the prevalence of upper-third gastric carcinoma. We compared the clinicopathologic features and prognosis in these patients, with and without lower esophageal invasion. Patients and methods  We reviewed the hospital records of 42 patients with lower esophageal invasion seen between 1986 and 2000. Results  Borrmann type IV gastric carcinoma was more frequently found in patients with esophageal invasion (P < 0.001). Multivariate analysis indicated that curability, the extent of lymph node dissection, and lymph node metastases were significant prognostic factors. When the patients with esophageal invasion were divided into those with or without curative resection, the 5-year survival rates were 37.3% and 0%, respectively (P < 0.001). In patients with lymph node dissection above the D2 lymph node, the 5-year survival rate was higher than that of patients with dissection below the D2 node level (34.4% vs 0%, P < 0.001). Conclusion  According to our results, curative resection and extensive lymph node dissection were the determining factors in improving survival.     

Survival of Young Patients after Gastrectomy for Gastric Cancer

It has been suggested that gastric cancer has a worse prognosis in young patients, but the data are controversial. The aim of this study was to compare the 5-year survivals after gastrectomy for gastric cancer in two groups of patients (those ≤45 years of age and those (>45 years) and to determine some of the prognostic factors. The 5-year survival was significantly better for patients ≤45 years of age. Survival was also better for young patients with a curative resection and also for those with lymph node metastases. However, survival was not significantly different for the two groups when the resection was not curative and when the lymph nodes were not involved. Survival was no different for the two groups when compared at each stage, although a multivariate analysis showed that age >45 years, moderate or poor degree of differentiation of the tumor, advanced tumors, the presence of lymph node involvement, and a noncurative resection were independent negative prognostic factors. Long-term survival after gastrectomy for gastric cancer depends on the stage of the disease; the age of the patient is not a decisive factor.     

Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with gallbladder carcinoma

OBJECTIVE: To investigate whether immunohistochemically demonstrated lymph node micrometastasis has a survival impact in patients with advanced gallbladder carcinoma (pT2-4 tumors). SUMMARY BACKGROUND DATA: The clinical significance of immunohistochemically detected lymph node micrometastasis recently has been evaluated in various tumors. However, few reports have addressed this issue with regard to gallbladder carcinoma. METHODS: A total of 1476 lymph nodes from 67 patients with gallbladder carcinoma (pN0, n = 40; pN1, n = 27) who underwent curative resection were immunostained with monoclonal antibody against cytokeratins 8 and 18. The results were correlated with clinical and pathologic features and with patient survival. RESULTS: Lymph node micrometastases were detected immunohistochemically in 23 (34.3%) of the 67 patients and in 37 (2.5%) of the 1476 nodes examined. Of the 37 nodal micrometastases, 21 (56.8%) were single-cell events, and the remaining 16 were clusters. Five micrometastases were detected in the paraaortic nodes. Clinicopathologic features showed no significant associations with the presence of lymph node micrometastases. Survival was worse in the 27 patients with pN1 disease than in the 40 with pN0 disease (5-year survival; 22.2% vs. 52.6%, P = 0.0038). Similarly, survival was worse in the 23 patients with micrometastasis than in the 44 without micrometastasis (5-year survival; 17.4% vs. 52.7%, P = 0.0027). Twenty-eight patients without any lymph node involvement had the best prognosis, whereas survival for the 11 patients with both types of metastasis was dismal. The grade of micrometastasis (single-cell or cluster) had no effect on survival. The Cox proportional hazard model identified perineural invasion, lymph node micrometastasis, and microscopic venous invasion as significant independent prognostic factors. CONCLUSIONS: Lymph node micrometastasis has a significant survival impact in patients with pN0 or pN1 gallbladder carcinoma who underwent macroscopically curative resection. Extensive lymph node sectioning with keratin immunostaining is recommended for accurate prognostic evaluation for patients with gallbladder carcinoma.     

Evaluation of extensive lymph node dissection for carcinoma of the stomach

We compared the results of curative resection for carcinoma of the stomach in 254 patients who underwent simple resection (SR) and 454 patients who underwent extensive regional lymph node dissection (ELD). The 5-year survival rates of the 2 procedures were significantly different in carcinoma involving the serosa of the stomach; it was 45% in the ELD group and 18% in the SR group (p<0.001). In patients with regional lymph node metastasis we obtained a 5-year survival rates of 39% and 18% by ELD and SR, respectively (p<0.001). The incidence of metastasis to the secondary lymph nodes, removable only by ELD, was higher in cases with carcinomatous invasion of the deeper layers of the gastric wall, and this may have been the reason why ELD proved to be more effective than SR. ELD is discussed in relation to the site of the primary carcinoma and the extent of lymph node metastasis.     

The Turkish experience with curative gastrectomies for gastric carcinoma: is D2 dissection worthwhile?

BACKGROUND: The only possible curative treatment in gastric carcinoma is surgery, and there is still controversy surrounding the value of extended lymph node dissection. STUDY DESIGN: A retrospective cohort study was conducted in patients who underwent curative D1 or D2 resection for operable gastric carcinoma. Survival and multivariate prognostic factor analyses were carried out to determine whether dissection type was significant for outcomes, and which subgroup of patients would benefit from D2 dissection. RESULTS: Three hundred one patients who had potentially curative treatment were eligible to enter the trial. Although mortality rates were 3.1% in the D1 group and 4.3% in the D2 group (p = NS), morbidity rates in the D1 and D2 groups were 6.2% and 27.9%, respectively (p<0.05). Multivariate analysis showed that lymph node dissection type, Borrmann type of tumor, number of metastatic lymph nodes, and depth of wall invasion were the most important independent prognosticators. Five-year disease-free and overall survival rates were 19% and 36% in D1, and 49% and 54% in D2, respectively (p<0.05). After stratifying for pT and pN, the significant survival advantage with D2 was observed in subgroups of pT2, pT3 and pN1, pN2. The subset analysis showed a significant prognostic benefit with D2 dissection in patients in stages II and III-A. CONCLUSIONS: D2 dissections can be carried out with low mortality rates, but they have high morbidity rates and a survival advantage over D1 dissection of only 18%. In principle, a survival benefit with D2 is obtained especially when the tumor invades muscularis propria, penetrates serosa without invasion of adjacent structures, or metastasizes to fewer than fifteen regional lymph nodes. Data in this homogeneous population support the use of extended lymphadenectomy for selected group of patients with gastric carcinoma.     

Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma

BACKGROUND: Pulmonary resection in metastatic renal cell carcinoma is an accepted method of treatment. The purpose of this study was to determine the clinical course, outcome, and prognostic factors after surgery. METHODS: Between 1985 and 1999, 191 patients (145 men, 46 women) with pulmonary metastases from a renal cell carcinoma underwent surgical resection. Inclusion criteria for the study were the absence of primary tumor recurrence and other extrapulmonary metastases. Complete resection (CR) was achieved in 149 patients. RESULTS: The overall 5-year survival rate was 36.9%. The 5-year survival rate after complete metastasectomy and incomplete resection was 41.5% and 22.1%, respectively. In patients with pulmonary or mediastinal lymph node metastases, we observed after complete resection a 5-year survival rate of 24.4%, whereas the rate was 42.1% in patients without lymph node involvement. A significantly longer survival was observed for patients with fewer than seven pulmonary metastases compared with patients with more than seven metastases (46.8% vs 14.5%). For surgically rendered complete resection (CR) patients with a disease-free interval of 0 to 23 months, the 5-year survival rate was 24.7% compared with 47% for those with more than a 23-month disease-free interval. By multivariate analyses, we showed that the number of pulmonary metastases, the involvement of lymph node metastases, and the length of the disease-free interval were all predictors of survival after complete resection. CONCLUSIONS: We conclude that pulmonary resection in metastatic renal cell carcinoma is a safe and effective treatment that offers improved survival benefit. Prognosis-related criteria are identified that support patient selection for surgery.     

A prognostic score for gastric cancer

BACKGROUND: Scoring systems are generally used for predicting prognosis in the intensive care unit, but there is no score being used frequently for predicting prognosis in gastric cancer. The aim of this study was to develop a prognostic score for gastric cancer patients. METHODS: Demographic, clinical, laboratory, radiologic, histopathologic data, and operative findings for 128 patients who had curative or palliative resection for gastric cancer were analyzed for their effect on overall and disease-free survival. Ten variables-invasion depth of tumor, node status (American Joint Committed on Cancer, 1992), metastasis, node status (Union Internationale Contre le Cancer, 1997), metastatic lymph node ratio, resectability, tumor location, extent of lymphadenectomy, Borrmann type, Lauren type-that have independent significant effect or borderline significance on both overall and disease-free survival according to multivariate analysis were chosen. Coefficients were calculated for these variables by using Cox regression analysis, and thus the Prognostic Score for Gastric Cancer (PSGC) was designed. All patients were scored using the PSGC and also staged clinically (AJCC 1992) and histopathologically (AJCC 1992 and UICC 1997). RESULTS: Patients were grouped according to their scores: group 1, patients with scores 20 to 50 (probability of 5-year overall survival 50% to 95%); group 2, patients with scores 51 to 80 (probability of 5-year overall survival 10% to 50%); and group 3, patients with scores 81 and higher (probability of 5-year overall survival <10%). Overall survival and disease-free survival decreased significantly with increasing scores. The association of PSGC and staging systems with survival was analyzed by stepwise logistic regression and Cox regression analyses. PSGC was proved to have the most significant association with overall and disease-free survival. CONCLUSIONS: Inclusion of more variables in PSGC seems to make it superior than staging. It is easy to adapt PSGC to different patient populations, which may make it accepted as a practical and useful scoring system in clinical practice.     

The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma

BACKGROUND: Splenectomy at the time of resection of esophageal, gastric, or colon cancer has been correlated with inferior longterm survival. No such effect has yet been demonstrated for pancreatic cancer. STUDY DESIGN: Patients undergoing resection of pancreatic adenocarcinoma with curative intent at Memorial Sloan-Kettering Cancer Center between October 1983 and October 1995 were identified from a prospective clinical database. The impact of splenectomy on hospital stay and survival was calculated with univariate and multivariate nonparametric methods. RESULTS: Of 332 patients undergoing pancreatectomy, 326 with confirmed local or regional disease only formed the study cohort. Of these, 37 underwent concomitant splenectomy (11.4%). Splenectomy was significantly correlated with distal or total pancreatectomy, primary location in tail or body, portal vein invasion or resection, a larger maximal tumor diameter, and an operative blood loss of greater than 2,000 mL. Death or need for reoperation was not affected by splenectomy. Patients undergoing splenectomy had a higher median transfusion requirement (3 versus 1; p = 0.002). The median postoperative length of stay was 15 days regardless of splenectomy. At a median followup of 16.3 months (36.4 months for surviving patients), the median actuarial survival was 12.2 months with splenectomy versus 17.8 months without splenectomy (p<0.005). On multivariate analysis, splenectomy emerged as an independent factor predictive of decreased postoperative survival (p = 0.02), in addition to pathologic lymph node status (p = 0.0002), tumor diameter (p = 0.0004), and tumor differentiation (p = 0.007). Tumor location within the pancreas and the type of pancreatectomy were not independent prognostic factors influencing survival. CONCLUSIONS: After pancreatectomy for pancreatic cancer, splenectomy has no significant measurable impact on postoperative recovery, but has a negative influence on longterm survival independent of disease-related factors. Unless required because of tumor proximity or invasion, splenectomy should be avoided in the operative treatment of exocrine pancreatic cancer at any location.