Prognostic factors in stage IV gastric cancer: univariate and multivariate analyses

Background. The prognosis of stage IV gastric cancer is poor with the 5-year survival rate still being about 10%. Methods. We classified 130 patients with stage IV gastric cancer into four groups: peritoneal metastasis, liver metastasis, lymph node metastasis, and multiple factor groups, according to the factors that determined stage IV in each patient and compared survival in the four groups. We also performed univariate and multivariate analyses of various prognostic clinicopathological factors. The 5-year survival rate in the patients with stage IV gastric cancer was 7.4%. Results. No significant differences were observed in survival among the four groups. Univariate analysis showed significant differences in survival among the categories of lymphatic invasion ( P = 0.0045), venous invasion ( P = 0.0024), peritoneal metastasis ( P = 0.0019), postoperative chemotherapy ( P = 0.0385), curability ( P = 0.0001), and lymph node dissection ( P = 0.0001). In the curability B group, survival was prolonged in the postoperative chemotherapy group. Multivariate analysis revealed the highest relative hazard (RH) for lymph node dissection (RH, 2.261), followed, in descending order, by curability (RH, 1.905), peritoneal metastasis (RH, 1.896), lymphatic invasion (RH, 1.736), and venous invasion (RH, 1.481). Conclusion. As prognostic factors in stage IV gastric cancer, the tumor factors of peritoneal metastasis and vessel invasion, and the treatment factors of curability and lymph node dissection may be important, and active treatment appears to improve survival. Received: March 2, 2000 / Accepted: June 2, 2000     

Prognostic factors of esophageal carcinoma: univariate and multivariate analyses

The correlation of 5-year survival rate with various clinical and histopathological factors was studied using univariate and multiple analyses of 128 patients who had undergone resection for esophageal carcinoma between 1965 and 1978 in the Department of Surgery, Kyushu University Hospital. The depth of penetration, lymph node metastasis, lymphatic or vascular invasion, and INF had a significant correlation with 5-year survival in the univariate analysis; however, only depth of penetration and lymph node metastasis were prognostic factors with a significant difference, in the multivariate analysis. In 55 patients in whom the cell nuclear DNA content had been determined, the DNA pattern was the greatest prognostic factor (p less than 0.01), in multivariate analysis. We propose that the DNA distribution in the malignant cells should be examined as a most pertinent prognostic factor.     

Prognostic factors for recurrent breast cancer: univariate and multivariate analyses including histologic grade and amplification of the c-erbB-2 proto-oncogene.

Post-recurrence survival was examined in 62 breast cancer patients who had undergone curative radical mastectomies between 1974 and 1976 and suffered recurrences within 127 months of surgery. The prognostic value of 11 clinical, histological and genetic factors, including histologic grade of malignancy and amplification of oncogenes was analyzed using univariate and multivariate analyses. Not only the site of first recurrence, clinical stage and size of primary tumor at initial surgery, and disease-free period, but also histologic grade and amplification of the c-erbB-2 proto-oncogene were significant prognostic indicators of recurrent breast cancer. Multivariate analysis using Cox's regression model, histologic grade and amplification of c-erbB-2 in the primary tumor, as well as clinical stage at surgery and site of first recurrence, were shown to be major independent prognostic factors of recurrent breast cancer. Because post-recurrence prognosis was strongly influenced by the clinical, histological and genetic status of the primary breast cancer, appropriate evaluation of the primary tumor for the grade of aggressiveness of the cancer cells, as well as the extent of cancer spread, seem to be important.     

Metastatic pattern of lymph node and surgery for gastric stump cancer

BACKGROUND AND OBJECTIVES: Metastatic pattern of lymph node (LN) and surgery options for gastric stump cancer (GSC) remain controversial. The aim of this study was to investigate LN metastasis and lymphadenectomy for GSC for curative purposes. METHODS: Sixty-seven patients with GSC were analyzed retrospectively. RESULTS: The metastatic rates of LN were as follows: 63.3% in right cardia (No. 1), 33.3% in left cardia (No. 2), 75.0% in lesser curvature (No. 3), 53.3% in greater curvature (No. 4), 40.0% in celiac artery (No. 9), 60.0% in splenic hilus (No. 10), 72.7% in splenic artery (No. 11), 36.1% in hepatoduodenal ligament (No. 12), 8.3% in retropancreatic (No. 13), 21.4% in para-aortic (No. 16), 50% in supra-diaphragm (No. 111), 16.7% in LN within jejunal mesentery, respectively. All nine patients who only received simple laparotomy died within 1 year. The overall 5-year survival rate of GSC was 17.9% (12/67), including 100% for stage I, 80.0% for stage II, 12.1% for stage III, and 0% for stage IV. Moreover, the 5-year survival rate (36.7%, 11/30) for curative patients was significantly better than that (3.6%, 1/28) of non-curative patients (chi(2) = 7.76, P < 0.01). CONCLUSIONS: Our results imply that GSC has a wide range of LN metastases, including LN within jejunal mesentery in B-II reconstruction cases, and curable resection may obtain better results. Therefore, we suggest that radical operation for B-I patients needs removal of gastroduodenectomy anastomosis and the above LNs, and that B-II patients need removal of 10 cm of jejunum besides gastrojejunostomy anastomosis, and clearance of LN within its mesentery, in addition to B-I GSC.     

The extent of lymph node dissection for gastric cancer: a critical appraisal

The extent of lymphadenectomy during therapeutic gastrectomy for gastric cancer remains a protracted and controversial issue. While traditionally extended lymphadenectomy is performed in Eastern Asia, limited lymphadenectomy is advocated by most western surgeons. Two large western randomized trials, meta-analyses and a recent systematic review were unable to demonstrate overall benefit from extended lymphadenectomy. In this review, the currently available data on this topic are critically evaluated, while ongoing studies and future perspective are discussed.     

晚期胃癌姑息性切除手术的临床价值

目的探讨Ⅳ期胃癌姑息性切除手术的临床意义.方法1990年-1997年获随访的Ⅳ期胃癌35例中,18例行肿瘤姑息性切除术,17例肿瘤未切除.结果晚期胃癌手术切除组生存率明显高于未切除组(P=0.0278),其中以胃癌仅伴邻近器官浸润及或仅伴非弥漫性肝转移,或仅伴腹膜种植组手术切除后疗效最佳,二、三年生存率分别为50%、33.33%.肿瘤切除组生存质量明显好于未切除组(P＜0.005).结论晚期胃癌全身情况及局部情况允许时应争取行肿瘤切除术,可提高术后生存率及术后生命质量.     

Prognostic factors and recurrence pattern in node-negative advanced gastric cancer

Aims

Despite better overall survival in node-negative advanced gastric cancer (AGC), a significant proportion of patients develop recurrence and they may benefit from adjuvant therapy. The aim of this study was to evaluate the prognostic factors and recurrence pattern of node-negative AGC.

Methods

A total of 424 patients who underwent curative gastrectomy with extended lymphadenectomy for node-negative AGC between 2003 and 2005 were retrospectively reviewed. Patients with tumor involvement of adjacent organs (T4b), gastric cancer recurrence, tumor in the remnant stomach, less than 15 harvested lymph nodes, and those who received neoadjuvant chemotherapy were excluded.

Results

Invasion to deeper layers, undifferentiated histology, signet ring cell type compared with tubular adenocarcinoma, and tumor size larger than 6.3 cm correlated with poorer prognosis in univariate analysis. In multivariate one, however, only differentiation and depth of invasion, especially the presence of serosa involvement were significant. The 5-year survival rates of the four groups classified by differentiation and depth of invasion [T2/3 (differentiated type), T2/3 (undifferentiated type), T4a (differentiated type), and T4a (undifferentiated type)] were 98%, 92%, 80%, and 72%, respectively (P < 0.01). In terms of recurrence pattern, Lauren's type and depth of invasion were significant. Recurrence with peritoneal seeding was associated with the diffuse type and invasion into the subserosa or serosa, while hematogenous metastasis was related to the intestinal type and invasion to the proper muscle or subserosa layer.

Conclusions

Differentiation and serosa involvement should be considered to stratify patients with node-negative AGC for adjuvant treatment.     

Clinicopathological Analysis as Predictive Factors for Recurrence in Early Gastric Cancer

OBJECTIVE To identify clinicopathological characteristics as predictive factors for recurrence in early gastric cancer(EGC),and to determine which lesions should be removed by gastrectomy by means other than endoscopic mucosal resection(EMR). METHODS Data from 249 patients with EGC were collected and the relationship between their clinicopathological characteristics and postoperative recurrence was retrospectively analyzed by univariate analysis. RESULTS Of the 249 patients a er gastrectomy,19 cases(7.6%) experienced a recurrence.The postoperative recurrence rate was 18.9%(7/37)in patients with lymph node metastasis,and 5.7% (12/212)in those without.Lymph node metastases were found to be significantly related to recurrence in EGC(P=0.005). CONCLUSION Lymph node metastases were the only predictive factor for recurrence in EGC.However,this was not the determining factor for performing gastrectomy rather than EMR.Although after gastrectomy with lymphadenectomy of EGC,patients with lymph node metastasis should be considered as candidates for adjuvant treatment.For lymph-node metastatic EGCs,adjuvant therapy is recommended following gastrectomy with lymphadenectomy.     

T4期胃癌手术方法的比较及其预后因素

Objective  

In advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, it is inconclusive as to whether or not there is an improvement in the survival rate. We compared with gastrectomy alone to analyze the prognostic factors in T4 gastric cancers.     

Prognostic factors after hepatectomy for hepatocellular carcinomas. A univariate and multivariate analysis

The current study determines the prognostic factors after hepatectomy for hepatocellular carcinomas. The 295 patients who underwent hepatectomy from 1973 through 1987 were included for a univariate and a Cox multivariate analysis. The favoring conditions were determined as follows. The essential requirements are (1) the absence of tumor thrombi; (2) no intrahepatic metastasis, but even when present, it should be close to the main tumor and removed with a massive resection; and (3) retention rate of indocyanine green dye (ICG) at 15 minutes should be within 14 +/- 4.2% (M +/- SD) to allow that resection. The desired requirement is that the tumor size should preferably be less than 5 cm; a wider free margin from tumors (greater than or equal to 1 cm) is recommended, but not determining factor. The eligible patients, having no thrombi, no intrahepatic metastasis, a tumor size of 5 cm or less, negative surgical margin (greater than or equal to 1 cm), had achieved a 5-year survival of 78%. In conclusion, resection therapy is the first option for patients with those requirements.     

D2 lymphadenectomy in gastric cancer surgery

Gastric cancer is one of the most common causes of cancer death worldwide. Surgery is the most widely utilized treatment for resectable gastric cancer. Evidence indicates that lymph node involvement and depth of invasion of the primary tumor are the most important prognostic factors for gastric cancer patients. Therefore, lymph node clearance is deemed a key procedure in gastric cancer surgery for the prognostic value to patients. Although the appropriate lymphadenectomy during gastrectomy for cancer still remains controversial, extended lymph node dissection （D2 lymphadenectomy） should be recommended in high volume hospitals.     

17例胃癌穿孔的诊断治疗体会

目的研究胃癌穿孔患者治疗方法的临床疗效。方法对17例胃癌穿孔的患者进行手术治疗并进行评价。结果治疗后，住院期间死亡率为0；胃肠吻合口瘘为11．8％；平均存活时间为18．3个月；行根治性手术者，平均存活36．2个月。结论对胃癌穿孔患者，只要休克能纠正，身体状态允许，病灶可切除，进行根治性切除治疗是积极的治疗方法。     

Prognostic impact of dimensional factors in pT1 gastric cancer

BackgroundThe significance of the dimensional factors (tumor diameter, area and volume) as the prognostic factor has not been precisely evaluated in pT1 gastric cancer.ObjectivesThis study aimed to identify the clinical impact and to confirm the clinical feasibility of the dimensional factors as prognostic factors in pT1 gastric cancer.MethodsWe analyzed prognostic factors for disease-specific survival (DSS), overall survival (OS) using clinicopathological factors by univariate and multivariate analyses and the pattern of recurrence in 2011 pT1 gastric cancer (mucosal and submucosal cancers) undergoing R0 gastrectomy. The cut-off values of each dimensional factor was decided by the ROC curve.ResultsCox proportional hazard regression model showed that older age (≥75) and more advanced pN stage were adverse independent prognostic factors for DSS, and revealed that older age (≥75), greater preoperative co-morbid diseases, proximal and total gastrectomy, operative method and Clavien-Dindo classification (≥grade III) were independent adverse factors for OS. Any dimensional factors were not independent prognostic factors for any survival.ConclusionsThe dimensional factors do not influence both OS and DSS in pT1 gastric cancer patients and so it is difficult to apply these dimensional factors for conducting therapeutic strategies.     

晚期胃癌二线化疗的预后因素分析

目的:探讨晚期胃癌患者二线化疗的预后因素,筛选二线化疗的最佳人群。方法:回顾性分析256例接受二线化疗的晚期胃癌患者,采用Kaplan-Meier法计算生存率,Log-rank检验比较各亚组生存率,采用Cox比例分析模型作临床病理特征对生存率影响的单因素和多因素分析。结果:二线化疗的客观有效率18.0%,中位至进展时间(TTP)3.0个月,中位生存期(OS)8.1个月,1年生存率24.4%。多因素分析发现,分化程度(RR=1.33;95%CI:1.02～1.74;P=0.04)、一线化疗的TTP(RR=2.12;95%CI:1.59～2.83;P=0.00)、二线化疗前PS评分(RR=5.42;95%CI:3.65～8.05;P=0.00)和血红蛋白(RR=3.56;95%CI:2.49～5.09;P=0.00)是晚期胃癌二线化疗的独立预后因素。根据患者含预后不良因素的个数,分为低危(0)、中危(1～2)和高危(3～4)3组,3组的中位生存期分别为10.2、6.4和3.3个月,1年生存率分别为39.2%和8.5%,0,P=0.00。结论:影响晚期胃癌二线化疗的独立预后因素包括分化程度、二线化疗前PS评分、血红蛋白和一线化疗的TTP,可作为筛选晚期胃癌二线化疗适宜人群的有效指标。     

Prognostic evaluation of lymphadenectomy for epithelial ovarian cancer

Between 1989 and 1991, 150 patients with ovarian cancer were treated with chemotherapy, including cisplatin, in the Tokai Ovarian Tumor Study Group. Of these patients, 25 underwent cytoreductive surgery with lymphadenectomy, including removal of either pelvic or para-aortic lymph nodes, and 36 underwent both lymphadenectomies. A significant difference was observed between survival curves of the groups with positive and negative lymph nodes, respectively (P = 0.0049). The overall survival was longer in the lymphadenectomy group than in the nonlymphadenectomy group (P = 0.0842), and a significantly longer survival time was noted for stage III patients who underwent lymphadenectomy compared to those who did not (P = 0.0185). Multivariate analysis demonstrated that lymphadenectomy is a positive prognostic factor. The authors conclude that both pelvic and para-aortic lymph nodes should be resected to improve survival as well as to assess exact staging in patients with ovarian cancer. © 1995 Wiley-Liss, Inc.     

Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: a 15-year experience at a single institute

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate whether microscopic positive margins are detrimental to the outcome of gastric cancer patients treated with extended (D2/3) gastrectomy. METHODS: Among 2,740 consecutive patients who had undergone extended gastrectomy for advanced gastric cancer between January 1987 and December 2002, 49 patients (1.8%) had positive resection margins on final histology. RESULTS: Among 49 patients, 29 (59.2%) had proximal involved margins and 20 (40.8%) had distal involved margins. The median survival time of the positive margin group was 34 months. The negative margin group had a significantly longer median survival time of 69 months (P = 0.025). When both groups of patients were stratified according to nodal stage, a positive resection margin determined a worse prognosis only in patients with node-negative disease (174 months vs. 37 months, P = 0.0001). In patients with nodal metastasis, the median survival time was similar in both groups. CONCLUSIONS: Our results suggest that a positive microscopic margin is associated with a worse outcome in patients with node-negative disease. Therefore, a more aggressive treatment, such as re-operation, is needed in node-negative patients with a positive microscopic disease.