An aggressive early gastric cancer: Kodama's PenA type |
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| Authors: | Paolo Morgagni Leonardo Solaini Luca Saragoni Maria Bencivenga Uberto Fumagalli Romario Luigina Graziosi Elisabetta Marino Daniele Marrelli Stefano Rausei Fausto Rosa Emanuela Scarpi Anna Tomezzoli Domenico Tringali Carla Vindigni Giovanni Vittimberga Franco Roviello |
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| Affiliation: | 1. General and Oncologic Surgery, Department of Surgery, G.B. Morgagni L.Pierantoni General Hospital, AUSL Romagna, Forlì, Italy;2. Department of Pathology, G.B. Morgagni L.Pierantoni General Hospital, Forlì, Italy;3. General and Upper GI Surgery, University of Verona, Italy;4. Chirurgia Generale 2, ASST Spedali Civili, Brescia, Italy;5. Department of Surgery, Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy;6. Department of Surgery, Policlinico le Scotte, University of Siena, Siena, Italy;g. Department of Surgery, ASST Settelaghi, University of Insubria, Varese, Italy;h. Digestive Surgery Department, “A. Gemelli” Hospital, Rome, Italy;i. Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy;j. Department of Pathology, University of Verona, Verona, Italy;k. Department of Pathology, Policlinico le Scotte, University of Siena, Siena, Italy;l. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy |
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| Abstract: | BackgroundTo investigate the role of Kodama PenA subtype in influencing survival in patients with early gastric cancer (EGC).MethodsAll patients surgically treated for EGC at 7 Italian centers (Forlì, Varese, Siena, Verona, Milan, Rome and Perugia) belonging to the Italian Research Group for Gastric Cancer (GIRCG) from January 1982 and December 2009 were included.ResultsPenA patients were 230 (21.5%) while other types were 839 (78.5%). Nodal metastases were more common in PenA (30.7%) than non-PenA (10.4%) EGCs. Among preoperative variables, only age (OR 1.02; 95% CI 1.00–1.03, p = 0.009) and macrotype III (OR 1.95; 95% CI 1.39–2.75, p = 0.0001) were significantly associated with Pen A type. Survival analysis performed on N0 patients demonstrated that only size >2 cm (HR 1.85; 95% CI 1.12–3.05, p = 0.017) and age (HR 1.06; 95% CI 1.03–1.08, p < 0.0001) were independent poor prognostic factor. Among N+ patients age (HR 1.04; 95% CI 1.00–1.07, p = 0.048), number of positive lymph nodes (HR 1.13; 95% CI 1.05–1.20, p = 0.0002) and PenA (HR 4.23; 95% CI 1.70–10.55, p = 0.002) were significantly correlated with poor prognosis at multivariate analysis.ConclusionsKodama PenA subtype was the most powerful independent prognostic factor in patients with nodal metastases. Its status should always be investigated in EGCs patients. |
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| Keywords: | Early gastric cancer Lymph node metastases Prognosis Histotype Prognostic factors |
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