Surgical Oncology 23 (2014) 5e10
Contents lists available at ScienceDirect
Surgical Oncology journal homepage: www.elsevier.com/locate/suronc
Review
Is tumor size a predictor of preoperative N staging in T2eT4a stage advanced gastric cancer? Chang-Ming Huang*, Mu Xu, Jia-Bin Wang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jian-Xian Lin, Jun Lu Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 12 January 2014
Background: The aim of this study was to assess the relationship between tumor size and preoperative N staging in patients with T2eT4a stage advanced gastric cancer. Methods: A total of 697 patients with gastric cancer were analyzed. The correlations between the number of metastatic lymph nodes (LNs) and other clinicopathologic factors were investigated. The Kappa consistency test was used to test the agreement between predicted and pathologic N staging. Results: Multivariate analysis showed that tumor size was independently (r ¼ 0.987, P < 0.05) and linearly (R2 ¼ 0.940, P < 0.05) correlated with the number of metastatic LNs. The numbers of predicted metastatic LNs in patients with primary tumors 6 regional LNs). Patients were included if they underwent curative (R0) resection, defined as no macroscopically or microscopically residual tumor, with no less than D2 LN dissection, and pathologic examination of resected specimens. In addition, none of these patients had received neoadjuvant chemotherapy, and all had complete medical records. Patients with gastric stump cancer, infiltration of surrounding organs (T4b) or distant metastases (hepatic, lung, peritoneal dissemination, or extraregional LNs such as the retropancreatic, mesenteric, and para-aortic LNs) were excluded.
opened along the greater curvature to expose the entire mucosa. If the tumor was located on the greater curvature, the stomach was opened along the lesser curvature. The opened stomach was placed on a flat board with the mucosal side up and examined macroscopically. The lengths of the greater and lesser curvature, the attached portion of the esophagus and/or duodenum and the size and thickness of the tumor were recorded (Fig. 1), as were the distances between the tumor border and the proximal and distal cut ends. The longer tumor size was used in the current study. When tumor margin was unclear such as type 4 advanced gastric cancer, the resected stomach was then fixed by formalin for 1 h. Afterward, the tumor margin was determined by the pathologists with gross observation of the microscopic examination [13,15]. Follow-up Routine follow-up consisted of physical examination, laboratory tests (including measurements of CEA, CA19-9 and CA125 concentrations), chest radiography, abdominopelvic ultrasonography and computed tomography (CT). Patients were followed-up every 3 months during the first year and every 6 or 12 months thereafter, for a total of 5 years. Endoscopy was performed every 6 or 12 months. All surviving patients were followed for more than five years. Overall survival (OS) was calculated from the date of diagnosis to last contact, date of death, or date when the survival information was collected. Of the 697 patients, 634 (91.0%) were followed-up. The median follow-up time was 60.0 months (range 1.0e186.0 months). Statistical analysis All statistical analyses were performed with the Statistical Package for Social Science (SPSS) version 18.0 for Windows. The c2 test was used to evaluate differences in proportions, and Student’s t-tests were used to evaluate continuous variables. Multivariate logistic regression model analysis was performed to further evaluate factors found to be significantly prognostic on univariate analysis. The relationship between tumor size and the number of metastatic LNs was assessed using the Pearson correlation test and further evaluated by the generalized linear regression model. The Kappa consistency test was used to assess the agreement between predicted and pathologic N staging. Survival analysis was performed using the KaplaneMeier method and curves were compared with the log-rank test. All P values were two-sided, with P values
Contents lists available at ScienceDirect
Surgical Oncology journal homepage: www.elsevier.com/locate/suronc
Review
Is tumor size a predictor of preoperative N staging in T2eT4a stage advanced gastric cancer? Chang-Ming Huang*, Mu Xu, Jia-Bin Wang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jian-Xian Lin, Jun Lu Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 12 January 2014
Background: The aim of this study was to assess the relationship between tumor size and preoperative N staging in patients with T2eT4a stage advanced gastric cancer. Methods: A total of 697 patients with gastric cancer were analyzed. The correlations between the number of metastatic lymph nodes (LNs) and other clinicopathologic factors were investigated. The Kappa consistency test was used to test the agreement between predicted and pathologic N staging. Results: Multivariate analysis showed that tumor size was independently (r ¼ 0.987, P < 0.05) and linearly (R2 ¼ 0.940, P < 0.05) correlated with the number of metastatic LNs. The numbers of predicted metastatic LNs in patients with primary tumors 6 regional LNs). Patients were included if they underwent curative (R0) resection, defined as no macroscopically or microscopically residual tumor, with no less than D2 LN dissection, and pathologic examination of resected specimens. In addition, none of these patients had received neoadjuvant chemotherapy, and all had complete medical records. Patients with gastric stump cancer, infiltration of surrounding organs (T4b) or distant metastases (hepatic, lung, peritoneal dissemination, or extraregional LNs such as the retropancreatic, mesenteric, and para-aortic LNs) were excluded.
opened along the greater curvature to expose the entire mucosa. If the tumor was located on the greater curvature, the stomach was opened along the lesser curvature. The opened stomach was placed on a flat board with the mucosal side up and examined macroscopically. The lengths of the greater and lesser curvature, the attached portion of the esophagus and/or duodenum and the size and thickness of the tumor were recorded (Fig. 1), as were the distances between the tumor border and the proximal and distal cut ends. The longer tumor size was used in the current study. When tumor margin was unclear such as type 4 advanced gastric cancer, the resected stomach was then fixed by formalin for 1 h. Afterward, the tumor margin was determined by the pathologists with gross observation of the microscopic examination [13,15]. Follow-up Routine follow-up consisted of physical examination, laboratory tests (including measurements of CEA, CA19-9 and CA125 concentrations), chest radiography, abdominopelvic ultrasonography and computed tomography (CT). Patients were followed-up every 3 months during the first year and every 6 or 12 months thereafter, for a total of 5 years. Endoscopy was performed every 6 or 12 months. All surviving patients were followed for more than five years. Overall survival (OS) was calculated from the date of diagnosis to last contact, date of death, or date when the survival information was collected. Of the 697 patients, 634 (91.0%) were followed-up. The median follow-up time was 60.0 months (range 1.0e186.0 months). Statistical analysis All statistical analyses were performed with the Statistical Package for Social Science (SPSS) version 18.0 for Windows. The c2 test was used to evaluate differences in proportions, and Student’s t-tests were used to evaluate continuous variables. Multivariate logistic regression model analysis was performed to further evaluate factors found to be significantly prognostic on univariate analysis. The relationship between tumor size and the number of metastatic LNs was assessed using the Pearson correlation test and further evaluated by the generalized linear regression model. The Kappa consistency test was used to assess the agreement between predicted and pathologic N staging. Survival analysis was performed using the KaplaneMeier method and curves were compared with the log-rank test. All P values were two-sided, with P values
