Influence of different biological behaviors on prognosis of patients with advanced gastric cancer at the same TNM stage
10.3760/cma.j.cn.441530-20190926-00361
- VernacularTitle:不同生物学行为对相同TNM分期进展期胃癌患者预后的影响
- Author:
Yingbo GONG
1
;
Zhi ZHU
;
Xin WANG
;
Huimian XU
Author Information
1. 中国医科大学附属第一医院胃肠肿瘤外科 辽宁省胃癌分子病理重点实验室，沈阳 110001
- Keywords:
Stomach neoplasms;
TNM staging;
Biological behavior;
Prognosis
- From:
Chinese Journal of Gastrointestinal Surgery
2020;23(10):953-962
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Although stage of disease is one of the main factors affecting the prognosis of gastric cancer, the prognosis of gastric cancer patients with different biological behaviors is also different, indicating that the biological behavior of gastric cancer is also of great significance. This study explores the clinicopathological characteristics of gastric cancer patients with different biological behaviors in the same TMN stage, and analyzes its impact on the prognosis, so as to provide reasonable and reliable evidences for surgical treatment.Methods:A retrospective cohort study was carried out. Clinicopathological data of patients with advanced gastric cancer undergoing radical surgery at Department of Gastrointestinal Surgery, the First Affiliated Hospital of China Medical University from January 1980 to December 2012 were collected. Case inclusion criteria: (1) advanced gastric cancer confirmed by postoperative pathology; (2) R0 resections; (3) complete follow-up data. Exclusion criteria: (1) history of previous gastric surgery, preoperative adjuvant therapy, and imaging evidence of distant metastasis before surgery; (2) age of patients <18 or > 90 years; (3) lack of clinical, pathological, or follow-up data. Cumulative survival was analyzed and plotted by the Kaplan-Meier method. Log-rank test was used for univariate analysis and Cox proportional hazard regression was used for multivariate analysis. Difference of prognosis was compared among different biological behaviors at the same TNM stage.Results:A total of 2522 patients were enrolled, including 246 cases in stage IB (T2N0M0), 422 cases in stage IIA, 474 cases in stage IIB, 681 cases in stage IIIA, 441 cases in stage IIIB, and 256 cases in stage IIIC. Their 5-year survival rates were 79.9%, 68.5%, 56.1%, 39.5%, 22.5%, and 8.1%, respectively, and the difference was statistically significant ( P<0.001). Univariate and multivariate analysis showed that for patients with stage IB gastric cancer, the macroscopic type as infiltration (HR=1.806, 95% CI:1.174-2.780, P=0.007), tissue growth mode as diffusion (HR=1.370, 95% CI:1.007-1.864, P=0.045), and positive lymphovascular cancer embolus (HR=2.073, 95% CI: 1.333-3.224, P=0.001) were independent risk factors of prognosis; for patients with stage IIA gastric cancer, the macroscopic type as infiltration (HR=1.376, 95% CI: 1.008-1.878, P=0.044), tissue growth mode as diffusion (HR=1.263, 95% CI: 1.061-1.505, P=0.009), positive lymphovascular cancer embolus (HR=2.296, 95% CI:1.753-3.008, P<0.001) were independent risk factors of prognosis; for patients with stage IIB gastric cancer, macroscopic type as infiltration (HR=1.445, 95% CI: 1.056-1.976, P=0.021), positive lymphovascular cancer embolus (HR=1.528, 95% CI: 1.194-1.955, P=0.001) were independent risk factors of prognosis; for patients with stage IIIA gastric cancer, macroscopic type as infiltration (HR=1.395, 95% CI: 1.095-1.777, P=0.007), positive lymphovascular cancer embolus (HR=1.583, 95% CI: 1.315-1.905, P<0.001) and serosal type (tendon type+colorful diffusion type) (HR=1.188, 95% CI: 1.102-1.282, P<0.001) were independent risk factors of prognosis; for patients with stage IIIB gastric cancer, macroscopic type as infiltration (HR=1.485, 95% CI: 1.063-2.076, P=0.021), positive lymphovascular cancer embolus (HR=1.315, 95% CI: 1.060-1.631, P=0.013), and serosal type (tendon type+colorful diffusion type) (HR=1.146, 95% CI: 1.052-1.248, P=0.002) were independent risk factors of prognosis; for patients with stage IIIC gastric cancer, macroscopic type as infiltration (HR=2.986, 95% CI: 1.293-6.898, P=0.010) and serosal type (tendon type+colorful diffusion type) (HR=1.135, 95% CI: 1.003-1.283, P=0.045) were independent risk factors of prognosis. Conclusion:Under the same TNM stage, different biological behaviors have very different prognosis, which indicates that the biological behavior of gastric cancer is equally as important as TNM staging for the prognosis of patients and the guidance of individualized treatment.
