Effect of Preoperative Tumour Under-Staging on the Long-Term Survival of Patients Undergoing Radical Gastrectomy for Gastric Cancer
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Purpose This study aimed to evaluate the effect of preoperative tumor staging deviation (PTSD) on the long-term survival of patients undergoing radical gastrectomy for gastric cancer (RGGC). Materials and Methods Clinicopathological data of 2,346 patients who underwent RGGC were retrospectively analyzed. The preoperative tumor-lymph node-metastasis (TNM) under-staging group (uTNM) comprised patients who had earlier preoperative TNM than postoperative TNM, and the no preoperative under-staging group (nTNM) comprised the remaining patients. Results There were 1,031 uTNM (44.0%) and 1,315 nTNM cases (56.0%). Cox prognostic analysis revealed that PTSD independently affected the overall survival (OS) after surgery. The 5-year OS was lower in the uTNM group (41.8%) than in the nTNM group (71.6%). The patients less than 65 years old, with lower American Society of Anaesthesiologists score, 2-5 cm tumor located at the lower stomach, and cT1 or cN0 preoperative staging would more likely undergo D1+ lymph node dissection (LND) in uTNM (p < 0.05). Logistic analyses revealed that tumor size > 2 cm and body mass index ≤ 22.72 kg/m2 were independent risk factors of preoperative TNM tumor under-staging in patients with cT1N0M0 staging (p < 0.05). Conclusion Underestimated tumor staging is not rare, which possibly results in inadequate LND and affects the long-term survival for patients undergoing RGGC. D2 LND should be carefully performed in patients who are predisposed to this underestimation.
Abstract
Purpose This study aimed to evaluate the effect of preoperative tumor staging deviation (PTSD) on the long-term survival of patients undergoing radical gastrectomy for gastric cancer (RGGC). Materials and Methods Clinicopathological data of 2,346 patients who underwent RGGC were retrospectively analyzed. The preoperative tumor-lymph node-metastasis (TNM) under-staging group (uTNM) comprised patients who had earlier preoperative TNM than postoperative TNM, and the no preoperative under-staging group (nTNM) comprised the remaining patients. Results There were 1,031 uTNM (44.0%) and 1,315 nTNM cases (56.0%). Cox prognostic analysis revealed that PTSD independently affected the overall survival (OS) after surgery. The 5-year OS was lower in the uTNM group (41.8%) than in the nTNM group (71.6%). The patients less than 65 years old, with lower American Society of Anaesthesiologists score, 2-5 cm tumor located at the lower stomach, and cT1 or cN0 preoperative staging would more likely undergo D1+ lymph node dissection (LND) in uTNM (p < 0.05). Logistic analyses revealed that tumor size > 2 cm and body mass index ≤ 22.72 kg/m2 were independent risk factors of preoperative TNM tumor under-staging in patients with cT1N0M0 staging (p < 0.05). Conclusion Underestimated tumor staging is not rare, which possibly results in inadequate LND and affects the long-term survival for patients undergoing RGGC. D2 LND should be carefully performed in patients who are predisposed to this underestimation.
참고문헌 (20)
- Ferlay J, "Cancer incidence and mortality worldwide : sources, methods and major patterns in GLOBOCAN 2012", Int J Cancer, 136, pp.E359~86 (2015)
- Amin MB, "The Eighth Edition AJCC Cancer Staging Manual : Continuing to build a bridge from a population-based to a more"personalized"approach to cancer staging", CA Cancer J Clin, 67, pp.93~99 (2017)
- Japanese Gastric Cancer Association, "Japanese gastric cancer treatment guidelines 2010 (ver. 3)", Gastric Cancer, 14, pp.113~123 (2011)
- Habermann CR, "Preoperative staging of gastric adenocarcinoma : comparison of helical CT and endoscopic US", Radiology, 230, pp.465~471 (2004)
- Hasegawa S, "A prospective validation study to diagnose serosal invasion and nodal metastases of gastric cancer by multidetector-row CT", Ann Surg Oncol, 20, pp.2016~2022 (2013)
- 김진웅, "The Role of Three-Dimensional Multidetector CT Gastrography in the Preoperative Imaging of Stomach Cancer: Emphasis on Detection and Localization of the Tumor", Korean Journal of Radiology, 16(1), pp.80~89 (2015), 대한영상의학회[DOI]
- Lee MH, "Gastric cancer : imaging and staging with MDCT based on the 7th AJCC guidelines", Abdom Imaging, 37, pp.531~540 (2012)
- Chen CY, "Gastric cancer : preoperative local staging with 3D multi-detector row CT : correlation with surgical and histopathologic results", Radiology, 242, pp.472~482 (2007)
- Chen QY, "Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion : a case control study", World J Surg Oncol, 10, pp.248~ (2012)
- Fairweather M, "Accuracy of EUS and CT imaging in preoperative gastric cancer staging", J Surg Oncol, 111, pp.1016~1020 (2015)
- Lei C, "Comparison of MRI and endoscope ultrasound detection in preoperative T", N staging of gastric cancer, 2013, pp.1, 699~702
- Giganti F, "Preoperative locoregional staging of gastric cancer : is there a place for magnetic resonance imaging? Prospective comparison with EUS and multidetector computed tomography", Gastric Cancer, 19, pp.216~225 (2016)
- Cardoso R, "A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer", Gastric Cancer, 1, pp.S19~26 (2012)
- Hwang SW, "Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector-row computed tomography", J Gastroenterol Hepatol, 25, pp.512~518 (2010)
- Yan C, "Value of multidetector-row computed tomography in the preoperative T and N staging of gastric carcinoma : a large-scale Chinese study", J Surg Oncol, 100, pp.205~214 (2009)
- Feng XY, "Comparison of endoscopic ultrasonography and multislice spiral computed tomography for the preoperative staging of gastric cancer : results of a single institution study of 610 Chinese patients", PLoS One, 8, pp.e78846~ (2013)
- Kim HJ, "Gastric cancer staging at multi-detector row CT gastrography : comparison of transverse and volumetric CT scanning", Radiology, 236, pp.879~885 (2005)
- Japanese Gastric Cancer Association, "Japanese gastric cancer treatment guidelines 2014 (ver. 4)", Gastric Cancer, 20, pp.1~19 (2017)
- Songun I, "Surgical treatment of gastric cancer : 15-year follow-up results of the randomised nationwide Dutch D1D2 trial", Lancet Oncol, 11, pp.439~449 (2010)
- Liu LH, "Impact of visceral adipose tissue on the accuracy of T-staging by CT in colon cancer", Eur J Radiol, 134, pp.109400~ (2021)