Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2017; 9(4): 166-175
Published online Apr 15, 2017. doi: 10.4251/wjgo.v9.i4.166
Macroscopic appearance of Type IV and giant Type III is a high risk for a poor prognosis in pathological stage II/III advanced gastric cancer with postoperative adjuvant chemotherapy
Keishi Yamashita, Akira Ema, Kei Hosoda, Hiroaki Mieno, Hiromitsu Moriya, Natsuya Katada, Masahiko Watanabe
Keishi Yamashita, Akira Ema, Kei Hosoda, Hiroaki Mieno, Hiromitsu Moriya, Natsuya Katada, Masahiko Watanabe, Department of Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
Author contributions: All authors contributed to the manuscript.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Research Ethics Committee of Kitasato University School of Medicine. The requirement for informed consent was waived because of the retrospective study design.
Conflict-of-interest statement: There is no conflict of interest in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keishi Yamashita, MD, PhD, FACS, Lecturer, Department of Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan. keishi23@med.kitasato-u.ac.jp
Telephone: +81-42-7788111 Fax: +81-42-7789556
Received: October 17, 2016
Peer-review started: October 19, 2016
First decision: November 22, 2016
Revised: December 7, 2016
Accepted: February 8, 2017
Article in press: February 10, 2017
Published online: April 15, 2017
Abstract
AIM

To evaluate whether a high risk macroscopic appearance (Type IV and giant Type III) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage II/III (pStage II/III) gastric cancer.

METHODS

One hundred and seventy-two advanced gastric cancer (defined as pT2 or beyond) patients with pStage II/III who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined.

RESULTS

Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival (RFS) (35.7%) and overall survival (OS) (34%) than an average risk appearance (P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13th Japanese Gastric Cancer Association (JGCA) pT (P = 0.01), but not with the 13th JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13th JGCA pStage (P < 0.0001) and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified high-risk macroscopic appearance (P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator.

CONCLUSION

A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13th JGCA stage in pStage II/III advanced gastric cancer.

Keywords: Macroscopic feature, Gastric cancer, Type IV, Giant type III, Stage II/III

Core tip: In this study, we for the first time clarify the clinicopathological relevance of the macroscopic high risk patients with pathological stage II/III gastric cancer who underwent curative surgery with postoperative S1 adjuvant chemotherapy in Japan.