J Gastric Cancer.  2012 Sep;12(3):149-155.

Risk Stratification for Serosal Invasion Using Preoperative Predictors in Patients with Advanced Gastric Cancer

• Park SS
• Min JS
• Lee KJ
• Jin SH
• Park S
• Bang HY
• Yu HJ
• Lee JI

Abstract

PURPOSE
Although serosal invasion is a critical predisposing factor for peritoneal dissemination in advanced gastric cancer, the accuracy of preoperative assessment using routine imaging studies is unsatisfactory. This study was conducted to identify high-risk group for serosal invasion using preoperative factors in patients with advanced gastric cancer.
MATERIALS AND METHODS
We retrospectively analyzed clinicopathological features of 3,529 advanced gastric cancer patients with Borrmann type I/II/III who underwent gastrectomy at Korea Cancer Center Hospital between 1991 and 2005. We stratified patients into low- (< or =40%), intermediate- (40~70%), and high-risk (>70%) groups, according to the probability of serosal invasion.
RESULTS
Borrmann type, size, longitudinal and circumferential location, and histology of tumors were independent risk factors for serosal invasion. Most tumors of whole stomach location or encircling type had serosal invasion, so they belonged to high-risk group. Patients were subdivided into 12 subgroups in combination of Borrmann type, size, and histology. A subgroup with Borrmann type II, large size (> or =7 cm), and undifferentiated histology and 2 subgroups with Borrmann type III, large size, and regardless of histology belonged to high-risk group and corresponded to 25% of eligible patients.
CONCLUSIONS
This study have documented high-risk group for serosal invasion using preoperative predictors. And risk stratification for serosal invasion through the combination with imaging studies may collaboratively improve the accuracy of preoperative assessment, reduce the number of eligible patients for further staging laparoscopy, and optimize therapeutic strategy for each individual patient prior to surgery.

Keyword

Stomach neoplasms; Invasion; Depth; Risk; Stratification; Laparoscopy

MeSH Terms

Gastrectomy
Humans
Korea
Laparoscopy
Retrospective Studies
Risk Factors
Stomach
Stomach Neoplasms

Figure

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  Fig. 1 Risk stratification for serosal invasion in advanced gastric cancer.

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  Fig. 2 Overall survival curves for low-, intermediate- and high-risk groups of serosal invasion in patients with advanced gastric cancer.

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  Fig. 3 Diagnostic and treatment approach in patients with advanced gastric cancer (AGC).

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