J Gastric Cancer.  2012 Sep;12(3):164-172.

Tumor Size as a Prognostic Factor in Gastric Cancer Patient

• Im WJ
• Kim MG
• Ha TK
• Kwon SJ

Abstract

PURPOSE
The purpose of this study is to investigate the prognostic significance of tumor size for 5-year survival rate in patients with gastric cancer.
MATERIALS AND METHODS
A total of 1,697 patients with gastric cancer, who underwent potentially curative gastrectomy, were evaluated. Patients were divided into 4 groups as follows, according to the median size of early and advanced gastric cancer, respectively: small early gastric cancer (tumor size < or =3 cm), large early gastric cancer (tumor size >3 cm), small advanced gastric cancer (tumor size < or =6 cm), and large advanced gastric cancer (tumor size >6 cm). The prognostic value of tumor size for 5-year survival rate was investigated.
RESULTS
In a univariate analysis, tumor size is a significant prognostic factor in advanced gastric cancer, but not in early gastric cancer. Multivariate analysis showed that tumor size is an independent prognostic factor for 5-year survival rate in advanced gastric cancer (P=0.003, hazard ratio=1.372, 95% confidence interval=1.115~1.690). When advanced gastric cancer is subdivided into 2 groups, according to serosa invasion: Group 1; serosa negative (T2 and T3, 7th AJCC), and Group 2; serosa positive (T4a and T4b, 7th AJCC), tumor size is an independent prognostic factor in Group 1 (P=0.011, hazard ratio=1.810, 95% confidence interval=1.149~2.852) and in Group 2 (P=0.033, hazard ratio=1.288, 95% confidence interval=1.020~1.627), respectively.
CONCLUSIONS
Tumor size is an independent prognostic factor in advanced gastric cancer irrespective of the serosa invasion, but not in early gastric cancer.

Keyword

Gastric cancer; Tumor size; Prognosis

MeSH Terms

Gastrectomy
Humans
Multivariate Analysis
Prognosis
Serous Membrane
Stomach Neoplasms
Survival Rate

Figure

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  Fig. 1 Survival rate according to tumor size showed significant difference in all cases of advanced gastric cancer (AGC) (P<0.0001), serosa-negative AGC (P<0.0001), and serosa-positive AGC (P<0.0001), respectively.

Reference

1. Cheung LY, Delcore R. Townsend CM, editor. Gastric cancer. Sabiston Textbook of Surgery. 2001. 16th ed. Philadelphia: W.B. Saunders;855–865.

2. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, et al. American Cancer Society. Cancer statistics, 2004. CA Cancer J Clin. 2004. 54:8–29.

3. Kim W, Park CH, Park SM, Park WB, Lim KW, Kim SN. Prognostic significance of lymphatic and perineural invasions in patients with gastric cancer who have no lymph node and serosal involvement. J Korean Gastric Cancer Assoc. 2001. 1:77–82.

4. Huh H, Hyung WJ, Chen J, Choi SH, Noh SH. Implication of lymphatic or blood vessel invasion in early gastric cancer. J Korean Surg Soc. 2003. 64:134–139.

5. Kim JJ, Song KY, Hur H, Hur JI, Park SM, Park CH. Lymph node micrometastasis in node negative early gastric cancer. Eur J Surg Oncol. 2009. 35:409–414.

6. Suh KW, Kim CB, Kim MW, Chi HS, Cho CH, Kim BR, et al. A clinical study of 2789 gastric cancers. J Korean Surg Soc. 1991. 41:148–158.

7. Park CH, Kim DG, Jung SS, Yoo SJ, Lee MD, Kim SK, et al. Clinical analysis of gastric adenocarcinoma experienced during recent 10 years and follow up results. J Korean Surg Soc. 1992. 42:787–798.

8. Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y, et al. Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer. 1992. 70:1030–1037.

9. Sobin LH, Wittekind C, editors. International Union against Cancer. TNM Classification of Malignant Tumours. 1997. 5th ed. New York: Wiley-Liss.

10. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010. 17:3077–3079.

11. Adachi Y, Oshiro T, Mori M, Maehara Y, Sugimachi K. Tumor size as a simple prognostic indicator for gastric carcinoma. Ann Surg Oncol. 1997. 4:137–140.

12. Giuliani A, Caporale A, Di Bari M, Demoro M, Gozzo P, Corona M, et al. Maximum gastric cancer diameter as a prognostic indicator: univariate and multivariate analysis. J Exp Clin Cancer Res. 2003. 22:531–538.

13. Li C, Oh SJ, Kim S, Hyung WJ, Yan M, Zhu ZG, et al. Risk factors of survival and surgical treatment for advanced gastric cancer with large tumor size. J Gastrointest Surg. 2009. 13:881–885.

14. Saito H, Osaki T, Murakami D, Sakamoto T, Kanaji S, Oro S, et al. Macroscopic tumor size as a simple prognostic indicator in patients with gastric cancer. Am J Surg. 2006. 192:296–300.

15. Liu X, Xu Y, Long Z, Zhu H, Wang Y. Prognostic significance of tumor size in T3 gastric cancer. Ann Surg Oncol. 2009. 16:1875–1882.

16. Maehara Y, Orita H, Okuyama T, Moriguchi S, Tsujitani S, Korenaga D, et al. Predictors of lymph node metastasis in early gastric cancer. Br J Surg. 1992. 79:245–247.

17. Tsujitani S, Oka S, Saito H, Kondo A, Ikeguchi M, Maeta M, et al. Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis. Surgery. 1999. 125:148–154.

18. Yamamura Y, Nakajima T, Ohta K, Nashimoto A, Arai K, Hiratsuka M, et al. Determining prognostic factors for gastric cancer using the regression tree method. Gastric Cancer. 2002. 5:201–207.

19. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987. 11:418–425.

20. Roviello F, Marrelli D, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, et al. Italian Research Group for Gastric Cancer. Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Br J Surg. 2003. 90:1113–1119.

21. Yokota T, Ishiyama S, Saito T, Teshima S, Yamada Y, Iwamoto K, et al. Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Res. 2002. 22:3673–3677.

22. Shiraishi N, Sato K, Yasuda K, Inomata M, Kitano S. Multivariate prognostic study on large gastric cancer. J Surg Oncol. 2007. 96:14–18.

23. Yasuda K, Shiraishi N, Adachi Y, Inomata M, Sato K, Kitano S. Risk factors for complications following resection of large gastric cancer. Br J Surg. 2001. 88:873–877.

24. Jun KH, Jung H, Baek JM, Chin HM, Park WB. Does tumor size have an impact on gastric cancer? A single institute experience. Langenbecks Arch Surg. 2009. 394:631–635.