Cancer Res Treat.  2021 Oct;53(4):1123-1133. 10.4143/crt.2020.651.

Effect of Preoperative Tumor Under-Staging on the Long-term Survival of Patients Undergoing Radical Gastrectomy for Gastric Cancer

• Lin M
• Chen QY
• Zheng CH
• Li P
• Xie JW
• Wang JB
• Lin JX
• Huang CM

• KMID: 2521587
• DOI: http://doi.org/10.4143/crt.2020.651

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.

Keyword

Stomach neoplasms; Prognosis; Long-term survival; Tumor staging; Preoperative underestimation deviation

Figure

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  Fig. 1 Distribution of preoperative staging deviation of the tumor. (A) Distribution of preoperative TNM staging deviation of the tumor. (B) Distribution of preoperative T staging deviation of the tumor. (C) Distribution of preoperative N staging deviation of the tumor.

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  Fig. 2 Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging.

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  Fig. 3 Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging in the pathological T stratification. (A) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological T1 patients. (B) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological T2 patients. (C) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological T3 patients. (D) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological T4 patients.

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  Fig. 4 Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging in the pathological N stratification. (A) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological N0 patients. (B) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological N1 patients. (C) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological N2 patients. (D) Overall survival curve of patients with preoperative TNM under-staging and those with no TNM under-staging among pathological N3 patients.

Reference

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