Prognostic factors of different pathological types of advanced gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Xinqiang ¹ , ZHANG Ming ¹ , DING Chuang ¹ , KONG Lingyong ¹ , CHEN Yan ¹ ,  GUAN Wenxian ²

1. Department of General Surgery, Suqian People’s Hospital, Nanjing Drum Tower Hospital Group, Affiliated to Nanjing University Medical School, Suqian, Jiangsu 223800, P.R.China;
2. Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing 210008, P.R.China;

Corresponding author：

GUAN Wenxian, Email: 15850502391@163.com

Keywords：

advanced gastric cancer; clinicopathologic characteristics; prognosis

DOI：

10.7507/1007-9424.201610048

Video：

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Objective To explore clinicopathologic features and prognostic factors of different pathological types of advanced gastric cancer. Methods The clinicopathologic data of 98 patients with advanced gastric cancer who underwent radical gastrectomy in Suqian People’s Hospital, Nanjing Drum Tower Hospital Group, Affiliated to Nanjing University Medical School in 2011 were analyzed retrospectively. There were 53 cases of gastric adenocar-cinoma, 30 cases of mucinous adenocarcinoma, and 15 cases of signet ring cell carcinoma among them. The differences of clinicopathologic characteristics and prognosis were compared among different pathological types of advanced gastric cancer. Results ① There were no significant differences in terms of the gender, age, nerve invasion, and degree of differentiation among the three groups (P>0.05), there were significant differences in terms of the tumor diameter, tumor location, radical surgery type, regional lymph node metastasis, lymphatic cancer embolus, depth of invasion, and pTNM stage among the three groups (P<0.05). ② The results of the univariate analysis showed that the prognosis of gastric adenocarcinoma was associated with the tumor diameter, tumor location, radical surgery type, regional lymph node metastasis, depth of invasion, or pTNM stage (P<0.05); the prognosis of mucinous adenocarcinoma was associated with the radical surgery type, regional lymph node metastasis, or pTNM stage (P<0.05); the prognosis of signet ring cell carcinoma was associated with the regional lymph node metastasis, depth of invasion, and pTNM stage (P<0.05). ③ The results of the Cox multivariate analysis showed that the tumor location (P=0.016), regional lymph node metastasis (P=0.042), invasion depth (P=0.021), and pTNM stage (P=0.009) were the independent risk factors of prognosis for the gastric adenocarcinoma; the regional lymph node metastasis was the independent risk factor of prognosis for gastric mucinous adenocarcinoma (P=0.000); the tumor invasion depth (P=0.032) and regional lymph node metastasis (P=0.002) were the independent risk factors of prognosis for signet ring cell carcinoma. ④ The follow-up time was 60 months. The median follow-up time was 32 months in the gastric adenocarcinoma, 43 months in the mucinous adenocarcinoma, 23 months in the signet ring cell carcinoma, the 5-year accumulated survival rate was 30.2%, 23.3%, and 26.7% respectively. The comparison of survival curves of these three different pathological types of gastric cancer had no significant difference (P=0.131). Conclusion Clinical and pathological features of patients with different pathological types of advance gastric cancer present some differences, and prognostic factors are also different, but regional lymph node metastasis is a common prognostic factor for different pathological types of advanced gastric cancer.

Citation： ZHU Xinqiang, ZHANG Ming, DING Chuang, KONG Lingyong, CHEN Yan, GUAN Wenxian. Prognostic factors of different pathological types of advanced gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(5): 580-586. doi: 10.7507/1007-9424.201610048 Copy

1.	Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
2.	Luo D, Lu ML, Zhao GF, et al. Reduced Popdc3 expression correlates with high risk and poor survival in patients with gastric cancer. World J Gastroenterol, 2012, 18(19): 2423-2429.
3.	柯彬, 刘宁, 梁寒, 等. 138 例淋巴结转移阴性胃癌患者的预后因素分析. 中华胃肠外科杂志, 2011, 14(3): 192-195.
4.	沈洁, 魏嘉, 刘宝瑞. 胃印戒细胞癌临床病理特征和生物标志的研究现状. 临床肿瘤学杂志, 2014, 19(11): 1033-1037.
5.	李增山, 李青. 2010 年版消化系统肿瘤 WHO 分类解读. 中华病理学杂志, 2011, 40(5): 351-354.
6.	虞哲科, 王晶晶, 邱振明, 等. 早期胃印戒细胞癌患者临床病理特征及预后分析. 浙江医学, 2016, 38(16): 1360-1361, 1381.
7.	Jiang CG, Wang ZN, Sun Z, et al. Clinicopathologic characteristics and prognosis of signet ring cell carcinoma of the stomach: results from a Chinese mono-institutional study. J Surg Oncol, 2011, 103(7): 700-703.
8.	Kwon KJ, Shim KN, Song EM, et al. Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach. Gastric Cancer, 2014, 17(1): 43-53.
9.	Kim BS, Oh ST, Yook JH. Signet ring cell type and other histologic types: differing clinical course and prognosis in T1 gastric cancer. Surgery, 2014, 155(6): 1030-1035.
10.	Isobe T, Hashimoto K, Kizaki J, et al. Characteristics and prognosis of mucinous gastric carcinoma. Mol Clin Oncol, 2015, 3(1): 44-50.
11.	Ryu SY, Kim HG, Lee JH, et al. Prognosis of early mucinous gastric carcinoma. Ann Surg Treat Res, 2014, 87(1): 5-8.
12.	Jiang H, Zhang H, Tian L, et al. The difference in clinic-pathological features between signet ring cell carcinoma and gastric mucinous adenocarcinoma. Tumour Biol, 2013, 34(5): 2625-2631.
13.	Bu Z, Zheng Z, Li Z, et al. Clinicopathological and prognostic differences between mucinous gastric carcinoma and signet-ring cell carcinoma. Chin J Cancer Res, 2013, 25(1): 32-38.
14.	彭建军, 吴恺明, 袁玉杰, 等. 不同部位胃癌患者的临床病理特点和预后. 中华普通外科杂志, 2015, 30(2): 92-95.
15.	Shiraishi N, Sato K, Yasuda K, et al. Multivariate prognostic study on large gastric cancer. J Surg Oncol, 2007, 96(1): 14-18.
16.	Reim D, Loos M, Vogl F, et al. Prognostic implications of the seventh edition of the international union against cancer classification for patients with gastric cancer: the Western experience of patients treated in a single-center European institution. J Clin Oncol, 2013, 31(2): 263-271.
17.	刘威, 杨韧, 张文涛, 等. 胃癌根治术 257 例预后多因素分析. 中国综合临床, 2010, 26(7): 723-726.
18.	胡建昆, 陈心足. 重视胃癌不同分型分期的治疗和预后. 中国普外基础与临床杂志, 2014, 21(1): 1-6.
19.	Kim DH, Oh CA, Oh SJ, et al. Validation of seventh edition AJCC gastric cancer staging modifications. J Surg Oncol, 2012, 105(1): 26-30.
20.	Wang W, Li YF, Sun XW, et al. Prognosis of 980 patients with gastric cancer after surgical resection. Chin J Cancer, 2010, 29(11): 923-930.
21.	Gholami S, Janson L, Worhunsky DJ, et al. Number of lymph nodes removed and survival after gastric cancer resection: An analysis from the US Gastric Cancer Collaborative. J Am Coll Surg, 2015, 221(2): 291-299.
22.	Aurello P, D’Angelo F, Rossi S, et al. Classification of lymph node metastases from gastric cancer: comparison between N-site and N-number systems. Our experience and review of the literature. Am Surg, 2007, 73(4): 359-366.
23.	Szczepanik AM, Paszko A, Szura M, et al. Alternative staging of regional lymph nodes in gastric cancer. Prz Gastroenterol, 2016, 11(3): 145-149.
24.	Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
25.	Chen JH, Cai SR, Wu H, et al. Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy. Tumour Biol, 2016, 37(8): 11105-11113.

1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
2. Luo D, Lu ML, Zhao GF, et al. Reduced Popdc3 expression correlates with high risk and poor survival in patients with gastric cancer. World J Gastroenterol, 2012, 18(19): 2423-2429.
3. 柯彬, 刘宁, 梁寒, 等. 138 例淋巴结转移阴性胃癌患者的预后因素分析. 中华胃肠外科杂志, 2011, 14(3): 192-195.
4. 沈洁, 魏嘉, 刘宝瑞. 胃印戒细胞癌临床病理特征和生物标志的研究现状. 临床肿瘤学杂志, 2014, 19(11): 1033-1037.
5. 李增山, 李青. 2010 年版消化系统肿瘤 WHO 分类解读. 中华病理学杂志, 2011, 40(5): 351-354.
6. 虞哲科, 王晶晶, 邱振明, 等. 早期胃印戒细胞癌患者临床病理特征及预后分析. 浙江医学, 2016, 38(16): 1360-1361, 1381.
7. Jiang CG, Wang ZN, Sun Z, et al. Clinicopathologic characteristics and prognosis of signet ring cell carcinoma of the stomach: results from a Chinese mono-institutional study. J Surg Oncol, 2011, 103(7): 700-703.
8. Kwon KJ, Shim KN, Song EM, et al. Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach. Gastric Cancer, 2014, 17(1): 43-53.
9. Kim BS, Oh ST, Yook JH. Signet ring cell type and other histologic types: differing clinical course and prognosis in T1 gastric cancer. Surgery, 2014, 155(6): 1030-1035.
10. Isobe T, Hashimoto K, Kizaki J, et al. Characteristics and prognosis of mucinous gastric carcinoma. Mol Clin Oncol, 2015, 3(1): 44-50.
11. Ryu SY, Kim HG, Lee JH, et al. Prognosis of early mucinous gastric carcinoma. Ann Surg Treat Res, 2014, 87(1): 5-8.
12. Jiang H, Zhang H, Tian L, et al. The difference in clinic-pathological features between signet ring cell carcinoma and gastric mucinous adenocarcinoma. Tumour Biol, 2013, 34(5): 2625-2631.
13. Bu Z, Zheng Z, Li Z, et al. Clinicopathological and prognostic differences between mucinous gastric carcinoma and signet-ring cell carcinoma. Chin J Cancer Res, 2013, 25(1): 32-38.
14. 彭建军, 吴恺明, 袁玉杰, 等. 不同部位胃癌患者的临床病理特点和预后. 中华普通外科杂志, 2015, 30(2): 92-95.
15. Shiraishi N, Sato K, Yasuda K, et al. Multivariate prognostic study on large gastric cancer. J Surg Oncol, 2007, 96(1): 14-18.
16. Reim D, Loos M, Vogl F, et al. Prognostic implications of the seventh edition of the international union against cancer classification for patients with gastric cancer: the Western experience of patients treated in a single-center European institution. J Clin Oncol, 2013, 31(2): 263-271.
17. 刘威, 杨韧, 张文涛, 等. 胃癌根治术 257 例预后多因素分析. 中国综合临床, 2010, 26(7): 723-726.
18. 胡建昆, 陈心足. 重视胃癌不同分型分期的治疗和预后. 中国普外基础与临床杂志, 2014, 21(1): 1-6.
19. Kim DH, Oh CA, Oh SJ, et al. Validation of seventh edition AJCC gastric cancer staging modifications. J Surg Oncol, 2012, 105(1): 26-30.
20. Wang W, Li YF, Sun XW, et al. Prognosis of 980 patients with gastric cancer after surgical resection. Chin J Cancer, 2010, 29(11): 923-930.
21. Gholami S, Janson L, Worhunsky DJ, et al. Number of lymph nodes removed and survival after gastric cancer resection: An analysis from the US Gastric Cancer Collaborative. J Am Coll Surg, 2015, 221(2): 291-299.
22. Aurello P, D’Angelo F, Rossi S, et al. Classification of lymph node metastases from gastric cancer: comparison between N-site and N-number systems. Our experience and review of the literature. Am Surg, 2007, 73(4): 359-366.
23. Szczepanik AM, Paszko A, Szura M, et al. Alternative staging of regional lymph nodes in gastric cancer. Prz Gastroenterol, 2016, 11(3): 145-149.
24. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
25. Chen JH, Cai SR, Wu H, et al. Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy. Tumour Biol, 2016, 37(8): 11105-11113.

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