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KMID : 0371420160900050250
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Annals of Surgical Treatment and Research
2016 Volume.90 No. 5 p.250 ~ p.256
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Prognostic significance of intraoperative macroscopic serosal invasion finding when it shows a discrepancy in pathologic result gastric cancer
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Kang Sang-Yull
Park Ho-Sung
Kim Chan-Young
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Abstract
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Purpose: Depth of wall invasion is an important prognostic factor in patients with gastric cancer, whereas the prognostic significance of intraoperative macroscopic serosal invasion (mSE) findings remain unclear when they show a discrepancy in pathologic findings. This study, therefore, assessed the prognostic significance of mSE.
Methods: Data from cohort of 2,835 patients with resectable gastric cancer who underwent surgery between 1990 and 2010 were retrospectively reviewed.
Results: The overall accuracy of mSE and pathologic results was 83.4%. The accuracy of mSE was 75.5% in pT2. On the other hand, the accuracy of pT3 dropped to 24.5%. According to mSE findings (+/?), the 5-year disease-specific survival (DSS) rate differed significantly in patients with pT2 (+; 74.2% vs. ?; 92.0%), pT3 (+; 76.7% vs. ?; 91.8%) and pT4a (+; 51.3% vs. ?; 72.8%) (P < 0.001 each), but not in patients with T1 tumor. Multivariate analysis showed that mSE findings (hazard ratio [HR], 2.275; 95% confidence interval [CI], 1.148?4.509), tumor depth (HR, 6.894; 95% CI, 2.325?20.437), nodal status (HR, 5.206; 95% CI, 2.298?11.791), distant metastasis (HR, 2.881; 95% CI, 1.388?6.209), radical resection (HR, 2.002; 95% CI, 1.017?3.940), and lymphatic invasion (HR, 2.713; 95% CI, 1.424?5.167) were independent predictors of 5-year DSS rate.
Conclusion: We observed considerable discrepancies between macroscopic and pathologic diagnosis of serosal invasion. However, macroscopic diagnosis of serosal invasion was independently prognostic of 5-year DSS. It suggests that because the pathologic results could not be perfect and the local inflammatory change with mSE(+) could affect survival, a combination of mSE(+/?) and pathologic depth may be predictive of prognosis in patients with gastric cancer.
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KEYWORD
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Stomach neoplasms, Serous membrane, Prognosis
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