Clinicopathological characteristics and prognosis of patients with pT1N3M0 gastric cancer / 中华普通外科杂志

ABSTRACT

Objective:To explore the clinicopathological features and prognostic factors of gastric cancer patients with pathological stage T1N3M0 (pT1N3M0) according the TCC staging criteria of the 8th edition of UICC.Methods:We retrieved the clincal data from the Third Department of Surgery, the Fourth Hospital of Hebei Medical University from 2010 to 2019 for pT1N3M0 patients, and analyzed the clinical and pathological characteristics affecting the prognosis.Results:A total of 110 pT1N3M0 gastric cancer patients were recruited, including 27 cases (24.5%) at pT1aN3aM0 stage, 10 cases (9.1%) of pT1aN3bM0, 45 cases (40.9%) of pT1bN3aM0, and 28 cases (25.5%) of pT1bN3bM0. Tumors were located in the cardia-gastric fundus in 51 cases (46.4%), in body antrum in 59 cases (53.6%); In 40 cases (36.4%) with lesion diameter ≥2cm, in 70 cases (63.6%) the lesion<2 cm; 59 cases (53.6%) were with high-medium differentiated adenocarcinoma, 51 cases (46.4%) with low undifferentiated adenocarcinoma. 104 patients (94.5%) were followed up. The 2-year overall survival rate (OS) was 63.5%, and the 2-year disease-free survival rate (DFS) was 57.7%. Counting seperately the 2-year OS was 92.0%, 50.0%, 70.7%, and 30.8%; and the 2-year DFS was 88.0%, 41.7%, 65.9%, and 23.1%, respectively in the 4 respective groups. The differences in 2-year OS and DFS between the groups were statistically significant (all P<0.05). Univariate analysis showed that the patient′s age, tumor diameter, infiltration depth (T stage), histological type, lymph node metastasis (N stage), tumor marker CA19-9, CA72-4, tumor vascular thrombus and nerve invasion, Ki67 and Lauren classification were related to the prognosis (all P<0.05). Multivariate analysis showed that tumor size≥ 2cm ( P=0.003), poor tumor tissue type ( P=0.004), N3b stage ( P=0.000), tumor vascular thrombus ( P=0.001) and nerve invasion ( P=0.002) is an independent risk factor affecting the prognosis of pT1N3M0 gastric cancer patients. ConclutionPatients with pT1N3M0 stage gastric cancer have a poor prognosis, and the N3b stage is an independent risk factor affecting the prognosis.