Disease-Specific Survival of AJCC 8th Stage II Gastric Cancer Patients After D2 Gastrectomy

Abstract

The association between the risk factors and long-term prognosis in patients with stage II gastric cancer after radical gastrectomy has been fully revealed. The purpose of this study was to investigate the independent risk factors for treatment failure in stage II gastric cancer. Demographic, clinical, and pathological information of 247 stage II gastric cancer patients who underwent radical D2 gastrectomy in our department between January 2011 and December 2014 were collected and retrospectively analyzed. The relationship between and long-term clinical outcomes of stage II gastric cancer was analyzed using t-tests, chi-square tests, receiver operating characteristic (ROC) analysis, time-dependent ROC analysis, K–M curves, and a Cox regression model. The median follow-up of 247 stage II gastric cancer patients was 5.49 years (range: 0.12–8.62 years). The Kaplan–Meier estimated 3-year and 5-year DSS rates of the study group were 92.7% (95% CI 89.4–95.9) and 88.7% (95% CI 84.7–92.7), respectively. Higher age (>70 vs. ≤70, log-rank p = 0.0406), nerve invasion (positive vs. negative, log-rank p = 0.0133), and non-distal gastrectomy (distal partial gastrectomy vs. other surgical methods, log-rank p = 0.00235) had worse prognoses compared to controls. Univariate and multivariate analyses of disease-specific survival showed that these three factors were independent prognostic factors for patients with stage II disease. The area under time-dependent ROC curve (AUC) is 0.748 of 5-year survival and c-index is 0.696 based on the three-marker model drawn for stage II patients. Subgroup analyses showed an interaction between tumor location and nerve invasion. The age, perineural invasion, and surgical approach are independent prognostic factors for disease-specific survival after radical gastrectomy. Tumor location may be an important confounding factor for outcomes by affecting surgical methods and the hazards of nerve invasion.

The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients

“…We demonstrated the degree of surgical training to be independent of recurrence rates within our observation period. This observation is consistent with previous reports by other investigators [24][25][26]. As our two patient groups had a similar distribution regarding patient characteristics and tumor stage, surgical quality, as measured by comparable and postoperative morbidity and mortality, may have contributed to equal survival curves in our study.…”

Implication of perineural invasion in patients with stage II gastric cancer

“…Another study also reported that the presence of PNI is an independent risk prognostic factor of DFS and cancer-specific survival of stage II/III GC [ 25 ]. For stage II GC after radical gastrectomy, PNI showed a predictive value for recurrence [ 26 ]. Similar with the literature, our results showed that the presence of PNI had a higher risk of recurrence and shorter OS in the patients with stage II GC.…”

“…However, Zheng et al . reported that AC is not a prognostic factor for stage II GC [ 26 ]. PNI has been shown to be a valuable prognostic factor, so whether PNI can serve as a biomarker to assist decision-making for AC in stage II GC is still unknown.…”

Preoperative sarcopenia combined with prognostic nutritional index predicts long-term prognosis of radical gastrectomy with advanced gastric cancer: a comprehensive analysis of two-center study

“…Overall survival (OS) was defined as the duration between the date of surgery and the date of the final follow-up or death and was used as the primary endpoint[ 8 ]. DSS is defined as the time between the date of operation and the date of all-cause death as the secondary endpoint [ 9 ].…”