Prognostic factors for patients after curative resection for proximal gastric cancer

Abstract

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, <10%, 10%-30% and >30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (chi2=4.57, P=0.0325), gross type (chi2=21.38, P<0.001), T stage (chi2=27.91, P<0.001), pN stage (chi2=44.72, P<0.001), MLR (chi2=61.12, P<0.001), TNM stage (chi2=44.91, P<0.001), and range of gastrectomy (chi2=4.36, P=0.0368). Multivariate analysis showed that MLR (chi2=10.972, P=0.001), pN stage (chi2=6.640, P=0.010), TNM stage (chi2=7.081, P=0.007), T stage (chi2=7.687, P=0.006) and gross type (chi2=6.252, P=0.012) were the independent prognostic factors. In addition, the prognosis of patients who underwent total gastrectomy (TG) was superior to that of patients who underwent proximal gastrectomy (PG) for the cases of tumor>or=5 cm (chi2=6.31, P=0.0120), Borrmann III/IV (chi2=7.96, P=0.0050), T4 (chi2=4.57, P=0.0325), pN2 (chi2=5.52, P=0.0188), MLR 10%-30% (chi2=4.46, P=0.0347), MLR>30% (chi2=13.34, P=0.0003), TNM III (chi2=14.05, P=0.0002) or TNM IV stage (chi2=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (chi2=5.68, P=0.0171) or MLR>30% (chi2=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM III/IV stage, serosa invasion, or extensive regional lymph node metastasis.

Treatment Selection and Survival Outcomes in Locally Advanced Proximal Gastric Cancer: A National Cancer Data Base Analysis

“…Our study suggested an improved survival benefit of PG compared to TG among patients diagnosed with LAPGC. In contrast to early studies that have reported no differences in survival outcomes between the two surgical procedures (3,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) or a better survival was associated with TG procedure (22)(23)(24)(25). Varying patients' characteristics in different study populations might account for the inconsistent results.…”

“…Several studies investigated overall survival (OS) of LAPGC patients who underwent TG or PG and reached inconsistent results. Some studies (3,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) reported that TG and PG had similar OS, whereas other studies (22)(23)(24)(25) showed that TG was associated with better 5-year OS than PG. Moreover, some studies even found that the prognosis of LAPGC patients undergoing PG was significantly better than those undergoing TG (9,26).…”

Clinical outcomes of proximal gastrectomy versus total gastrectomy for locally advanced proximal gastric cancer: a propensity score matching analysis

“…However, concerning to locally advanced PGC (LAPGC), it still has not reached a consensus. Proponents ( 10 , 16 , 17 ) of PG have argued that PG can achieve an equivalent overall survival (OS) compared to total gastrectomy (TG), whereas others ( 18 , 19 ) showed that TG was associated with better 5-year OS. Moreover, there was no clinical outcome of clinical randomized trial targeting the same issue.…”

Intervention effects of lotus leaf flavonoids on gastric mucosal lesions in mice infected with Helicobacter pylori

“…The stomach was removed from the mouse, using an aseptic surgical procedure; the stomach cavity was cut along the greater curvature and ushed with saline; and H. pylori eradication by rapid urease test and bacterial culture was observed. 21…”