Prognostic significance of perigastric tumor deposits in patients with primary gastric cancer

Abstract

BackgroundThe presence and the prognostic significance of perigastric tumor deposits (TDs) in primary gastric cancer have not been extensively studied. The aim of this study was to evaluate the prognostic significance perigastric TDs in primary gastric cancer.MethodsFrom 2005 to 2010, 1250 patients underwent R0 gastrectomy at the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. Out of 1250 patients, 132 patients with perigastric TDs were identified. Additionally, 132 patients with staged matched gastric cancer without tumor deposits were selected as a control group.ResultsPerigastric TDs were observed in 132 (10.5%) of the 1250 patients with gastric cancer who underwent R0 gastrectomy. There were 94 males (71.21%) and 38 females (28.79%) (2.47:1). The mean age was 57.21 years. Clinicopathologic characteristics between the two groups matched well. There was a significant difference in the overall survival of those with and without TDs by univariate (p<0.05) and multivariate (p < 0.05) survival analysis. The 1-, 3-and 5-year overall survival rates of patients with TDswere69.6%, 39.3%, and 24.2%, respectively, and were significantly poorer than those of the staged matched control group. There was no correlation between the number of TDs and patient survival in patients with gastric cancer (p>0.05); however, when comparing each pT tumor group with the perigastric TD group, the stage T4 survival rate was very similar to that observed in patients with TDs.ConclusionsPerigastric TDs are an independent predictive prognostic factor for gastric cancer and may be appropriately considered a form of serosal invasion. We suggest that TDs should be included in TNM staging system for better outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-017-0280-4) contains supplementary material, which is available to authorized users.

Tumour deposits are a significant prognostic factor in gastric cancer – a systematic review and meta‐analysis

“…Eight studies were included in the meta‐analysis to correlate TD presence with patient overall survival and with other prognostic factors such as lymph node metastasis (LNM) and invasion depth. For lymph vessel invasion (LVI) only five could be included, and only four for vascular invasion (VI) .…”

“…With the information from the studies we included and the correlation we observe with poor prognostic factors, we are inclined to believe that the second hypothesis might be the most factual hypothesis. Some of the studies included even provided a TNM adjustment for their cases, and found that patients with TDs had similar survival curves to those patients without TDs but with N3, M1 or T4 staging . Another study proposed they should be included in the N‐category not because of their origin, but because in their cohort, TD+ patient survival behaved more like that of pN1 patients.…”

“…In colorectal cancer (CRC), tumour deposits (TDs) are included in staging because they have been shown to be an independent prognostic factor . Until now, TDs have not been included in GC staging due to limited evidence, but are presumably also an independent prognostic factor . TDs were first described in 1935 in the rectum.…”

“…Since then, ‘tumour deposits’ have been reported under a variety of other terms, such as ‘extranodal spread’, ‘positive niduses in extranodal soft tissues’ and ‘extranodal metastases’ . With regard to definition their origin is controversial, as some authors consider TDs to be metastatic lymph nodes that have lost their structure, while others consider them to be disseminated cancer cells that originated from the primary tumour. The consensus is that they are discrete tumour foci found in surrounding fat (perigastric in GC) that show no evidence of residual lymph node tissue or continuity with the primary tumour …”

Cancer cells invasion to the gastric bare area adipose tissue: a poor prognostic predictor for gastric cancer

“…In the 8th edition of AJCC gastric cancer staging manual 19 , TDs without identi able lymph node tissue or identi able vascular or neural structure, regardless of their shape, contour and size, are considered as regional LN metastases for the purposes of gastric cancer staging. However, some research suggested that TDs in GC should be incorporated into the T category and treated as a form of serosal invasion 20,21 . Nevertheless, the prognostic impact of TDs is undeniable, the algorithm of staging with TDs is controversial.…”