Purpose: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. Materials and Methods: Among 1,874 gastric cancer patients who received curative resection, 967 patients were...
Purpose: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. Materials and Methods: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. Results: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph nodepositive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (${\geq}59$, hazard ratio, 2.882), and carcinoembryonic antigen level (${\geq}5$ ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. Conclusions: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.
Purpose: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. Materials and Methods: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. Results: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph nodepositive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (${\geq}59$, hazard ratio, 2.882), and carcinoembryonic antigen level (${\geq}5$ ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. Conclusions: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.
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문제 정의
The objective of this study was to investigate prognosis factors relevant to clinical pathologic characteristics, metastasis risks, and long-term survival rates of patients who had no lymph nodes metastasis after extensive lymph nodes dissection of more than D2. Therefore, this study would help establishing specialized tailored strategies with regards to follow-up observations and prognosis predictions of the patients without lymph nodes metastasis after surgery.
제안 방법
After the surgery, follow-up examinations of pathologic stage I and II were carried out once every 6 months for 5 years and then every year. Follow-up examinations of pathologic stage III and IV were carried out once every 3 months for 3 years after the surgery, once every 6 months from 3 years to 5 years, and then annually after 5 years.
After the surgery, follow-up examinations of pathologic stage I and II were carried out once every 6 months for 5 years and then every year. Follow-up examinations of pathologic stage III and IV were carried out once every 3 months for 3 years after the surgery, once every 6 months from 3 years to 5 years, and then annually after 5 years. For the follow-up examination, gastrofiberscopy and chest X-ray were performed once in a year and abdominal computed tomography and abdominal ultrasound were performed every 6 months alternatively.
Follow-up examinations of pathologic stage III and IV were carried out once every 3 months for 3 years after the surgery, once every 6 months from 3 years to 5 years, and then annually after 5 years. For the follow-up examination, gastrofiberscopy and chest X-ray were performed once in a year and abdominal computed tomography and abdominal ultrasound were performed every 6 months alternatively. Other than that, serum tumor markers, blood, and biochemical examinations were carried out every 3 to 6 months.
For the follow-up examination, gastrofiberscopy and chest X-ray were performed once in a year and abdominal computed tomography and abdominal ultrasound were performed every 6 months alternatively. Other than that, serum tumor markers, blood, and biochemical examinations were carried out every 3 to 6 months. Recently, in advanced gastric cancer patients, positron emission tomography-computed tomography scanning was performed additionally.
The objective of this study was to investigate prognosis factors relevant to clinical pathologic characteristics, metastasis risks, and long-term survival rates of patients who had no lymph nodes metastasis after extensive lymph nodes dissection of more than D2. Therefore, this study would help establishing specialized tailored strategies with regards to follow-up observations and prognosis predictions of the patients without lymph nodes metastasis after surgery.
The prognostic factors affecting 5-year survival rates were used as analytic variables, including demographic traits of patients (age and sex) and tumor factors (the stomach walls invasion degree, lymph nodes metastasis degree, tumor size, tumor position, blood vessels, lymphatic vessels, whether or not invading around nerves, histological classification, visual classification, and tumor marker value before surgery (carcinoembryonic antigen, CA19-9).
This study was performed on patients with early gastric cancer without the lymph nodes metastasis and the venous invasion was an important prognosis factor. Saito et al.
대상 데이터
Among 1,874 patients, 967 patients who didn’t have lymph nodes metastasis based upon the result of histopathologic examination were assigned to the experimental group.
This study was carried out on 967 patients who had negative lymph nodes metastasis. The patients with early gastric cancer and advanced gastric cancer were 728 subjects and 239 subjects out of 967 patients, respectively. Whether or not having lymph nodes metastasis after curative gastrectomy of gastric cancer has been well know as a important prognostic factor related to the survival rate.
This study was carried out on 967 patients who had negative lymph nodes metastasis. The patients with early gastric cancer and advanced gastric cancer were 728 subjects and 239 subjects out of 967 patients, respectively.
The study is a retrospective, record based. Total 1,874 patients who were diagnosed with gastric cancer and had curative gastrectomy including lymph node dissection of more than D2 at the Department of General Surgery in Hanyang University Medical Center from June 1992 to December 2010. Among 1,874 patients, 967 patients who didn’t have lymph nodes metastasis based upon the result of histopathologic examination were assigned to the experimental group.
데이터처리
For survival rates, Kaplan-Meier method was used to obtain survival curves and the significance was verified utilizing Log-Rank test. Multi-variable analysis of the survival rate was performed using Cox regression. Null hypotheses of no difference were rejected if P-values were less than 0.
Statistical analysis was performed using SPSS 18.0 (IBM Co., Armonk, NY, USA) and Chi-square test was used to compare several clinical pathologic characteristics between early gastric cancer and advanced gastric cancer. For survival rates, Kaplan-Meier method was used to obtain survival curves and the significance was verified utilizing Log-Rank test.
이론/모형
, Armonk, NY, USA) and Chi-square test was used to compare several clinical pathologic characteristics between early gastric cancer and advanced gastric cancer. For survival rates, Kaplan-Meier method was used to obtain survival curves and the significance was verified utilizing Log-Rank test. Multi-variable analysis of the survival rate was performed using Cox regression.
성능/효과
In the analysis of recurrence pattern depending upon whether or not lymph nodes were metastasized, hematogenous metastasis (36%) occurred the most in the negative lymph nodes metastasis group while peritoneal metastasis (42%) occurred the most in the positive lymph nodes metastasis group, with statistical significance. A recurrence pattern depending upon early gastric cancer and advanced gastric cancer was analyzed in the negative lymph nodes metastasis group and resulted in statistically significant difference between them (Table 5).
Whether or not having lymph nodes metastasis after curative gastrectomy of gastric cancer has been well know as a important prognostic factor related to the survival rate. (7,8) The results of the current study showed significant differences on the clinicopathological analysis and long-term survival depending upon lymph nodes metastasis. That is because frequencies of lymph nodes metastasis are closely related to the depth of tumor invasion and biological behavior of the negative lymph node gastric cancer is relatively less aggressive than that of positive lymph node gastric cancer.
후속연구
(9-11)The current study also confirmed that being elderly was unfavorable for prognosis in all patient groups. However, since competing causes of death such as heart diseases and lung diseases were not excluded in this study, additional study would be required even though age was a statistically significant unfavorable prognosis factor.
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