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      Improvement of T stage precision by integration of surgical and pathological staging in radically resected stage pT3-pT4b gastric cancer

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          Abstract

          Background

          Both surgical TNM (sTNM) and pathological TNM (pTNM) staging are important clinicopathologic indexes of gastric cancer (GC). However, surgeons and pathologists might assess tumor depth differently in the same patient. To investigate the prognostic significance of sTNM status in patients with radically resected stage pT3-pT4b GC, we examined the relationship between sTNM and pTNM.

          Methods

          Clinicopathologic and survival data of 1289 patients with stage pT3-pT4b GC were studied retrospectively, in the aftermath of radical surgery.

          Results

          The unconformity for assessing tumor invasion depth were frequently exhibited between sT and pT staging. Comparison of 5-year OS among them, no significant differences were observed (pT3/sT3 vs pT3/sT4a, p=0.962; pT4a/sT4b vs pT4b/sT4b, p=0.508). Also, pT3/sT4b, pT4a/sT3 and pT4a/sT4a were homogeneity in prognosis. We proposed a revised pT stage in which surgical macroscopic T4b (sT4b) was incorporated into the pT stage, namely, patients in the pT3 stage with sT4b cancers were reclassified as being in the r-pT4a stage; patients in the pT4a stage with sT4b cancers were reclassified as being in the r-pT4b stage. In two-step multivariate analysis, revised pT stage proved more suitable for determining prognosis, surpassing both UICC/AJCC pT stage and sT stage as an independent prognostic index.

          Conclusions

          Surgical T stage is a significant and independent prognostic index of overall survival (OS) in patients with radically resected advanced GC. Patients in the pT3/4a stage with sT4b cancers, are potentially underestimated, and should be considered higher stage in terms of prognostic.

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          Most cited references22

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          Review article: the epidemiology and prevention of gastric cancer.

          K Fock (2014)
          Gastric cancer can be divided into cardia and noncardia gastric adenocarcinoma (NCGA). Non cardia gastric cancer is a disease that has declined in global incidence but has remained as an extremely lethal cancer. To review recent advances in epidemiology and strategies in prevention of non cardia gastric cancer. A rapid literature search strategy was developed for all English language literature published before March 2013. The search was conducted using the electronic databases PubMed and EMBASE. The search strategy included the keywords 'stomach neoplasms', 'gastric cancer', 'epidemiology', 'risk factor', 'early detection of cancer', 'mass screening', 'cancer burden', 'prevention' and 'cost-effectiveness'. The search strategy was adjusted according to different requirements for each database. The specific search was also performed in cancer-related websites for country-specific information. The search was limited to past 10 years. Gastric cancer is the fifth most common cancer but the third leading cause of cancer death. The case fatality rate is 75%. Screening by radiological or endoscopic methods has limited success in prevention of gastric cancer. Helicobacter pylori has been identified as a carcinogen, accounting for 60-70% of gastric cancer globally and eradication is a potential preventive measure. A meta-analysis in 2009 demonstrated that individuals treated with H. pylori eradication therapy can reduce gastric cancer risk. The extended Shandong Intervention trial that lasted 14.3 years showed that H. pylori eradication therapy significantly reduced gastric cancer incidence by 39%. Consensus groups from Asia, Europe and Japan have recommended H. pylori eradication as primary prevention in high-risk areas. Following eradication therapy, endoscopic surveillance of pre-malignant lesions using enhanced imaging appears to be another promising preventive strategy. Gastric cancer remains a major diagnostic and therapeutic challenge. There is emerging evidence that H. pylori eradication in high gastric cancer regions can lead to a decline in the incidence of this highly lethal disease. © 2014 John Wiley & Sons Ltd.
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            Morbidity and mortality associated with gastrectomy for gastric cancer.

            Surgery alone is often inadequate for advanced-stage gastric cancer. Surgical complications may delay adjuvant therapy. Understanding these complications is needed for multidisciplinary planning.
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              A comparison of the prognostic value of preoperative inflammation-based scores and TNM stage in patients with gastric cancer

              Background People’s Republic of China is one of the countries with the highest incidence of gastric cancer, accounting for 45% of all new gastric cancer cases in the world. Therefore, strong prognostic markers are critical for the diagnosis and survival of Chinese patients suffering from gastric cancer. Recent studies have begun to unravel the mechanisms linking the host inflammatory response to tumor growth, invasion and metastasis in gastric cancers. Based on this relationship between inflammation and cancer progression, several inflammation-based scores have been demonstrated to have prognostic value in many types of malignant solid tumors. Objective To compare the prognostic value of inflammation-based prognostic scores and tumor node metastasis (TNM) stage in patients undergoing gastric cancer resection. Methods The inflammation-based prognostic scores were calculated for 207 patients with gastric cancer who underwent surgery. Glasgow prognostic score (GPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic nutritional index (PNI), and prognostic index (PI) were analyzed. Linear trend chi-square test, likelihood ratio chi-square test, and receiver operating characteristic were performed to compare the prognostic value of the selected scores and TNM stage. Results In univariate analysis, preoperative serum C-reactive protein (P<0.001), serum albumin (P<0.001), GPS (P<0.001), PLR (P=0.002), NLR (P<0.001), PI (P<0.001), PNI (P<0.001), and TNM stage (P<0.001) were significantly associated with both overall survival and disease-free survival of patients with gastric cancer. In multivariate analysis, GPS (P=0.024), NLR (P=0.012), PI (P=0.001), TNM stage (P<0.001), and degree of differentiation (P=0.002) were independent predictors of gastric cancer survival. GPS and TNM stage had a comparable prognostic value and higher linear trend chi-square value, likelihood ratio chi-square value, and larger area under the receiver operating characteristic curve as compared to other inflammation-based prognostic scores. Conclusion The present study indicates that preoperative GPS and TNM stage are robust predictors of gastric cancer survival as compared to NLR, PLR, PI, and PNI in patients undergoing tumor resection.
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                Author and article information

                Journal
                Oncotarget
                Oncotarget
                Oncotarget
                ImpactJ
                Oncotarget
                Impact Journals LLC
                1949-2553
                11 July 2017
                26 January 2017
                : 8
                : 28
                : 46506-46513
                Affiliations
                1 Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
                Author notes
                Correspondence to: Hui-Mian Xu, cmu13940207707@ 123456163.com
                Article
                14828
                10.18632/oncotarget.14828
                5542286
                28148895
                73e789e2-6657-4cac-84a7-1d885093c803
                Copyright: © 2017 Wang et al.

                This article is distributed under the terms of the Creative Commons Attribution License (CC-BY), which permits unrestricted use and redistribution provided that the original author and source are credited.

                History
                : 16 May 2016
                : 16 January 2017
                Categories
                Clinical Research Paper

                Oncology & Radiotherapy
                surgical staging,pathological staging,prognosis,gastric cancer
                Oncology & Radiotherapy
                surgical staging, pathological staging, prognosis, gastric cancer

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