Tumor deposit serves as a prognostic marker in gastric cancer: A propensity score‐matched analysis comparing survival outcomes

Background: Increasing numbers of studies have shown that postoperative complication is a negative predictor of long-term survival outcomes in in various malignancies. However, the impact of severity of complications on long-term survival for patients with gastric cancer still remains unclear. Aim: This study aimed to explore the relationship between the severity of complications and long-term survival outcomes after laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC). Methods: The study analyzed 571 patients with AGC who underwent LTG in a single institution between April 2008 and June 2015. Patients were divided into 2 groups based on the occurrence or absence of postoperative complications which were recorded using the Clavien-Dindo (C-D) classification. Long-term survival outcomes were compared between groups in the propensity score-matched cohort. Results: The groups were well balanced after the propensity score matched. The complication (C) group was associated with decreased 5-year cancer-specific survival (CSS) (65.1% vs 76.2%, P = 0.049). Subgroup analysis showed that the severe complication (C-D grade > II) group was associated with decreased 5-year overall survival (OS) (46.3% vs 65.9%, P = 0.042) and cancer-specific survival (CSS) (53.7% vs 74.4%, P = 0.030). However, a comparative analysis of 5-year OS and CCS showed no significant differences between the minor complication (C-D grade II) group and matched NC group (68.9% vs 72.2%, P = 0.578; 75.6% vs 77.8%, P = 0.649; respectively). Multivariate analysis confirmed severe complication was an independent risk factor for decreased OS. Further analysis showed that older age, lower body mass index (BMI), and combined resection were independent risk factor for the occurrence of severe complications. Conclusion: Severe complications adversely affected long-term survival outcomes after LTG with D2 lymph node dissection for AGC. More attention should be paid to patients at high risk for severe complications in preoperative assessment and postoperative management.

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Surgical and Long-Term Survival Outcomes After Laparoscopic and Open Total Gastrectomy for Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis

World Journal of Surgery ◽

10.1007/s00268-018-4799-z ◽

2018 ◽

Vol 43 (2) ◽

pp. 594-603

Author(s):

Zhengyan Li ◽

Yezhou Liu ◽

Bin Bai ◽

Deliang Yu ◽

Bo Lian ◽

...

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Total Gastrectomy ◽

Locally Advanced ◽

Survival Outcomes ◽

Term Survival ◽

Locally Advanced Gastric Cancer ◽

Open Total Gastrectomy

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A novel pN3 gastric cancer staging system with superior prognostic utility based upon the examination of over 31 lymph nodes: a propensity score-matching analysis

BMC Gastroenterology ◽

10.1186/s12876-021-01928-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiantao Hu ◽

Siwei Pan ◽

Zijun Guo

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Lymph Nodes ◽

Propensity Score Matching ◽

Staging System ◽

Tnm Staging ◽

Survival Outcomes ◽

The Novel ◽

Risk Of Death ◽

Tnm Staging System

Abstract Background Individuals with pN3 gastric cancer (GC) account for a large proportion of pN + GC, and exhibit poor survival outcomes. The pN3 stage is defined based upon the number of metastatic lymph nodes (mLNs), but the subclassification of pN3 patients based upon the number of examined LNs (eLNs) is rarely performed. Methods In total, 2894 pTxN3M0 GC patients in the Surveillance, Epidemiology, and End Results database that had undergone surgery from 2000 to 2016 were selected for analysis. The X-tile software was used to select the optimal cutoff values. Cox proportional regression analyses were used to evaluated hazard ratios corresponding to the risk of death. Selection bias was minimized via propensity score matching (PSM). Results As the number of eLNs rose, the risk of death for patients trended downwards. Survival analyses indicated that patients with ≤ 31 eLNs exhibited significantly poorer survival outcomes as compared to patients with > 31 eLNs (5-year OS: 18.4% vs. 24.7%), and this result remained significant when analyzing 857 pairs of patients following PSM analysis. Significant differences in prognosis were additionally observed when comparing pN3a and pN3b patients with ≤ 31 or > 31 eLNs under pT3/4a stage. For pT4b stage, pN3a patients with > 31 eLNs also exhibited a better prognosis than other patients. The novel TNM staging system designed exhibited excellent utility as a tool for the prognostic evaluation of this GC patient population. Conclusions These results suggest that in pN3 GC, a minimum of 32 LNs should be examined. The novel TNM staging system for pN3 patients described herein, which was developed based upon the number of eLNs, may thus be of value in clinical settings.

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Tumor deposit indicates worse prognosis than metastatic lymph node in gastric cancer: a propensity score matching study

Annals of Translational Medicine ◽

10.21037/atm.2019.10.33 ◽

2019 ◽

Vol 7 (22) ◽

pp. 671-671

Author(s):

Jianan Tan ◽

Bin Yang ◽

Zhimeng Xu ◽

Shengning Zhou ◽

Zhitao Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Propensity Score ◽

Propensity Score Matching ◽

Metastatic Lymph Node ◽

Metastatic Lymph ◽

Tumor Deposit ◽

Worse Prognosis

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Effects of Clavien-Dindo classification on long-term survival of patients with advanced gastric cancer after radical resection:A propensity score-matched study

10.21203/rs.3.rs-139111/v1 ◽

2021 ◽

Author(s):

Wenwu Yan ◽

Jun Du ◽

Qingyi Li ◽

Changsheng Yao ◽

Mengxiang Zhu ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Multivariate Analysis ◽

Propensity Score ◽

Radical Resection ◽

Survival Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Independent Risk Factors

Abstract Background The impact of postoperative complications (POCs) classified by the Clavien-Dindo (C-D) system on long-term survival after radical resection in patients with advanced gastric cancer (AGC) is not yet clear.Methods This study analyzed 531 patients with AGC who underwent radical resection in an institution between January 2015 and December 2017. Patients were divided into two groups according to the occurrence of POCs and recorded according to C-D classifications.The long-term survival outcomes of the entire cohort after propensity score matching (PSM) were compared.Results After PSM, there was no significant difference in baseline data between the complications (C) group (n = 92) and the non-complications (NC) group (n = 92). Survival analysis showed that the 5-year overall survival (OS) and relapse-free survival (RFS) were lower in the C group (48.9% vs. 62.0%, p = 0.040; 38.5% vs. 54.9%, p = 0.005; respectively). Subgroup analysis showed that severe complications (C-D grade > II) were associated with a decrease in 5-year OS and RFS compared with the matched NC group (40.0% vs. 62.0%, p = 0.008; 29.4% vs. 54.9%, p = 0.001; respectively). Multivariate analysis confirmed adjuvant chemotherapy, tumor size, and complications were independent risk factors for poor survival outcomes. Further multivariate analysis showed that older age, combined excision, and comorbidities were independent risk factors for POCs.Conclusions Severe complications reduced the survival outcome of patients.Older age, combined excision, and comorbidities were independent risk factors for POCs. More attention should be paid to perioperative management of patients with high risk factors for complications.

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