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Prognostic Significance of Microscopic Positive Margins for Gastric Cancer Patients with Potentially Curative Resection

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Most previous studies concerning the impact of positive margins on patient outcomes were based on patients with D1 lymphadenectomy. The prognostic significance of positive margins for patients with D2/D3 lymphadenectomy has not been investigated.

Methods

Clinicopathologic and prognostic data were compared between 110 patients with positive margins and 2,159 patients with negative margins who underwent R0 surgery (D2/D3 lymphadenectomy). Multivariate analysis was performed to identify independent factors correlated with positive margins. Cox’s proportional hazard model was applied to investigate whether a positive margin was an independent factor predicting poor outcome. Overall survival rates and the incidence of recurrence were compared between patients with positive and negative margins, stratifying by pT, pN, and TNM stage.

Results

Tumor size, pT stage, and pN stage were independent factors associated with positive margins. Although the overall survival rate of patients with positive margins was significantly poorer than that of patients with negative margins, margin status was not an independent prognostic factor on multivariate analysis. Significant differences in survival between patients with negative and positive margins could be observed for those in pT1-2, pN0-1, and I–II stage, but not for those in pT3-4, pN2-3, and III–VI stage. Although locoregional recurrence was more frequently observed for patients with positive margins, the incidence of any recurrence was significantly higher only for patients in pT1-2, pN0-1, and I-II stage, but not for those in pT3-4, pN2-3, and III–VI stage.

Conclusion

A positive margin results in a significantly worse outcome for pT1-2, pN0-1, and I–II stage gastric cancer patients who undergo D2/D3 lymphadenectomy, but not for those in pT3-4, pN2-3, and III–IV stage.

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References

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.

    Article  PubMed  Google Scholar 

  2. Goggins WB, Wong GK. Poor survival for US Pacific Islander cancer patients: evidence from the Surveillance, Epidemiology, and End Results database: 1991 to 2004. J Clin Oncol. 2007;25:5738–41.

    Article  PubMed  Google Scholar 

  3. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.

    PubMed  Google Scholar 

  4. Sobin LH, Wittekind C. TNM classification of malignant tumors, 5th ed. New York: Wiley; 1997.

    Google Scholar 

  5. Songun I, Bonenkamp JJ, Hermans J, et al. Prognostic value of resection line involvement in patients undergoing curative resection for gastric cancer. Eur J Cancer. 1996;32A:433–7.

    Article  CAS  PubMed  Google Scholar 

  6. Kakeji Y, Tsujitani S, Baba H, et al. Clinicopathologic features and prognostic significance of duodenal invasion in patients with distal gastric carcinoma. Cancer. 1991;68:380–4.

    Article  CAS  PubMed  Google Scholar 

  7. Papachristou DN, Agnanti N, D’Agostino H, et al. Histologically positive esophageal margin in the treatment of gastric cancer. Am J Surg. 1980;139:711–3.

    Article  CAS  PubMed  Google Scholar 

  8. Cascinu S, Giordani P, Catalano V, et al. Resection-line involvement in gastric cancer patients undergoing curative resections: implications for clinical management. Jpn J Clin Oncol. 1999;29:291–3.

    Article  CAS  PubMed  Google Scholar 

  9. Kim SH, Karpeh MS, Klimstra DS, et al. Effect of microscopic resection line disease on gastric cancer survival. J Gastrointest Surg. 1999;3:24–33.

    Article  CAS  PubMed  Google Scholar 

  10. Morgagni P, Garcea D, Marrelli D, et al. Resection line involvement after gastric cancer surgery: clinical outcome in nonsurgically retreated patients. World J Surg. 2008;32:2661–7.

    Article  CAS  PubMed  Google Scholar 

  11. Siewert JR, Bittcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. 1998;228:449–61.

    Article  CAS  PubMed  Google Scholar 

  12. Dicken BJ, Bigam DL, Cass C, et al. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg. 2005;241:27–39.

    PubMed  Google Scholar 

  13. Kim JP, Lee JH, Kim SJ, et al. Clinicopathologic characteristics and prognostic factors in 10,783 patients with gastric cancer. Gastric Cancer. 1998;1:125–33.

    Article  PubMed  Google Scholar 

  14. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.

    Article  CAS  PubMed  Google Scholar 

  15. Roviello F, Marrelli D, Morgagni P, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg Oncol. 2002;9:894–900.

    Article  PubMed  Google Scholar 

  16. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual, 6th ed. New York: Springer; 2002.

    Google Scholar 

  17. Hallissey MT, Jewkes AJ, Dunn JA, et al. Resection-line involvement in gastric cancer: a continuing problem. Br J Surg. 1993;80:1418–20.

    Article  CAS  PubMed  Google Scholar 

  18. Yokota T, Sawai K, Yamaguchi T, et al. Resection margin in patients with gastric cancer associated with esophageal invasion: clinicopathological study. J Surg Oncol. 1993;53:60–3.

    Article  CAS  PubMed  Google Scholar 

  19. Park JM, Jang YJ, Kim JH, et al. Gastric cancer histology: clinicopathologic characteristics and prognostic value. J Surg Oncol. 2008;98:520–5.

    Article  PubMed  Google Scholar 

  20. Kasakura Y, Fujii M, Mochizuki F, et al. Clinicopathological features of the superficial spreading type of early gastric cancer. Gastric Cancer. 1999;2:129–35.

    Article  PubMed  Google Scholar 

  21. Rosenberg R, Nekarda H, Bauer P, et al. Free peritoneal tumour cells are an independent prognostic factor in curatively resected stage IB gastric carcinoma. Br J Surg. 2006;93:325–31.

    Article  CAS  PubMed  Google Scholar 

  22. Majima T, Ichikura T, Mochizuki H. Prognostic significance of the cytologic features of free cancer cells in the peritoneal cavity of patients with gastric cancer. Surg Today. 2002;32:35–9.

    Article  PubMed  Google Scholar 

  23. Suzuki T, Ochiai T, Hayashi H, et al. Peritoneal lavage cytology findings as prognostic factor for gastric cancer. Semin Surg Oncol. 1999;17:103–7.

    Article  CAS  PubMed  Google Scholar 

  24. Maehara Y, Hasuda S, Koga T, et al. Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg. 2000;87:353–7.

    Article  CAS  PubMed  Google Scholar 

  25. Kodera Y, Nakanishi H, Ito S, et al. Quantitative detection of disseminated free cancer cells in peritoneal washes with real-time reverse transcriptase–polymerase chain reaction: a sensitive predictor of outcome for patients with gastric carcinoma. Ann Surg. 2002;235:499–506.

    Article  PubMed  Google Scholar 

  26. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.

    Article  CAS  PubMed  Google Scholar 

  27. Roviello F, Marrelli D, Morgagni P, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg Oncol. 2002;9:894–900.

    Article  PubMed  Google Scholar 

  28. Wu CW, Hsiung CA, Lo SS, et al. Stage migration influences on stage-specific survival comparison between D1 and D3 gastric cancer surgeries. Eur J Surg Oncol. 2005;31:153–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China

    Zhe Sun MD, De-ming Li MD, Zhen-ning Wang MD, Bao-jun Huang MD, Yan Xu MD, Kai Li MD & Hui-mian Xu MD

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  1. Zhe Sun MD
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  2. De-ming Li MD
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  3. Zhen-ning Wang MD
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  4. Bao-jun Huang MD
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  5. Yan Xu MD
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  6. Kai Li MD
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  7. Hui-mian Xu MD
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Corresponding author

Correspondence to Hui-mian Xu MD.

Additional information

Zhe Sun and De-ming Li contributed equally to this work.

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Sun, Z., Li, Dm., Wang, Zn. et al. Prognostic Significance of Microscopic Positive Margins for Gastric Cancer Patients with Potentially Curative Resection. Ann Surg Oncol 16, 3028–3037 (2009). https://doi.org/10.1245/s10434-009-0624-0

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  • DOI: https://doi.org/10.1245/s10434-009-0624-0

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