title: Risk factors of survival and surgical treatment for advanced gastric cancer with large tumor size.
abstract: BACKGROUND
  The purpose of this study was to clarify the clinical significance of tumor size in advanced gastric cancer and to evaluate the risk factors of survival in advanced gastric cancer with large tumor size.
  
  
  METHODS
  The cut-off point for tumor size, 90th percentile value of tumor size in advanced gastric cancer, was determined to be 10 cm. We retrospectively studied the clinicopathological features and prognosis of 406 patients with advanced gastric tumors measuring 10 cm or more.
  
  
  RESULTS
  Large tumors had a propensity for the following: Borrmann type IV, adjacent organ invasion, lymph node and distant metastasis, and stage IV classification. Tumor size was an independent risk factor for lymph node metastasis and survival in advanced gastric cancer. In patients with large advanced gastric cancer, Borrmann type IV, adjacent organ invasion, and N2-3 nodal involvement were independent factors associated with a poorer prognosis. The 5-year survival rate in large gastric cancer patients without any risk factors (65.5%) was similar with those in small gastric cancer patients (59.3%, P = 0.123).
  
  
  CONCLUSIONS
  Tumor size was a simple predictor for lymph node metastasis and survival in advanced gastric cancer. Radical surgery should be recommended for large advanced gastric cancer patients without risk factors, while large gastric cancer with risk factors may not be a surgically treatable disease.
authors.affiliation: Department of Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Li
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Oh
authors.forename: Sungsoo
authors.initials: S
authors.lastname: Kim
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Min
authors.initials: M
authors.lastname: Yan
authors.forename: Zheng Gang
authors.initials: ZG
authors.lastname: Zhu
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D047368:Tumor Burden