title: Macroscopic Serosal Classification as a Prognostic Index in Radically Resected Stage pT3-pT4b Gastric Cancer.
abstract: BACKGROUND
  Macroscopic serosal classification (MSC) is an important clinicopathologic index of gastric cancer (GC). To investigate the prognostic significance of MSC status in patients with radically resected stage pT3-pT4b GC, we examined the relationship between MSC type and pT stage.
  
  
  METHODS
  Clinicopathologic and survival data of 1613 patients with stage pT3-pT4b GC were studied retrospectively, in the aftermath of radical surgery.
  
  
  RESULTS
  MSC types, including reactive, nodular, tendonoid, and color-diffused type, correlated significantly with overall survival (OS) in this cohort, but prognosis was similar for all stages of color-diffused type GC. We proposed a revised pT stage in which color-diffused type cancers at pT3 or pT4a stage were reclassified into pT4b stage. In two-step multivariate analysis, revised pT stage (stage pT4b for all color-diffused types) proved more suitable for determining prognosis, surpassing both Union for International Cancer Control/American Joint Committee on Cancer pT stage and MSC type as an independent prognostic index.
  
  
  CONCLUSIONS
  MSC type is a significant and independent prognostic index of OS in patients with radically resected stage pT3-pT4b GC. For prognostic purposes, tumors of color-diffused type at pT3 or pT4a stage should be considered stage pT4b disease.
authors.affiliation: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Hong-Hu
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Jin-Yu
authors.initials: JY
authors.lastname: Huang
authors.affiliation: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Zhen-Ning
authors.initials: ZN
authors.lastname: Wang
authors.affiliation: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China. xuhuimian@126.com.
authors.forename: Hui-Mian
authors.initials: HM
authors.lastname: Xu
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000145:classification* / Q000175:diagnosis*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012704:Serous Membrane / Q000473:pathology* / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate