title: Prognostic Significance of Tumor Size in 2405 Patients With Gastric Cancer: A Retrospective Cohort Study.
abstract: The clinical prognostic significance of tumor size (Ts) in gastric cancer remains under debate. This study aims to evaluate the prognostic value of Ts in gastric cancer patients undergoing gastrectomy. A total of 2405 patients with gastric cancer, all having received radical resection, were enrolled in this retrospective study from 2000 to 2011. Patients were categorized by minimum P value from log-rank χ2 statistics using X-tile. The relationships between Ts and other clinicopathologic characteristics were analyzed, and the survival prediction accuracy was also compared between Ts and T stage. Patients were divided into 5 groups, according to which Ts stage and TsNM stage system were proposed. Ts, an independent prognostic factor identified by univariate and multivariate survival analysis, was significantly associated with sex, age, tumor location, macroscopic type, tumor diffferentiation, vessel invasion, perineural invasion, T stage, N stage, and TNM stage. Compared with T stage system, Ts stage system was found no superiorities in survival prediction. However, for patients with lymph node metastasis and patients with age ≥60, Ts stage system revealed a significant improvement of predictive accuracy in subgroup survival analysis. Furthermore, TsNM stage (c-index = 0.783) system was found to be superior to TNM stage (c-index = 0.743) system in prognostic prediction accuracy (P < 0.05). Ts is significantly correlated with gastric cancer progression, which can be regarded as a reliable prognostic factor, and the TsNM stage system may improve the prognostic prediction accuracy in gastric cancer patients.
authors.affiliation: From the Department of Gastrointestinal Surgery (L-YZ, W-HZ, X-ZC, KY, X-LC, KL, BZ, Z-XC, J-PC, Z-GZ, J-KH); and the Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China (L-YZ, W-HZ, X-ZC, KY, X-LC, KL, J-KH).
authors.forename: Lin-Yong
authors.initials: LY
authors.lastname: Zhao
authors.forename: Wei-Han
authors.initials: WH
authors.lastname: Zhang
authors.forename: Xin-Zu
authors.initials: XZ
authors.lastname: Chen
authors.forename: Kun
authors.initials: K
authors.lastname: Yang
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Chen
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Zhi-Xin
authors.initials: ZX
authors.lastname: Chen
authors.forename: Jia-Ping
authors.initials: JP
authors.lastname: Chen
authors.forename: Zong-Guang
authors.initials: ZG
authors.lastname: Zhou
authors.forename: Jian-Kun
authors.initials: JK
authors.lastname: Hu
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D047368:Tumor Burden