Improvement of T stage precision by integration of surgical and pathological staging in radically resected stage pT3-pT4b gastric cancer.
BACKGROUND
Both surgical TNM (sTNM) and pathological TNM (pTNM) staging are important clinicopathologic indexes of gastric cancer (GC). However, surgeons and pathologists might assess tumor depth differently in the same patient. To investigate the prognostic significance of sTNM status in patients with radically resected stage pT3-pT4b GC, we examined the relationship between sTNM and pTNM.


METHODS
Clinicopathologic and survival data of 1289 patients with stage pT3-pT4b GC were studied retrospectively, in the aftermath of radical surgery.


RESULTS
The unconformity for assessing tumor invasion depth were frequently exhibited between sT and pT staging. Comparison of 5-year OS among them, no significant differences were observed (pT3/sT3 vs pT3/sT4a, p=0.962; pT4a/sT4b vs pT4b/sT4b, p=0.508). Also, pT3/sT4b, pT4a/sT3 and pT4a/sT4a were homogeneity in prognosis. We proposed a revised pT stage in which surgical macroscopic T4b (sT4b) was incorporated into the pT stage, namely, patients in the pT3 stage with sT4b cancers were reclassified as being in the r-pT4a stage; patients in the pT4a stage with sT4b cancers were reclassified as being in the r-pT4b stage. In two-step multivariate analysis, revised pT stage proved more suitable for determining prognosis, surpassing both UICC/AJCC pT stage and sT stage as an independent prognostic index.


CONCLUSIONS
Surgical T stage is a significant and independent prognostic index of overall survival (OS) in patients with radically resected advanced GC. Patients in the pT3/4a stage with sT4b cancers, are potentially underestimated, and should be considered higher stage in terms of prognostic.
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Hong-Hu
HH
Wang
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Kai
K
Li
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Hao
H
Xu
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Zhe
Z
Sun
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Zhen-Ning
ZN
Wang
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Hui-Mian
HM
Xu
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden
gastric cancer; pathological staging; prognosis; surgical staging