Cargando…
A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer
BACKGROUND: Although a 3–5 cm surgical margin distance is recommended for advanced gastric cancer (GC) in Japanese guidelines, little is known about the clinical effects of the surgical margin, especially the distal resection margin (DM). This study aims to clarify the clinical significance of DM in...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629168/ https://www.ncbi.nlm.nih.gov/pubmed/37936119 http://dx.doi.org/10.1186/s12885-023-11570-2 |
_version_ | 1785131908958519296 |
---|---|
author | Takashima, Yusuke Komatsu, Shuhei Nishibeppu, Keiji Ohashi, Takuma Kosuga, Toshiyuki Konishi, Hirotaka Shiozaki, Atsushi Kubota, Takeshi Fujiwara, Hitoshi Otsuji, Eigo |
author_facet | Takashima, Yusuke Komatsu, Shuhei Nishibeppu, Keiji Ohashi, Takuma Kosuga, Toshiyuki Konishi, Hirotaka Shiozaki, Atsushi Kubota, Takeshi Fujiwara, Hitoshi Otsuji, Eigo |
author_sort | Takashima, Yusuke |
collection | PubMed |
description | BACKGROUND: Although a 3–5 cm surgical margin distance is recommended for advanced gastric cancer (GC) in Japanese guidelines, little is known about the clinical effects of the surgical margin, especially the distal resection margin (DM). This study aims to clarify the clinical significance of DM in GC. METHODS: A total of 415 GC patients who underwent curative distal gastrectomy between 2008 and 2018 were analyzed retrospectively. RESULTS: The DM significantly stratified recurrence-free survival (P = 0.002), and a DM < 30 mm was an independent factor of a poor prognosis (P = 0.023, hazard ratio: 1.91). Lymphatic recurrence occurred significantly more frequently in the DM < 30 mm group than in the DM ≥ 30 mm group (P = 0.019, 6.9% vs. 1.9%). Regarding the station No.6 lymph node metastases in advanced GC (DM < 30 mm vs. 30 mm ≤ DM ≤ 50 mm vs. DM > 50 mm), the number (P < 0.001, 1.42 ± 1.69 vs. 1.18 ± 1.80 vs. 0.18 ± 0.64), the positive rate (P < 0.001, 59.0% vs. 46.7% vs. 11.3%) and therapeutic value index (43.3 vs. 14.5 vs. 8.0) were significantly higher in the DM < 30 mm group. By subdivision using the DM distance of 30 mm, more segmented prognostic stratifications were possible (P < 0.001). CONCLUSIONS: A DM of less than 30 mm could be a surrogate marker of poor RFS, especially increasing nodal recurrence. More intensive treatment strategies, including lymphadenectomy and chemotherapy, are needed for patients with this condition. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-023-11570-2. |
format | Online Article Text |
id | pubmed-10629168 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-106291682023-11-08 A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer Takashima, Yusuke Komatsu, Shuhei Nishibeppu, Keiji Ohashi, Takuma Kosuga, Toshiyuki Konishi, Hirotaka Shiozaki, Atsushi Kubota, Takeshi Fujiwara, Hitoshi Otsuji, Eigo BMC Cancer Research BACKGROUND: Although a 3–5 cm surgical margin distance is recommended for advanced gastric cancer (GC) in Japanese guidelines, little is known about the clinical effects of the surgical margin, especially the distal resection margin (DM). This study aims to clarify the clinical significance of DM in GC. METHODS: A total of 415 GC patients who underwent curative distal gastrectomy between 2008 and 2018 were analyzed retrospectively. RESULTS: The DM significantly stratified recurrence-free survival (P = 0.002), and a DM < 30 mm was an independent factor of a poor prognosis (P = 0.023, hazard ratio: 1.91). Lymphatic recurrence occurred significantly more frequently in the DM < 30 mm group than in the DM ≥ 30 mm group (P = 0.019, 6.9% vs. 1.9%). Regarding the station No.6 lymph node metastases in advanced GC (DM < 30 mm vs. 30 mm ≤ DM ≤ 50 mm vs. DM > 50 mm), the number (P < 0.001, 1.42 ± 1.69 vs. 1.18 ± 1.80 vs. 0.18 ± 0.64), the positive rate (P < 0.001, 59.0% vs. 46.7% vs. 11.3%) and therapeutic value index (43.3 vs. 14.5 vs. 8.0) were significantly higher in the DM < 30 mm group. By subdivision using the DM distance of 30 mm, more segmented prognostic stratifications were possible (P < 0.001). CONCLUSIONS: A DM of less than 30 mm could be a surrogate marker of poor RFS, especially increasing nodal recurrence. More intensive treatment strategies, including lymphadenectomy and chemotherapy, are needed for patients with this condition. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-023-11570-2. BioMed Central 2023-11-07 /pmc/articles/PMC10629168/ /pubmed/37936119 http://dx.doi.org/10.1186/s12885-023-11570-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Takashima, Yusuke Komatsu, Shuhei Nishibeppu, Keiji Ohashi, Takuma Kosuga, Toshiyuki Konishi, Hirotaka Shiozaki, Atsushi Kubota, Takeshi Fujiwara, Hitoshi Otsuji, Eigo A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer |
title | A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer |
title_full | A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer |
title_fullStr | A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer |
title_full_unstemmed | A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer |
title_short | A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer |
title_sort | shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629168/ https://www.ncbi.nlm.nih.gov/pubmed/37936119 http://dx.doi.org/10.1186/s12885-023-11570-2 |
work_keys_str_mv | AT takashimayusuke ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT komatsushuhei ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT nishibeppukeiji ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT ohashitakuma ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT kosugatoshiyuki ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT konishihirotaka ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT shiozakiatsushi ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT kubotatakeshi ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT fujiwarahitoshi ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT otsujieigo ashorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT takashimayusuke shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT komatsushuhei shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT nishibeppukeiji shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT ohashitakuma shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT kosugatoshiyuki shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT konishihirotaka shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT shiozakiatsushi shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT kubotatakeshi shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT fujiwarahitoshi shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer AT otsujieigo shorterdistalresectionmarginisasurrogatemarkerofnodalmetastasisandpoorprognosisindistalgastrectomyforadvancedgastriccancer |