Length of negative resection margin does not affect local recurrence and survival in the patients with gastric cancer

doi:10.3748/wjg.v20.i30.10518

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Aug 14, 2014 (publication date) through Jan 7, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Aug 14, 2014; 20(30): 10518-10524
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10518

Table 1 Demographics and clinicopathologic characteristics n (%)

	EGC	AGC
	(n = 1001)	(n = 787)
Sex (male:female)	668:333	520:267
Age (yr)	59.0 ± 11.5	59.4 ± 12.5
Tumor size (cm)	2.9 ± 1.8	5.8 ± 3.1
Borrmann type (%)	-	I: 3.3
		II: 16.5
		III: 64.7
		IV: 10.2
		V: 1.4
WHO classification (%)	Differentiated: 58.8	Differentiated: 37.6
WHO classification (%)	Undifferentiated: 40.2	Undifferentiated: 62.0
Lauren classification (%)	Intestinal: 57.3	Intestinal: 36.5
Lauren classification (%)	Diffuse: 34.9	Diffuse: 55.3
Operation method (DG:TG)	915:86	539:248
Lymphatic invasion (%)	14.6	68
Vascular invasion (%)	1.2	20.5
Perineural invasion (%)	2.4	62.8
Harvested lymph nodes	40.2 ± 15.0	49.6 ± 19.5
Positive lymph nodes	0.4 ± 2.4	6.7 ± 9.6
Proximal resection margin (cm)	3.6 ± 2.4 (0.1-16.5)	3.3 ± 2.6 (0.1-13.5)
Distal resection margin (cm)	5.7 ± 3.8 (0.1-25.5)	5.6 ± 4.7 (0.1-26.2)
Stage (%)	I: 96.1	I: 14.1
	II: 3.9	II: 31.8
	III: 0.0	III: 48.5
	IV: 0.0	IV: 5.6
Recurrence	19 (1.9)	233 (29.6)
Local recurrence	6 (0.6)	29 (3.7)

The cases involving local recurrence included 5 stump recurrences in EGC and 11 stump recurrences in AGC. EGC: The group including the patients undergoing gastrectomy for early gastric cancer; AGC: The group including the patients undergoing gastrectomy for advanced gastric cancer; DG: Distal gastrectomy; TG: Total gastrectomy.

Table 2 Overall appearance of adjusted hazard ratio

Tumor type	Cut-off value	HR (95%CI, P value) - OS	HR (95%CI, P value) - RFS
EGC	PM = 0.5 cm	0.300 (0.074-1.218, 0.092)	0.310 (0.050-1.927, 0.209)
EGC	PM = 1 cm	0.541 (0.158-1.850, 0.327)	0.494 (0.112-2.177, 0.351)
EGC	PM = 2 cm	1.208 (0.433-3.366, 0.718)	1.367 (0.379-4.928, 0.632)
EGC	DM = 1 cm	9.229 (0.479-177.727, 0.141)	12.979 (0.174-969.978, 0.244)
EGC	DM = 2 cm	2.350 (0.520-10.620, 0.267)	2.354 (0.444-12.476, 0.314)
AGC	PM = 0.5 cm	1.122 (0.658-1.915, 0.672)	0.870 (0.535-1.417, 0.577)
AGC	PM = 1 cm	0.922 (0.608-1.398, 0.703)	0.917 (0.623-1.351, 0.661)
AGC	PM = 2 cm	0.979 (0.674-1.422, 0.911)	1.050 (0.738-1.495, 0.786)
AGC	DM = 0.5 cm	0.615 (0.366-1.032, 0.066)	0.772 (0.458-1.302, 0.332)
AGC	DM = 1 cm	0.706 (0.466-1.070, 0.101)	0.852 (0.570-1.273, 0.434)
AGC	DM = 2 cm	1.109 (0.787-1.563, 0.554)	1.338 (0.952-1.882, 0.093)

In the EGC group, we excluded the comparison between the cases where DM < 0.5 and DM ≥ 0.5 because reliable estimates could not be obtained from such a small number of events. EGC: Early gastric cancer; AGC: Advanced gastric cancer; PM: Proximal resection margin; DM: Distal resection margin; OS: Actual 3-year overall survival; RFS: Actual 3-year recurrence-free survival.

Table 3 Survival-related factors in early gastric cancer

Clinicopathologic factors	Univariable analysis for OS (P value, HR)	Multivariable analysis for OS (P value, HR)	Univariable analysis for RFS (P value, HR)	Multivariable analysis for RFS (P value, HR)
Sex	0.094, 0.438		0.117, 0.373
Age	< 0.001, 1.086	< 0.001, 1.081	0.848, 1.004
Size of the tumor	0.003, 1.267	0.124, 1.158	0.018, 1.253	0.515, 1.079
Operation method	0.270, 1.185		0.618, 0.599
Lymphatic invasion	< 0.001, 5.289	0.077, 2.437	< 0.001, 13.310	< 0.001, 7.689
Vascular invasion	0.219, 3.503		0.002, 10.119	0.046, 0.208
Perineural invasion	0.005, 5.642	0.173, 2.416	0.027, 5.229	0.492, 0.580
WHO classification	0.760, 0.886		0.441, 0.683
Lauren classification	0.593, 0.783		0.601, 0.754
Harvested lymph node	0.676, 0.994		0.658, 1.007
Positive lymph node	< 0.001, 1.065	0.164, 1.038	< 0.001, 1.078	0.006, 1.068
PM	0.405, 0.930		0.592, 1.049
DM	0.609, 1.025		0.235, 0.916
Stage	< 0.001, 10.515	0.028, 3.836	< 0.001, 16.028	0.168, 2.416

Age, size of the tumor, harvested lymph node, positive lymph node, PM, DM were included as continuous values in this analysis. EGC: Early gastric cancer; OS: Actual 3-year overall survival; RFS: Actual 3-year recurrence-free survival; PM: The length of proximal resection margin; DM: The length of distal resection margin.

Table 4 Correlation between clinicopathologic factors and local recurrence

Clinicopathologic Factors	Univariable analysis for EGC (P value, HR)	Multivariable analysis for EGC (P value, HR)	Univariable analysis for AGC (P value, HR )	Multivariable analysis for AGC (P value, HR)
Sex	0.403, 0.399		0.650, 1.194
Age	0.946, 0.998		0.267, 0.984
Size of the tumor	0.032, 1.385	0.097, 1.318	< 0.001, 1.223	0.040, 1.146
Lymphatic invasion	0.031, 5.895	0.078, 4.409	0.023, 4.052
Vascular invasion	0.999, 0.000		0.128, 1.879
Perineural invasion	0.057, 8.357		0.013, 3.868	0.191, 2.327
Borrmann Type	-		0.007	0.167
WHO Classification	0.719, 0.731		0.059, 2.401
Lauren Classification	0.602, 0.547		0.180, 1.825
Harvested lymph node	0.696, 0.988		0.713, 1.003
Positive lymph node	0.309, 1.055		0.012, 1.035	0.928, 1.002
PM	0.236, 0.745		0.579, 1.958
DM	0.308, 0.862		0.769, 0.988
Stage	0.998, 0.000		0.017	0.191

Age, size of the tumor, harvested lymph node, positive lymph node, PM, DM were included as continuous values in this analysis. EGC: Early gastric cancer; AGC: Advanced gastric cancer; PM: The length of proximal resection margin; DM: The length of distal resection margin.

Table 5 Survival related factors in advanced gastric cancer

Clinicopathologic factors	Univariable analysis for OS (P value, HR)	Multivariable analysis for OS (P value, HR)	Univariable analysis for RFS (P value, HR)	Multivariable analysis for RFS (P value, HR)
Sex	0.449, 1.113		0.306, 1.150
Age	0.025, 1.013	0.001, 1.020	0.470, 0.996
Size of the tumor	< 0.001, 1.139	0.127, 1.046	< 0.001, 1.177	0.012, 1.081
Operation method	0.029, 1.361	0.145, 0.727	0.004, 1.474	0.091, 0.697
Lymphatic invasion	< 0.001, 3.537	0.696, 1.094	< 0.001, 3.082	0.975, 0.993
Vascular invasion	< 0.001, 2.876	0.026, 1.428	< 0.001, 2.868	0.094, 1.313
Perineural invasion	< 0.001, 2.440	0.343, 1.189	< 0.001, 2.342	0.634, 1.092
Borrmann type	< 0.001	0.087	< 0.001	0.05
WHO Classification	0.025, 1.389	0.856, 1.030	0.003, 1.537	0.169, 1.745
Lauren Classification	0.099, 1.281		0.004, 1.530	0.165, 0.572
Harvested lymph node	0.191, 1.004		0.288, 1.003
Positive lymph node	< 0.001, 1.048	0.001, 1.021	< 0.001, 1.047	< 0.001, 1.021
PM	0.278, 0.970		0.207, 0.966
DM	0.047, 0.969	0.660, 1.009	0.035, 0.968	0.670, 1.009
Stage	< 0.001	< 0.001	< 0.001	< 0.001

Age, size of the tumor, harvested lymph node, positive lymph node, PM, DM were included as continuous values in this analysis. AGC: Advanced gastric cancer; OS: Actual 3-year overall survival; RFS: Actual 3-year recurrence-free survival; PM: The length of proximal resection margin; DM: The length of distal resection margin.

Citation: Lee CM, Jee YS, Lee JH, Son SY, Ahn SH, Park DJ, Kim HH. Length of negative resection margin does not affect local recurrence and survival in the patients with gastric cancer. World J Gastroenterol 2014; 20(30): 10518-10524
URL: https://www.wjgnet.com/1007-9327/full/v20/i30/10518.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i30.10518