Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2023; 15(9): 1605-1615
Published online Sep 15, 2023. doi: 10.4251/wjgo.v15.i9.1605
Incorporation of perigastric tumor deposits into the TNM staging system for primary gastric cancer
Yang Li, Shuo Li, Lu Liu, Li-Yu Zhang, Di Wu, Tian-Yu Xie, Xin-Xin Wang
Yang Li, Shuo Li, Lu Liu, Li-Yu Zhang, Di Wu, Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
Tian-Yu Xie, Xin-Xin Wang, Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
Author contributions: Li Y, Li S, and Liu L contributed equally to this work; Wang XX, Li Y, Li S, and Liu L designed the study; Li Y, Li S, and Liu L collected the sample data of the patients; Li S, Liu L, Zhang LY, Wu D, and Xie TY performed the statistical analysis; Li Y wrote the manuscript; all of the authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Chinese PLA General Hospital (No. S2023-065-01).
Informed consent statement: Due to the approval of the Medical Ethics Committee, the informed consent form has been waived.
Conflict-of-interest statement: All of the authors declare no interest in this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [301wxx@sina.com]. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Xin Wang, MD, PhD, Assistant Professor, Chief Doctor, Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. 301wxx@sina.com
Received: June 14, 2023
Peer-review started: June 14, 2023
First decision: July 7, 2023
Revised: July 15, 2023
Accepted: August 2, 2023
Article in press: August 2, 2023
Published online: September 15, 2023
Processing time: 91 Days and 0.7 Hours
Abstract
BACKGROUND

The current prognostic significance of perigastric tumor deposits (TDs) in gastric cancer (GC) remains unclear.

AIM

To assess the prognostic value of perigastric TDs and put forward a new TNM staging framework involving TDs for primary GC.

METHODS

This study retrospectively analyzed the pathological data of 6672 patients with GC who underwent gastrectomy or surgery for GC with other diseases from January 1, 2012 to December 31, 2017 at the Chinese PLA General Hospital. According to the presence of perigastric TDs or not, the patients were divided into TD-positive and TD-negative groups by using the method of propensity score matching. The differences between TD-positive and TD-negative patients were analyzed using binary logistic regression modeling. The Kaplan-Meier method was used to plot survival curves. Multivariate Cox regression modeling and the log-rank test were used to analyze the data.

RESULTS

Perigastric TDs were found to be positive in 339 (5.09%) of the 6672 patients with GC, among whom 237 were men (69.91%) and 102 were women (30.09%) (2.32:1). The median age was 59 years (range, 27 to 78 years). Univariate and multivariate survival analyses indicated that TD-positive GC patients had a poorer prognosis than TD-negative patients (P < 0.05). The 1-, 3-, and 5-year overall survival rates of GC patients with TDs were 68.3%, 19.6%, and 11.2%, respectively, and these were significantly poorer than those without TDs of the same stages. There was significant variation in survival according to TD locations among the GC patients (P < 0.05). A new TNM staging framework for GC was formulated according to TD location. When TDs appear in the gastric body, the original stages T1, T2, and T3 are classified as T4a with the new framework, and the original stages T4a and T4b both are classified as T4b. When TDs appear in the lesser curvature, the previous stages N0, N1, N2, and N3 now both are classified as N3. When TDs appear in the greater curvature or the distant tissue, the patient should be categorized as having M1. With the new GC staging scheme including TDs, the survival curves of patients in the lower grade TNM stage with TDs were closer to those of patients in the higher grade TNM stage without TDs.

CONCLUSION

TDs are a poor prognostic factor for patients with primary GC. The location of TDs is associated with the prognosis of patients with primary GC. Accordingly, we developed a new TNM staging framework involving TDs that is more appropriate for patients with primary GC.

Keywords: Tumor deposits; Gastric cancer; Prognosis; Stage; Overall survival

Core Tip: The aim of this study was to assess the prognostic value of perigastric tumor deposits (TDs) and put forward a new TNM staging framework involving TDs for primary gastric cancer (GC). This study indicated that TDs serve as a bad prognostic factor in patients with primary GC and the new TNM staging system incorporating TDs is more suitable for patients with primary GC.