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Risk stratification for serosal invasion using preoperative predictors in patients with advanced gastric cancer.

Park SS, Min JS, Lee KJ, Jin SH, Park S, Bang HY, Yu HJ, Lee JI - J Gastric Cancer (2012)

Bottom Line: We retrospectively analyzed clinicopathological features of 3,529 advanced gastric cancer patients with Borrmann type I/II/III who underwent gastrectomy at Korea Cancer Center Hospital between 1991 and 2005.Patients were subdivided into 12 subgroups in combination of Borrmann type, size, and histology.A subgroup with Borrmann type II, large size (≥7 cm), and undifferentiated histology and 2 subgroups with Borrmann type III, large size, and regardless of histology belonged to high-risk group and corresponded to 25% of eligible patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

ABSTRACT

Purpose: Although serosal invasion is a critical predisposing factor for peritoneal dissemination in advanced gastric cancer, the accuracy of preoperative assessment using routine imaging studies is unsatisfactory. This study was conducted to identify high-risk group for serosal invasion using preoperative factors in patients with advanced gastric cancer.

Materials and methods: We retrospectively analyzed clinicopathological features of 3,529 advanced gastric cancer patients with Borrmann type I/II/III who underwent gastrectomy at Korea Cancer Center Hospital between 1991 and 2005. We stratified patients into low- (≤40%), intermediate- (40~70%), and high-risk (>70%) groups, according to the probability of serosal invasion.

Results: Borrmann type, size, longitudinal and circumferential location, and histology of tumors were independent risk factors for serosal invasion. Most tumors of whole stomach location or encircling type had serosal invasion, so they belonged to high-risk group. Patients were subdivided into 12 subgroups in combination of Borrmann type, size, and histology. A subgroup with Borrmann type II, large size (≥7 cm), and undifferentiated histology and 2 subgroups with Borrmann type III, large size, and regardless of histology belonged to high-risk group and corresponded to 25% of eligible patients.

Conclusions: This study have documented high-risk group for serosal invasion using preoperative predictors. And risk stratification for serosal invasion through the combination with imaging studies may collaboratively improve the accuracy of preoperative assessment, reduce the number of eligible patients for further staging laparoscopy, and optimize therapeutic strategy for each individual patient prior to surgery.

No MeSH data available.


Related in: MedlinePlus

Diagnostic and treatment approach in patients with advanced gastric cancer (AGC).
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Figure 3: Diagnostic and treatment approach in patients with advanced gastric cancer (AGC).

Mentions: An overall survival analysis, according to serosal invasion risk, showed that the patent's prognoses were poorer in the high-risk group than in the other groups. This result indicates that risk stratification for serosal invasion is correlated with the patient's disease stage. Based on the results of this study, an algorithm for the diagnosis and treatment of patients with AGC was presented, using the preoperative predictors (Fig. 3). In particular, diagnostic laparoscopy, including peritoneal lavage, is recommended to be conducted on the high-risk group for the accurate determination of disease stage.


Risk stratification for serosal invasion using preoperative predictors in patients with advanced gastric cancer.

Park SS, Min JS, Lee KJ, Jin SH, Park S, Bang HY, Yu HJ, Lee JI - J Gastric Cancer (2012)

Diagnostic and treatment approach in patients with advanced gastric cancer (AGC).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473221&req=5

Figure 3: Diagnostic and treatment approach in patients with advanced gastric cancer (AGC).
Mentions: An overall survival analysis, according to serosal invasion risk, showed that the patent's prognoses were poorer in the high-risk group than in the other groups. This result indicates that risk stratification for serosal invasion is correlated with the patient's disease stage. Based on the results of this study, an algorithm for the diagnosis and treatment of patients with AGC was presented, using the preoperative predictors (Fig. 3). In particular, diagnostic laparoscopy, including peritoneal lavage, is recommended to be conducted on the high-risk group for the accurate determination of disease stage.

Bottom Line: We retrospectively analyzed clinicopathological features of 3,529 advanced gastric cancer patients with Borrmann type I/II/III who underwent gastrectomy at Korea Cancer Center Hospital between 1991 and 2005.Patients were subdivided into 12 subgroups in combination of Borrmann type, size, and histology.A subgroup with Borrmann type II, large size (≥7 cm), and undifferentiated histology and 2 subgroups with Borrmann type III, large size, and regardless of histology belonged to high-risk group and corresponded to 25% of eligible patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

ABSTRACT

Purpose: Although serosal invasion is a critical predisposing factor for peritoneal dissemination in advanced gastric cancer, the accuracy of preoperative assessment using routine imaging studies is unsatisfactory. This study was conducted to identify high-risk group for serosal invasion using preoperative factors in patients with advanced gastric cancer.

Materials and methods: We retrospectively analyzed clinicopathological features of 3,529 advanced gastric cancer patients with Borrmann type I/II/III who underwent gastrectomy at Korea Cancer Center Hospital between 1991 and 2005. We stratified patients into low- (≤40%), intermediate- (40~70%), and high-risk (>70%) groups, according to the probability of serosal invasion.

Results: Borrmann type, size, longitudinal and circumferential location, and histology of tumors were independent risk factors for serosal invasion. Most tumors of whole stomach location or encircling type had serosal invasion, so they belonged to high-risk group. Patients were subdivided into 12 subgroups in combination of Borrmann type, size, and histology. A subgroup with Borrmann type II, large size (≥7 cm), and undifferentiated histology and 2 subgroups with Borrmann type III, large size, and regardless of histology belonged to high-risk group and corresponded to 25% of eligible patients.

Conclusions: This study have documented high-risk group for serosal invasion using preoperative predictors. And risk stratification for serosal invasion through the combination with imaging studies may collaboratively improve the accuracy of preoperative assessment, reduce the number of eligible patients for further staging laparoscopy, and optimize therapeutic strategy for each individual patient prior to surgery.

No MeSH data available.


Related in: MedlinePlus