Clinicopathological Characteristics Of 4311 Resected Gastric Adenocarcinoma Patients

OBJECTIVES:Review the clinical and pathological data of 4311 patients with gastric adenocarcinoma who underwent gastrectomy in Renji Hospital,and analyzed the related factors that affect the prognosis of patients with gastric cancer.To analyze the treatment efficiency of the gastric cancer patients before and after subspecialty adjustment.To summarize the clinicopathological characteristics of early gastric cancer,and identify the factor which impact the prognosis and lymph node metastasis.To analyze the treatment efficiency of laparoscopic distal gastrectomy.To analysis the prognosis according to the seventh and eighth edition of AJCC/UICC stage system,and evaluate the priority of new two staging system.METHODS:(1)The clinical data,pathological information and overall survival of 4311gastric cancer patients who underwent gastrectomy from December 2005 to December2016 in Renji Hospital Shanghai Jiaotong University School of Medicine were collected and reviewed.The impact factors on prognosis were analyzed.(2)Early gastric cancer cases were reviewed,and analysis factors related to prognosis and lymph node metastasis,and the treatment efficiency of laparoscopic distal gastrectomy.(3)The patients above were analyzed according to two AJCC/UICC staging system,and compared the changes of the two versions of staging system and calculated by linear trend chi square,likelihood ratio Chi square,AIC and ROC curve to evaluation the advantages and limitations of the new stage system.RESULT:In our cohort,a total of 4311 cases is enrolled including 2942 males(68.2%),and 1369 females(31.8%).The average age is 62.15±11.56 years and a median age of62 years.4073 cases(94.5%)underwent radical surgery,and 238 cases(5.5%)palliative surgery.Among them,1358 cases(31.5%)underwent the total gastrectomy,2953 cases(68.5%)underwent subtotal gastrectomy.3622 cases(84.0%)underwent open surgery,and 689 cases(16.0%)underwent laparoscopic surgery.170 patients were treated with combined devisceration surgery.There were 794 cases(18.4%)of upper gastric cancer,993 cases(23.0%)of middle gastric cancer,2003 cases(46.5%)of lower gastric cancer,470 cases(10.9%)of total gastric cancer and 51 cases(1.2%)of gastric stump cancer.Mean tumor diameter was 4.9±3.0 cm,median 4.0cm;According to differentiation,204 cases(4.7%)are well differentiation;983 cases(22.8%)are moderated differentiation and 3124 cases(72.5%)are poor differentiation;2132cases(49.5%)of diffuse type and 2179 cases(50.5%)of intestinal type with Lauren classification;794 cases are early gastric cancer,accounting for 18.4%;In 3517 advanced gastric cancer cases,type?include 152 cases(4.3%);type?type include 495case(14.1%),type?include 2081 cases(59.2%);and type?include 789 cases(22.4%)with Borrmann classification.In term of postoperative pathological,there are 794 cases of T1(18.4%);486 cases of T2(11.3%);1030 cases(23.9%)of T3;1701 cases(39.5%)of T4a;300 cases(7.0%)T4b according to T stage.In term of N stage,1607 cases(37.3%)are N0;641 cases are N1(14.9%);779 cases(18.1%)are N2;899 cases(20.9%)are N3a;385 cases(8.9%)are N3b;The average number of retrieved lymph nodes was 24.7±8.9,the median number of retrieved lymph nodes was 24.3859cases(89.5%)which the inspected number of lymph node?15 pieces.The average number of lymph node metastasis in this cohort was 5.1±7.1 pieces,the median number was 2.The 1,3,5-year overall survival rates of whole patients were 86.2%,64.5%and 56.2%respectively.Univariate analysis showed that age(P<0.001),tumor location(P<0.001),tumor size(P<0.001),differentiation(P<0.001),Lauren classification(P<0.001),Bormann classification(P<0.001),radical surgery(P<0.001),T stage(P<0.001),N stage(P<0.001),M stage(P<0.001),number of lymph nodes inspected(P<0.001),nerve invasion(P<0.001)and vessel invasion(P<0.001)were statistically significantly correlated with overall survival of gastric cancer patients.Cox regression analysis showed that age,tumor location,tumor size,Bormann classification,radical surgical,T stage,N stage,M stage,number of lymph nodes inspected as well as vascular invasion were independent predictors of overall survival.After the specialization,the blood loss and hospital stay were significantly reduced,the number of lymph nodes was significantly increased,and the complications associated with perioperative gastrectomy significantly decreased compared with that before specialization.The overall survival after specialization was significantly increased.In 271 cases of stage IV,there was significant differences of prognosis according to tumor residue.(2)The 1,3,5-year survival rates of 794 cases early gastric cancer 98.9%,95.4%and 92.0%respectively.Univariate analysis showed that age(P<0.001),tumor location(P=0.031),T stage(P<0.001),N stage(P<0.001),and vessel invasion(P=0.005)were statistically significantly correlated with overall survival of early gastric cancer patients.Cox regression analysis showed that age,tumor location,T stage,N stage were independent predictors of overall survival.In logistic regression,tumor size and vessel invasion were statistically significantly correlated with lymph node metastasis.The incidence of lymph node metastasis was different between groups of upper gastric cancer,middle gastric cancer and lower gastric cancer.The operation time is longer in laparoscopic group(P=0.014),the incidence of postoperative luminal bleeding,anastomotic leakage,fistula,ileus,wound infection and pulmonary infection are lower in laparoscopic group,the data of blood loss(P<0.001)and postoperative hospital stay(P=0.014)is better in laparoscopic group.There are no statistically significant in term of OS between two group.(3)Stage migration happened in 940 cases(21.8%),all of which included in stage?.The 5 year overall survival rate according to 7^th edition of AJCC/UICC stage group among?A/?B/?C were 56.3%,34.6%,22.6%,respectively(P<0.001).According to 8^th edition,the 5 year overall survival rate of?A/?B/?C were 49.9%,29.3%,17.4%(P<0.001).The Likelihood ratio?²,Linear trend?²,AIC and AUC of 7^th edition are 1078.9,946.7,23044.4 and 0.781.the statistics of 8th edition are1114.6,981.9,23015.7 and 0.787,respectively.Indicate the prognostic priority of new stage system over the previous one.CONCLUSION:(1)Age,tumor location,tumor size,differentiation,Lauren classification,Bormann type,radical surgery,T stage,N stage,M stage,number of lymph nodes inspected,nerve invasion and vessel invasion were statistically significantly correlated with overall survival of gastric cancer patients.Age,tumor location,tumor size,Bormann type,radical surgery,T stage,N stage,M stage,number of lymph nodes inspected and vessel invasion were independent predictors of long-term survival.After subspecialized reform of department of gastrointestinal surgery in our hospital,the efficacy of gastric cancer has been improved.There was significant differences of prognosis according to tumor residue in stage?patients.(2)Age,tumor location,T stage,N stage,and vessel invasion were statistically significantly correlated with overall survival of early gastric cancer patients.Age,tumor location,T stage,N stage were independent predictors of overall survival.Tumor size and vessel invasion were correlated with lymph node metastasis.Tumor location effected the incidence of lymph node metastasis.The incidence of postoperative complication is lower in laparoscopic surgery group,and the long-term outcome is comparable to open group.(3)AJCC 8^th edition of TNM stage group is superior to AJCC 7^th edition in predicting overall survival rates of gastric cancer patient in terms of Likelihood ratio?²,Linear trend?²,AIC and AUC.