| Background: Tumor Deposits(TDs)are defined as cluster of peritumoral nodules in the peritumoral adipose tissue of a primary carcinoma without histologic evidence of residual lymph node in the nodule.These may represent discontinuous spread,venous invasion with the extravascular spread,or a totally replaced lymph node.The recently released 7th edition of the American Joint Committee on Cancer(AJCC)staging system for gastric cancer does not distinguish between lymph node metastasis and perigastric TDs.The presence and the prognostic significance of perigastric TDs in primary gastric cancer have not been extensively studied.Objective: The objective of this study was to evaluate the prognostic significance perigastric TDs in primary gastric cancer who underwent radical gastrectomy and also to incorporate the perigastric TDs in the TNM staging system to improve the treatment management plan and outcome of the patients.Method: From 2005 to 2010,1250 patients underwent radical gastrectomy at the Department of Gastric Surgery,Fujian Medical University Union Hospital,Fuzhou,China.Out of 1250 patients,132 patients with perigastric TDs were identified.An identical number of patients without TDs who underwent radical gastrectomy during the same period and matched with same TNM stage were included as a reference group for prognostic comparison to those with TDs.All the surgical procedures were done by our expert team of surgeons from Department of Gastric Surgery,Fujian Medical University Union Hospital,Fuzhou,China.Radical gastrectomy was either open gastrectomy or laparoscopy assisted gastrectomy.The perigastric TDs was carefully well recognized during the operation and the TDs specimens was carefully examined by the experienced pathologists from Department of Pathology,Fujian Medical University Union Hospital.Results: Perigastric TDs were observed in 132(10.5%)of the 1250 patients with gastric cancer who underwent radical gastrectomy.There were 94 males(71.21%)and 38 females(28.79 %)(2.47:1).The mean age was 57.21 years.Clinicopathologic characteristics between the two groups matched well.There was a significant difference between the Kaplan–Meier curves for those patients with and without perigastric TDs(p=0.008).The 1-year,3-year,and 5-year survival rates of patients with tumor deposits were 69.6 %,39.3 %,and 24.2 %,respectively,and those for patients without perigastric TDs were 91.7 %,46.6 %,and 38.5 %,respectively.Of the 8 clinicopathological variables identified by univariate analysis,the statistically significant prognostic factors for survival in all patients were tumor size(P= 0.014),depth of invasion(P? 0.001),lymph node metastasis(p?0.001),histologic grading(P=0.014),and perigastric TDs(P=0.010).Multivariate analysis showed that perigastric TDs was independent statistically significant prognostic factor(p< 0.05 each)There was no correlation between the number of perigastric TDs and patient survival in patients with gastric cancer(p>0.05);however,when comparing each p T tumor group with the perigastric TD group,the stage T4 group's survival rate was very similar to that observed in patients with TDs.Conclusion: The prognosis of patients with perigastric TDs was significantly worse than the patients without perigastric TDs.Perigastric TDs is an independent predictive prognostic factor for gastric cancer and may be appropriately considered a form of serosal invasion.We suggest that TDs should be included in TNM staging system for better outcomes. |
PDF Full Text Request