| ObjectiveThis study aims to evaluate the correlation between tumor deposits(TDs)and clinicopathological features of gastric cancer by exploring the relationship between TDs and clinicopathological features and prognosis of patients with gastric cancer after surgery.To investigate the effect of perigastric TDs on the prognosis of gastric cancer.Methods1.A total of 976 patients diagnosed with gastric cancer by surgery and pathology from January 1,2015 to November 26,2021 in Department of General Surgery,East Hospital of Qingdao Municipal Hospital were included in the study.By the inclusion and exclusion criteria,a total of 761 patients were included.A retrospective case-control study was conducted to collect the clinical and pathological data of patients and analyze the relationship between tumor deposits and clinical and pathological features.2.A retrospective case-control study was conducted to collect the clinicopathological data of 445 patients with gastric cancer who underwent radical surgery in Department of General Surgery,East Hospital of Qingdao Municipal Hospital from January 1,2015 to October 30,2019.According to the TDs status,they were divided into TDs positive group(61 cases)and TDs negative group(384 cases).Eleven factors including age,sex,preoperative CEA,preoperative CA19-9,tumor site,T stage,nerve invasion,vascular tumor thrombus,ascites status,tumor size,and the number of metastatic lymph nodes were matched according to the minimum radius method(PSM)of 1:2.Kaplan-Meier method was used to analyze the survival rate,and log-rank test was used to compare the survival rate between the two groups.Cox regression analysis was used for multivariate analysis,analyzed the effect of TDs on the 3-year survival of gastric cancer patients.ResultsPart Ⅰ The relationship between perigastric tumor deposits and clinicopathological features of gastric cancer.Tumor deposits were present in 122 of the 761 patients,with a positive rate of 16.03%.Univariate analysis showed that preoperative serum carcinoembryonic antigin(CEA),Borrmann type,tumor size,the depth of invasion,N stage,distant metastasis,pTNM stage,vascular invasion,nerve invasion and intraoperative ascites were positively correlated with tumor deposits(all P<0.001).There was no correlation with gender,age,preoperative serum carbohydrate antigen 19-9(CA19-9),Lauren type,tumor location,Her-2 expression and Ki67(all P>0.05).Multivariate analysis showed that Preoperative serum CEA level increased(OR=2.119 95%CI:1.313～3.419,P=0.002),nerve invasion(OR=1.992 95%CI:1.165～3.406,P=0.012)and more Metastatic lymph nodes(OR=1.245 95%CI:1.045～1.505,P=0.016)and distant metastasis(OR=2.53495%CI:1.288～4.986,P=0.007)were independent risk factors for positive tumor deposits.In the tumor deposits positive group,82 cases(67.21%)had 1-2 tumor deposits and 40 cases(32.79%)had more than 2 tumor deposits.Univariate analysis showed that distant metastasis(P=0.007)and pTNM stage(P=0.019)were correlated with multiple tumor deposits.Multivariate analysis showed that only distant metastasis(OR=2.790 95%CI:1.005～7.741,P=0.049)was an independent risk factor for multiple tumor deposits.Each tumor deposit was counted as a metastatic lymph node,and there were statistical differences in ascites status,nerve infiltration,distant metastasis and pTNM between the two groups after matching according to the number of lymph nodes of 1:1(all P<0.05).The positive group of tumor deposits had more aggressive clinicopathological features.Part Ⅱ The effect of perigastric TDs on the prognosis of gastric cancer by propensity score matching methodAfter matching,there were 44 cases in TDs positive group and 73 cases in TDs negative group.The baseline data of patients in the two groups were balanced(P>0.05).The median follow-up time was 43.0(10.0-86.0)months in the whole group.Twenty-eight cases(63.6%)in the TDs positive group died,of which 28 cases died of gastric cancer.In the TDs-negative group,30 cases(41.1%)died,including 29 cases of gastric cancer and 1 case of other diseases.The 3-year survival rate of TDs positive group was lower than that of TDs negative group(54.5%vs 82.2%)(χ2=10.404,P=0.001).Subgroup analyses with different numbers of TDs suggested that in terms of 3-year overall survival rate,the multiple-TDs group was lower than the singleTDs group(37.5%vs 75.0%,χ2=6.148,P=0.013).The results of univariate analysis suggested that T stage(P=0.004),preoperative increased CA19-9(P=0.017),tumor size(P=0.012),N stage(P<0.001),and TDs(P=0.014)were related to the prognosis of gastric cancer in this group.Multivariate analysis revealed that positive TDs(HR=2.258,95%CI:1.288-3.960,P=0.004),tumor diameter>6cm(HR=2.463,95%CI:1.351-4.491,P=0.003),high T stage(HR=1.972,95%CI:1.160-3.351,P=0.012)and high N stage(HR=6.017,95%CI:3.862-9.373,P<0.001)were independent prognostic factors for gastric cancer.Conclusion1.Patients with gastric cancer with preoperative CEA elevation,nerve infiltration,high N stage and distant metastasis are more likely to have perigastric TDs;2.Perigastric TDs have higher invasive biological behavior than metastatic lymph nodes,and are closer to localized peritoneal metastasis(Pla);3.According to propensity score matching,perigastric TDs positive is an independent risk factor affecting the prognosis of gastric cancer patients. |
