Abstract
Abstract
Background
Large type 3 (diameter ≥ 8 cm) and type 4 gastric cancers have been arbitrarily combined in Japan as a single entity. However, whether these two types are oncologically similar remain unclear. This study aimed to clarify this issue.
Methods
In this retrospective study, we analyzed a database of 3,575 patients from nine institutions who underwent gastrectomy between 2010 and 2014. Using propensity scores to balance significant variables, we compared prognoses and tumor recurrences.
Results
Of patients with clinical T3/T4 who underwent R0 resection, 75 and 73 had large type 3 and 4 tumors, respectively. Patients with type 4 tumors had significantly lower overall survival rates than those of patients with large type 3 tumors (hazard ratio [HR] 1.77; 95% confidence interval [CI] 1.14–2.74). However, among the large type 3 tumors, a remarkable difference in prognosis was observed between the differentiated and undifferentiated histological types. A comparison was made between large type 3 with undifferentiated phenotype and type 4, each with 39 patients after propensity score matching. Outcomes in both groups were similar in terms of overall survival (HR 1.28; 95% CI 0.73–2.25) and relapse-free survival (HR 1.34; 95% CI 0.80–2.27). No statistically significant differences were observed in the incidence of peritoneal recurrence (35.9% vs. 46.1%, P = 0.36) and lymph node recurrence (25.6% vs. 12.8%, P = 0.15).
Conclusions
Large type 3 tumors with undifferentiated phenotype and type 4 tumors were oncologically similar. This subgroup could be considered as a new entity for future clinical trials.
Publisher
Springer Science and Business Media LLC
Reference26 articles.
1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 15th ed. Tokyo: Kanehara Publisher; 2017.
2. Yamashita K, Sakuramoto S, Katada N, Kikuchi S, Watanabe M. Simple prognostic indicators using macroscopic features and age in advanced gastric cancer. Hepatogastroenterology. 2014;61:512–7.
3. Hosoda K, Watanabe M, Yamashita K. Re-emerging role of macroscopic appearance in treatment strategy for gastric cancer. Ann Gastroenterol Surg. 2019;3:122–9.
4. Moriguchi S, Maehara Y, Korenaga D, Sugimachi K, Hayashi Y, Nose Y. Prediction of survival time after curative surgery for advanced gastric cancer. Eur J Surg Oncol. 1992;18:287–92.
5. Van Cutsem E, Sagaert X, Topal B, Haustermans K, Prenen H. Gastric cancer. Lancet (London, England). 2016;388:2654–64.