Clinical significance of primary tumor score determined by tumor depth and size in patients with resectable gastric cancer

A scoring model for predicting early recurrence of gastric cancer with normal preoperative tumor markers: A multicenter study

INTRODUCTION

Prognostic factors for postoperative early recurrence (ER) of gastric cancer (GC) in patients with normal or abnormal preoperative tumor markers (pre-TMs) remain unclear.

MATERIALS AND METHODS

2875 consecutive patients with GC who underwent radical gastrectomy (RG) between January 2010 and December 2016 were enrolled and randomly divided into training and internal validation groups. ER was defined as recurrence within two years of gastrectomy. Normal pre-TMs were defined as CEA≤5 ng/mL and CA199 ≤ 37 U/mL. Least absolute shrinkage selection operator (LASSO) Cox regression analysis was used to screen ER predictors. The scoring model was validated using 546 patients from another hospital.

RESULTS

A total of 3421 patients were included. Multivariate Cox analysis showed that pre-TMs was an independent prognostic factor for ER. Survival after ER was equally poor in the normal and abnormal pre-TMs groups (P = 0.160). Based on LASSO Cox regression, the ER of patients with abnormal pre-TMs was only associated with the pT and pN stages; however, in patients with normal pre-TMs, it was also associated with tumor size, perineural invasion, and prognostic nutritional index. Scoring model constructed for patients with normal pre-TMs had better predictive performance than TNM staging (concordance-index:0.826 vs. 0.807, P < 0.001) and good reproducibility in both validation sets. Moreover, through risk stratification, the scoring model could not only identify the risk of ER but also distinguish ER patterns and adjuvant chemotherapy benefit subgroups.

CONCLUSION

pre-TMs is an independent prognostic factor for ER in GC after RG. The established scoring model demonstrates excellent predictive performance and clinical utility.

Proposal for a clinicopathological prognostic score for resected gastric cancer patients

BACKGROUND

Factors other than pTNM stage have been associated with gastric cancer (GC) prognosis, and several alternative prognostic scores have been constructed. Our aims are to identify prognostic factors in western GC patients and to build clinicopathological prognostic models for overall survival (OS) and disease-free survival (DFS).

METHODS

A Retrospective study of 204 cases of GC resected during the years 2000 to 2014 was conducted in our hospital. Clinicopathological features were assessed, univariate and multivariate analysis were performed and prognostic scores were constructed.

RESULTS

Most patients were diagnosed at pTNM stages II and III (36.9% and 48.1%, respectively). According to Laurén classification, tumors were intestinal (55.8%), diffuse (35.2%) and mixed (9%). During follow-up, 43.5% of patients had tumor recurrence, and 28.6% died due to tumor. Univariate analysis showed that patient age, Laurén subtype, signet-ring cell morphology, pTNM stage, tumor grade, perineural invasion, growth pattern, intratumoral inflammation, adjuvant therapy, and desmoplasia were significantly related to tumor progression or death. Multivariate analysis showed that Laurén subtype, pT stage, and lymph node ratio (LNR) were significantly and independently associated with GC recurrence. Laurén subtype and LNR were significantly related to patient survival. Prognostic scores for tumor progression and death were developed and patients were classified into four prognostic groups which showed good prognostic performance.

CONCLUSION

A prognostic model comprising histological features such as Laurén subtype can be easily applied in clinical practice, and provides more prognostic information than pTNM stage alone. These models can further stratify resected GC patients and have the potential to aid in the individualization of patient management.

Update, validation and comparison of three different clinicopathological scores for patients with resected gastric cancer: A western experience

INTRODUCTION

Gastric cancer (GC) is a multifactorial disease. Several prognostic scores have been proposed for refining the prognostic information provided by the TNM classification. Our aim is to validate and compare the prognostic performance of different clinicopathological scores in a western cohort of patients (Marubini, Haraguchi and Kologlu scores).

MATERIAL AND METHODS

Retrospective study of all cases of GC resected in a western tertiary center (N = 377). Clinicopathological features were collected, scores were applied and statistical analyses were performed.

RESULTS

315 cases were finally included. According to Marubini, Haraguchi and Kologlu scores, patients were stage I (18.5%, 13.3% and 49%), II (29.3%, 47.2% and 29.5%) and III (52.2%, 39.5% and 21.5%, respectively). All classifications were significantly associated with lymphovascular invasion, perineural infiltration, lymph node involvement, patient progression and death due to GC. All scores showed good patient stratification by Kaplan-Meier analyses, but OS and DFS curves depending on Haraguchi score were less evenly spaced. Kologlu classification showed prognostic superiority over Haraguchi and Marubini classifications by ROC analysis. AUC values for OS and DFS were 0.654 and 0.647 (Marubini), 0.626 and 0.618 (Haraguchi) and 0.724 and 0.709 (Kologlu). Kologlu and Marubini classifications were independent factors for both OS and DFS, but Haraguchi classification was independently associated only with DFS.

CONCLUSIONS

Clinicopathological scores can be easily validated and are cost-effective. Kologlu score is the most thorough classification, and it showed the best prognostic performance for both DFS and OS in our study. More studies are needed to validate its value in other populations.

Correlation among postoperative uncertainty, social support, and quality of life in patients with esophageal cancer in a tertiary hospital

BACKGROUND

Esophageal cancer is one of the most common malignant tumors. It is easy to cause patients to change their dietary structure after surgery, which leads to decreased quality of life. The decrease of quality of life affects the patients' psychosocial mood to some extent, and the degree of social support is one of the important factors affecting the quality of life of cancer patients.

AIM

To investigate the correlation among the feeling of disease uncertainty, social support, and quality of life in patients with esophageal cancer after operation in a tertiary hospital.

METHODS

A total of 120 patients admitted to Yiwu Central Hospital of Zhejiang Province from February 2017 to September 2019 after esophageal cancer surgery were selected as study subjects. After admission, the patients were investigated and analyzed using the scales of disease uncertainty, social support status, and quality of life. SPSS 23.0 software was used to analyze the data, and the correlation between postoperative quality of life and social support was analyzed by multiple regression.

RESULTS

The disease uncertainty scores of patients with esophageal cancer were 68-126 (102.65 ± 8.76). Among the four dimensions, the score of uncertainty dimension was 3.56 ± 0.46, the complexity score was 2.87 ± 0.52, the score of unpredictability of prognosis was 3.12 ± 0.35, and the score of lack of information was 3.62 ± 0.34. The postoperative social support score of patients with esophageal cancer was 41.87 ± 8.96, which was significantly higher than the norm score (33.75 ± 4.12; P < 0.05). The scores of body function, role function, and overall health dimensions of the postoperative quality of life scale in patients with esophageal cancer were positively correlated with social support (r = 0.724, 0.602, and 0.654, respectively). Physical function and overall health were positively correlated with subjective support (r = 0.712, 0.625). Body function was positively correlated with objective support (r = 0.528). Role function and overall health were positively correlated with paired support utilization (r = 0.538, 0.526).

CONCLUSION

The overall postoperative quality of life of patients with esophageal cancer is positively correlated with three dimensions of social support, indicating that social support plays an important role in patients' quality of life.