Prognostic value and nomograms of proximal margin distance in gastric cancer with radical distal gastrectomy
- PMID: 32410796
- PMCID: PMC7219099
- DOI: 10.21147/j.issn.1000-9604.2020.02.06
Prognostic value and nomograms of proximal margin distance in gastric cancer with radical distal gastrectomy
Abstract
Objective: The proximal margin (PM) distance for distal gastrectomy (DG) of gastric cancer (GC) remains controversial. This study investigated the prognostic value of PM distance for survival outcomes, and aimed to combine clinicopathologic variables associated with survival outcomes after DG with different PM distance for GC into a prediction nomogram.
Methods: Patients who underwent radical DG from June 2004 to June 2014 at Department of General Surgery, Nanfang Hospital, Southern Medical University were included. The first endpoints of the prognostic value of PM distance (assessed in 0.5 cm increments) for disease-free survival (DFS) and overall survival (OS) were assessed. Multivariate analysis by Cox proportional hazards regression was performed using the training set, and the nomogram was constructed, patients were chronologically assigned to the training set for dates from June 1, 2004 to January 30, 2012 (n=493) and to the validation set from February 1, 2012 to June 30, 2014 (n=211).
Results: Among 704 patients with pTNM stage I, pTNM stage II, T1-2, T3-4, N0, differentiated type, tumor size ≤5.0 cm, a PM of (2.1-5.0) cmvs. PM≤2.0 cm showed a statistically significant difference in DFS and OS, while a PM>5.0 cm was not associated with any further improvement in DFS and OSvs. a PM of 2.1-5.0 cm. In patients with pTNM stage III, N1, N2-3, undifferentiated type, tumor size >5.0 cm, the PM distance was not significantly correlated with DFS and OS between patients with a PM of (2.1-5.0) cm and a PM≤2 cm, or between patients with a PM >5.0 cm and a PM of (2.1-5.0) cm, so there were no significant differences across the three PM groups. In the training set, the C-indexes of DFS and OS, were 0.721 and 0.735, respectively, and in the validation set, the C-indexes of DFS and OS, were 0.752 and 0.751, respectively.
Conclusions: It is necessary to obtain not less than 2.0 cm of PM distance in early-stage disease, while PM distance was not associated with long-term survival in later and more aggressive stages of disease because more advanced GC is a systemic disease. Different types of patients should be considered for removal of an individualized PM distance intra-operatively. We developed a universally applicable prediction model for accurately determining the 1-year, 3-year and 5-year DFS and OS of GC patients according to their preoperative clinicopathologic characteristics and PM distance.
Keywords: Gastric cancer; distal gastrectomy; margin distance; nomograms.
Copyright © 2020 Chinese Journal of Cancer Research. All rights reserved.
Figures
![1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/7219099/bin/cjcr-32-2-186-1.gif)
![2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/7219099/bin/cjcr-32-2-186-2.gif)
![3](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/7219099/bin/cjcr-32-2-186-3.gif)
![4](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/7219099/bin/cjcr-32-2-186-4.gif)
Similar articles
-
A systematic review of minimal length of lroximal margin in gastric adenocarcinoma resection.Langenbecks Arch Surg. 2023 May 3;408(1):172. doi: 10.1007/s00423-023-02910-8. Langenbecks Arch Surg. 2023. PMID: 37133626 Review.
-
A novel nomogram based on the prognostic nutritional index for predicting postoperative outcomes in patients with stage I-III gastric cancer undergoing robotic radical gastrectomy.Front Surg. 2022 Oct 25;9:928659. doi: 10.3389/fsurg.2022.928659. eCollection 2022. Front Surg. 2022. PMID: 36386538 Free PMC article.
-
Optimal proximal resection margin distance for gastrectomy in advanced gastric cancer.World J Gastroenterol. 2020 May 14;26(18):2232-2246. doi: 10.3748/wjg.v26.i18.2232. World J Gastroenterol. 2020. PMID: 32476789 Free PMC article.
-
[Establishment of a prognostic nomogram to predict long-term survival in non-metastatic colorectal cancer patients].Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jun 25;20(6):654-659. Zhonghua Wei Chang Wai Ke Za Zhi. 2017. PMID: 28643310 Chinese.
-
Is it time to abandon the 5-cm margin rule during resection of distal gastric adenocarcinoma? A multi-institution study of the U.S. Gastric Cancer Collaborative.Ann Surg Oncol. 2015 Apr;22(4):1243-51. doi: 10.1245/s10434-014-4138-z. Epub 2014 Oct 15. Ann Surg Oncol. 2015. PMID: 25316491
Cited by
-
Chinese national clinical practice guidelines on the prevention, diagnosis, and treatment of early gastric cancer.Chin Med J (Engl). 2024 Apr 20;137(8):887-908. doi: 10.1097/CM9.0000000000003101. Epub 2024 Mar 21. Chin Med J (Engl). 2024. PMID: 38515297 Free PMC article.
-
Prognostic Implications of LRP1B and Its Relationship with the Tumor-Infiltrating Immune Cells in Gastric Cancer.Cancers (Basel). 2023 Dec 8;15(24):5759. doi: 10.3390/cancers15245759. Cancers (Basel). 2023. PMID: 38136305 Free PMC article.
-
A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer.BMC Cancer. 2023 Nov 7;23(1):1075. doi: 10.1186/s12885-023-11570-2. BMC Cancer. 2023. PMID: 37936119 Free PMC article.
-
A systematic review of minimal length of lroximal margin in gastric adenocarcinoma resection.Langenbecks Arch Surg. 2023 May 3;408(1):172. doi: 10.1007/s00423-023-02910-8. Langenbecks Arch Surg. 2023. PMID: 37133626 Review.
-
Development of web-based dynamic nomogram to predict survival in patients with gastric cancer: a population-based study.Sci Rep. 2022 Mar 17;12(1):4580. doi: 10.1038/s41598-022-08465-w. Sci Rep. 2022. PMID: 35301382 Free PMC article.
References
LinkOut - more resources
Full Text Sources
Miscellaneous