Ann Surg Treat Res.  2016 May;90(5):250-256. 10.4174/astr.2016.90.5.250.

Prognostic significance of intraoperative macroscopic serosal invasion finding when it shows a discrepancy in pathologic result gastric cancer

• Kang SY
• Park HS
• Kim CY

• KMID: 2163064
• DOI: http://doi.org/10.4174/astr.2016.90.5.250

Abstract

PURPOSE
Depth of wall invasion is an important prognostic factor in patients with gastric cancer, whereas the prognostic significance of intraoperative macroscopic serosal invasion (mSE) findings remain unclear when they show a discrepancy in pathologic findings. This study, therefore, assessed the prognostic significance of mSE.
METHODS
Data from cohort of 2,835 patients with resectable gastric cancer who underwent surgery between 1990 and 2010 were retrospectively reviewed.
RESULTS
The overall accuracy of mSE and pathologic results was 83.4%. The accuracy of mSE was 75.5% in pT2. On the other hand, the accuracy of pT3 dropped to 24.5%. According to mSE findings (+/-), the 5-year disease-specific survival (DSS) rate differed significantly in patients with pT2 (+; 74.2% vs. -; 92.0%), pT3 (+; 76.7% vs. -; 91.8%) and pT4a (+; 51.3% vs. -; 72.8%) (P < 0.001 each), but not in patients with T1 tumor. Multivariate analysis showed that mSE findings (hazard ratio [HR], 2.275; 95% confidence interval [CI], 1.148-4.509), tumor depth (HR, 6.894; 95% CI, 2.325-20.437), nodal status (HR, 5.206; 95% CI, 2.298-11.791), distant metastasis (HR, 2.881; 95% CI, 1.388-6.209), radical resection (HR, 2.002; 95% CI, 1.017-3.940), and lymphatic invasion (HR, 2.713; 95% CI, 1.424-5.167) were independent predictors of 5-year DSS rate.
CONCLUSION
We observed considerable discrepancies between macroscopic and pathologic diagnosis of serosal invasion. However, macroscopic diagnosis of serosal invasion was independently prognostic of 5-year DSS. It suggests that because the pathologic results could not be perfect and the local inflammatory change with mSE(+) could affect survival, a combination of mSE(+/-) and pathologic depth may be predictive of prognosis in patients with gastric cancer.

Keyword

Stomach neoplasms; Serous membrane; Prognosis

MeSH Terms

Cohort Studies
Diagnosis
Hand
Humans
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Retrospective Studies
Serous Membrane
Stomach Neoplasms*

Figure

• 

  Fig. 1 Macroscopic serosal invasion (mSE) and pathologic serosal invasion (pSE) show a discrepancy. (A) Overestimation into mSE(+) among pSE(–;) is 18.9%. Underestimation into mSE(–;) among pSE(+) is 12.9%. We could calculate sensitivity (87.1%), specificity (81.1%), positive predictive value (48.6%), negative predictive value (96.9%) and accuracy (82.1%) of mSE. (B) It shows the discrepancy according to pT category. pT1 (3.5%), pT2 (24.5%) and pT3 (75.5%) were overestimated to mSE(+). T4a (12.9%) was underestimated to mSE(–;).

• 

  Fig. 2 Five-year disease-specific survival rate according to tumor depth (pT category). Five-year disease-specific survival rate of pT1, pT2, pT3, and pT4a were 98.7%, 88.1%, 80.7%, and 54.1%, respectively.

• 

  Fig. 3 Five-year disease-specific survival rate in pT1.T4a according to mSE(+/–). (A) Five-year disease-specific survival rates were similar in patients with mSE(+) and mSE(–;) of T1 tumors. (B-D) Five-year disease-specific survival rates were significantly higher in patients with mSE(–;) than mSE(+) tumors of pT2 (92.0% vs. 74.2%, P < 0.001), pT3 (91.8% vs. 76.7%, P < 0.001), and pT4a (72.8% vs. 51.3%, P < 0.001). a)Macroscopic finding of serosal invasion. b)Indicates 5-year disease-specific survival rate. mSE, macroscopic serosal invasion.

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