Prognostic value of surgical margin status in gastric cancer patients

Abstract

Background: It has been reported that positive surgical margin is one of the most significant risk factors for local recurrence and poor survival. However, the survival of gastric cancer (GC) patients with positive margin is still controversial.

Methods: A total of 1025 stage I-III GC patients who underwent gastrectomy with curative intent between January 2003 and April 2008 in our centre were enrolled in this study, of whom, 75 patients got a microscopic positive resection margin. Other 950 patients with negative resection margin were used for comparison.

Results: Borrmann type and extranodal metastasis were independent risk factors for positive margin. The 5-year overall survival for the patients with positive margin is merely 13.3%. Survival in such patients was similar to that of the patients staged IIIc with R0 resection. In multivariate analysis, surgical margin status was found to be an independent prognostic factor for GC patients, while histology, tumour location, TNM stage and chemotherapy were independently associated with overall survival for patients with positive margin.

Conclusion: Surgical margin status is an independent prognostic factor for GC. Patients with positive margin have a poor prognosis, similar to that of IIIc stage disease. When the tumour demonstrates infiltrative growth pattern (Borrmann type III and IV) and the surgical margin status is difficult to determine, extended gastrectomy should be implemented to ensure an R0 resection. Those high-risk patients should be considered for postoperative chemotherapy.

Keywords: gastric carcinoma; positive surgical margin; prognosis.