Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 15;9(4):166-175.
doi: 10.4251/wjgo.v9.i4.166.

Macroscopic appearance of Type IV and giant Type III is a high risk for a poor prognosis in pathological stage II/III advanced gastric cancer with postoperative adjuvant chemotherapy

Keishi Yamashita  1 , Akira Ema  1 , Kei Hosoda  1 , Hiroaki Mieno  1 , Hiromitsu Moriya  1 , Natsuya Katada  1 , Masahiko Watanabe  1
Affiliations

Macroscopic appearance of Type IV and giant Type III is a high risk for a poor prognosis in pathological stage II/III advanced gastric cancer with postoperative adjuvant chemotherapy

Keishi Yamashita et al. World J Gastrointest Oncol. .

Abstract

Aim: To evaluate whether a high risk macroscopic appearance (Type IV and giant Type III) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage II/III (pStage II/III) gastric cancer.

Methods: One hundred and seventy-two advanced gastric cancer (defined as pT2 or beyond) patients with pStage II/III who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined.

Results: Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival (RFS) (35.7%) and overall survival (OS) (34%) than an average risk appearance (P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13th Japanese Gastric Cancer Association (JGCA) pT (P = 0.01), but not with the 13th JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13th JGCA pStage (P < 0.0001) and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified high-risk macroscopic appearance (P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator.

Conclusion: A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13th JGCA stage in pStage II/III advanced gastric cancer.

Keywords: Gastric cancer; Giant type III; Macroscopic feature; Stage II/III; Type IV.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: There is no conflict of interest in this study.

Figures

Figure 1
Figure 1
Representative gastroendoscopy images of advanced gastric cancer by macroscopic classification. Upper panels include high-risk macroscopic features of type IV (left) and giant type III (right). Lower panels include average risk macroscopic features of type 0, type I, type II, small type III, and type V (in order from left to right).
Figure 2
Figure 2
Prognosis of pathological stage II/III advanced gastric cancer patients who underwent curative gastrectomy followed by S1 postoperative adjuvant chemotherapy. A: Kaplan-Meier curves for overall survival (OS) (upper panel) and relapse free survival (RFS). Five year survival is shown; B: Stage distribution of pathological stage according to the 13th Japanese Gastric Cancer Association stage in Kitasato University in comparison with the ACTS-GC trial; C: Rate of each macroscopic feature in pathological stage II/III advanced gastric cancer. High-risk macroscopic features (type IV and giant type III) are seen in 10.5% as shown in this figure.
Figure 3
Figure 3
Survival curve of independent prognostic factors with regard to relapse free survival (left panel) and overall survival (right panel). A: Survival curve according to macroscopic features for the high-risk group and the average-risk group. Five-year survival is shown; B: Survival curve by age; C: Survival curve by sex; D: Survival curve by pathological stage according to the 13th JGCA stage. JGCA: Japanese Gastric Cancer Association.
See this image and copyright information in PMC

References

    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86. - PubMed
    1. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–1820. - PubMed
    1. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, Nashimoto A, Fujii M, Nakajima T, Ohashi Y. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011;29:4387–4393. - PubMed
    1. Yamashita K, Sakuramoto S, Kikuchi S, Katada N, Kobayashi N, Watanabe M. Validation of staging systems for gastric cancer. Gastric Cancer. 2008;11:111–118. - PubMed
    1. Yamashita K, Sakuramoto S, Nemoto M, Shibata T, Mieno H, Katada N, Kikuchi S, Watanabe M. Trend in gastric cancer: 35 years of surgical experience in Japan. World J Gastroenterol. 2011;17:3390–3397. - PMC - PubMed

LinkOut - more resources